Oral Saline as Effective as IV Saline for Prevention of Contrast-Induced Nephropathy

According to this study:

"Oral saline hydration was as efficient as intravenous saline hydration for the prevention of contrast nephropathy in patients with stage 3 renal diseases."

Researchers prospectively studied 312 patients with chronic renal failure who were undergoing radiological procedures with a non-ionic, low osmolality IV contrast. In arm A of the study, patients received 1 g/10 kg of body weight/day of sodium chloride PO for 2 days before the procedure. In arm B, patients received 0.9% saline IV at a rate of 15 ml/kg for 6 hr before the procedure.

References:
A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients. Nephrology Dialysis Transplantation 2006 21(8):2120-2126; doi:10.1093/ndt/gfl133.
Image source: Wikipedia

A Squirrel with a Walking Stick?

Does this squirrel really have a walking stick? Click below to see the larger size photo on Flickr.

Walk in the woods
Originally uploaded by Roselea.

16-Row CT Not Ready for Reliable CAD Diagnosis

According to a Cleveland Clinic study published in JAMA:

"CT coronary angiography performed with 16-row scanners is limited by a high number of nonevaluable cases and a high false-positive rate. Thus, its routine implementation in clinical practice is not justified. "

Sensitivity for detecting more than 50% luminal stenoses was 89%; specificity, 65%; positive predictive value, 13%; and negative predictive value, 99%.


According to investigators:

"If you have a positive result on a cardiac CT, the diagnosis could be in doubt, but if the result is negative, you virtually exclude the possibility of having a blockage."

The study was done with the first generation of cardiac CT. Many centers now use more advanced scanners which have 64 detectors instead of just 16.


References:
Accuracy of 16-Row Multidetector Computed Tomography for the Assessment of Coronary Artery Stenosis. JAMA. 2006;296:403-411.
Heart Scan Study. NBC4.TV.
Image sources: Wikipedia

The 3 Most Prestigious Careers: Firefighter, Doctor, Nurse

According to a telephone survey reported by the WSJ, Americans view firefighters, doctors and nurses as having the most prestigious professions.

The survey compares current data to a similar poll back in 1977. Doctors lost 3% in "prestige points" which is negligible compared to lawyers who are now respected by just 21% of the population, a drop of 15 % since 1977.

Reference:
Firefighters, Doctors Viewed As Most Prestigious Careers. WSJ.
Image source: Openclipart.org, public domain

The "BEST" Communication Model

This mnemonic is from a 2006 article from BMJ Career Focus that is not available on their website anymore (the archive was deleted a few years ago):

Begin with non-verbal cues. Soften (smile, open arms, forward lean, touch with arm, handshake, eye contact, nod)
Establish information gathering with informal talk
Support with emotional channels
Terminate with positive note

Hopefully, this will make your patients feel better. If you want to feel better yourself, you can try following the "MOTORS" mnemonic.

MOTORS of Your Life

Studies describe a set of wellbeing practices that are correlated with the feeling of happiness (BMJ, WJM). I tried to summarize them in the mnemonic MOTORS because the pursuit of happiness, in its altruistic sense, could be the "motor" of your life.

“MOTORS” stands for:

Meaning - find a meaning in what you do for a living but don't forget to set limits around it.
Outlook - have a positive outlook on life. Be philosophical but also focused on success.
Time - spend quality time with F&F (Family & Friends).
Out of the singular chase of money or prestige.
Religious and/or spiritual practices.
Self care practices, like sports or meditation.

All these 6 features are correlated with feeling happier, and some of them even with living longer.

References:

BEST: a communication model. BMJ Career Focus 2006;333:35.
Six Tips for Happiness by a Harvard Teacher
Thinking About Medicine - Your Inner Peace
Image source: Wikipedia

Updated: 03/08/2010

Places to go, people to see: Niagara Falls, Boston and Cape Cod

Click below to see the photos from:

Niagara Falls, New York

Boston, Massachusetts

Provincetown, Cape Cod - the place where Pilgrims first stepped on American soil

Plymouth, Massachusetts - site of first permanent English settlement in North America



Niagara Falls view from Goat Island on Google Video

Google Video serves as a perfect distribution channel and the Cleveland Clinic is already using it with Health Edge.

2006 National NOW Conference - Wrap up

Reposed from my old blog:

OK, maybe not a full wrap up as the weekend flew by in a blinding flash. Instead, highlights:

* Meeting Jessica from Feministing with the always "WTF" question: "Can I take a picture of you with my Pooh Bear?" She asked if I would send her the photo and I said, "It'll be on Flickr." Yes, I'm a smart ass.

* As I walked away, Amanda from Pandagon said to Jessica, "See her bag!?" Jessica said, "Oh, the woman who made that is one of the Hot 100." And I got to retort, "Yup, she's my best friend." Yes, I gloat as well.

* Meeting Ani and again, asking the "WTF" question. I guess because I'm not as big of a fan of Ani as I am of Dar, I neglected to ask her for a beer. 20 minutes later, I learned that she would had said no for a whole different reason that 'who the fuck are you?' Waking up at 3:30 am to take cab to Midway = $50, Flight to Albany = $200, hearing Ani DiFranco announce her pregnancy at NOW's 40th anniversary = PRICELESS.

* I got to listen to Dr. Susan Wood...again. And each time I get chills down my spine with her courage and fierceness. If she is coming anywhere near you, you HAVE to get your ass over to see her. She has stared our enemy in the eye and made them blink.

* I've never been a fan of Tyne Daly, other than she played a kick ass woman on TV, but she totally won me over this weekend with her wit. She also made me cry a bit while she talked about being at her daughter's home birth and thanking NOW for making it possible. Not only for nurturing her feminist ways, but for making our country a place where home births are possible.

* I use to watch "One Life to Live" every day as a kid in the summer. After school, we'd run home and ask our mom what happened. As we got older, the VCR took over that job. So it was pretty neat to meet Bree Williamson. And she's the first person to really HOLD Poohbear for a photo and not treat him as just a prop. Kudos to her!

* I got to see many dear friends who I really only see at NOW conferences. It's weird saying that as this was only my 3rd conference. It's funny how quickly you bond over this shit and beer. Yes, beer makes it much easier to bond. And it's awesome how you can stroll up to someone, start chatting, and then realize, "Shit! This woman works at ABC Organization. She not only works there, but she's the National (fill in the blank) Director!"

* I missed [the kid] almost as much as she missed me. There weren't as many kids as last year (it wasn't an election year), but enough and ones [the kid's] age that made me think I should had brought her. And she does want to go. I've set an age of 8 for her to come without having to be in the child care room. We'll see if that happens.

* I heard many long-time NOW conference goers say that this year's conference was the most diverse and gave all the props to the young feminists. So let's keep it up, ok?

SOOOOO....2007's conference is in Detroit, Michigan chicas. Who's up for a road trip?

Free Biostatistics Lecture Notes from Johns Hopkins

The biostatistics course with downloadable lectures is just one of the several courses from OpenCourseWare at the Johns Hopkins Bloomberg School of Public Health (JHSPH).

MicrobiologyBytes.com has useful short video tutorials about the main statistics methods.

References:

Introduction to Statistics. Free video webcasts from UC Berekely.
Link via The Patient's Doctor.
Image source: OpenClipart.org, public domain.

Further reading:

MIT OpenCourseWare features 1800 course syllabus, written notes, video and audio lectures all available online for free. Highlights for High School are also included.
NPR Audio: How To Make Sense Of Medical Statistics (28 minutes), 01/2009.
MedPage Guide to Biostatistics (PDF).
The one medical statistic that you really need to know: Number needed to treat - BMJ, 2011.
Tufts School of Medicine - OpenCourseWare
Med school course materials from University of Michigan http://goo.gl/t84PI
The UMass Boston OpenCourseWare - University of Massachusetts Boston http://goo.gl/DzeLB
UC Irvine, OpenCourseWare http://goo.gl/XH1Ed

Tall Ships at Cleveland Harborfest

See the photos with text.

See this Tabblo

"Headbutt" and Commotio Cordis

During the 2006 FIFA World Cup final match, Zidane was sent off for violent behavior after "headbutting" one of Italy players in the chest in the 110th minute. Luckily, the attacked player, Marco Materazzi, rapidly recovered and even went on to score Italy's second penalty in the shoot-out, which Italy won 5-3, to win the World Cup.



The consequences could have been much different though if Materazzi had gone into cardiac arrest due to commotio cordis.

Ventricular fibrillation and sudden death triggered by a blunt, nonpenetrating, and often innocent-appearing unintentional blow to the chest without damage to the ribs, sternum, or heart (and in the absence of underlying cardiovascular disease) constitute an event known as commotio cordis, which translates from the Latin as agitation of the heart. This term was first used in the 19th century. However, the occurrence of commotio cordis was described earlier, in accounts of the ancient Chinese martial art of Dim Mak (or touch of death), in which blows to the left of the sternum caused sudden death in opponents.

Commotio cordis is a recognized cause of sudden death in young athletes in which a blow to the chest causes ventricular fibrillation and cardiac arrest.

In 70% of cases, the victim was struck by a projectile, which was most commonly a baseball or a hockey puck. In 30%, chest trauma resulted from bodily contact with another person or an object.

Survival after commotio cordis is unusual.

References:

Zinedine Zidane, from Wikipedia, the free encyclopedia.
Commotio cordis--a report of three cases. Int J Legal Med. 2005.

Commotio Cordis. NEJM, 2010.
Commotio Cordis. eMedicine.
Commotio cordis from Wikipedia, the free encyclopedia.
Zidane. The French Hero who was, ultimately, just a Man. WSJ.
Zidane the Web Game, via Google Blogoscoped.
Top Soccer Players Are Seen to Have Superior Brain Function - NYTimes, 2012 -- Good to know, NYT.

Related reading:

Lethal headbutt. AP, 09/2007.
Is the Superbowl Hazardous to Your Health?Once again, the New England Journal of Medicine has sunk to new lows in the interest of increasing its impact factor. Dr. Wes, 01/2008.
Commotio Cordis. Life in the fast lane, 2010.

Cleveland Clinic Advances to Number 3 on the List of America's Best Hospitals

Cleveland Clinic has not only a new logo this year but also a new higher ranking on the List of America's Best Hospitals 2006 by the U.S. News and World Report.

The Clinic has been number 4 on the list, behind Johns Hopkins, Mayo and Mass General, for several years but managed to advance to # 3 this year, scoring 23 points in 12 specialties.

Cleveland Clinic made the top 10 in 11 fields, and the heart center was at number one for the 12th straight year with the perfect score of 100. Nephrology was at number 3 and a score of 94.7. Complete 2006 rankings for Cleveland Clinic are: cardiology, 1; digestive disease, 2; urology, 2; nephrology, 3; endocrinology, 7; gynecology, 8; neurology and neurosurgery, 5; ophthalmology, 14; orthopedics, 5; otolaryngology, 7; cancer, 13; pediatrics, 20; psychiatry, 20; pulmonary, 7; rehabilitation, 22; rheumatology, 4.

I am proud to be one of the staff physicians who work at the Cleveland Clinic, although I am not sure how scientific these rankings really are.

Who knows, may be next year the U.S. News and World Report will include a category for hospital medicine and our section may be listed among the top 10...

References:
Cleveland Clinic Has a New Logo (and a Shorter Name)
Is rating the "best" hospitals "good"? Managed Care Matters.
Image source: Cleveland Clinic

Keep on Blogging...

Why medical bloggers quit?

Dr. RW was wondering: "What'’s happening to the medical blogosphere? Here are some casual observations. Two of our more prolific med bloggers have called it quits (Medpundit and, more recently, Shrinkette). Two of our pioneers (Jacob Reider and Chris Rangel) are posting less frequently over the past year or so, and many of the links on Medlogs are either dead or have been inactive for months..."

Medical bloggers definitely have something to blog about, unlike the guy in the cartoon here. Many of them just do not have time.

My humble opinion: keep on blogging

I guess it depends on your motivation for maintaining a blog. I write mine for a very basic and personal reason: to keep track of the things that interest me. They may not be interesting to anybody else. If other readers find my blog worth-visiting, I feel flattered but I will not change my writing style to reflect the news of the moment...

If you write a blog about the things you like and you don't spend 2 hours a day on it, you would be less likely to stop blogging, I think. This is only a blog after all, it is not the New York Times or NEJM... :-)

SGIM president tells why he blogs

DB'’s Medical Rants recorded a podcast explaining why he blogs and how he collects information for his posts. Robert Centor, a.k.a Doctor Bob (DB), is the current president of the SGIM and a great medical blogger. Well, much better than me at least...

You don't doubt that he is busy, do you? If he can find time for blogging, you can too.

References:
How much time do you spend blogging?
Another blogger quits due to "blog fatigue"
Medpundit Stops Blogging. She Started in March 2002
The Changing Face of Healthcare Blogosphere. HealthVoices.com.
Image source: We Blog Cartoons. Free cartoons for your blog.

Updated: 01/02/2008

"Google Epocrates" Integrated in Search Results for Medications

Via Palmdoc Chronicles:

"You can now look up Epocrates drug info via Google. If you are a Gmail account holder, you can subscribe to Epocrates Online via Google Co-op... You will automatically see links to FREE Epocrates drug monographs at the top of your results list when doing Google drug searches."

This integration of Epocrates in Google search results is very useful. I am starting to see how Google Co-op will take off.

The interesting thing about Google is that sometimes they launch a service without an easy-to-understand purpose (take Google Base, for example) but with time, things seem to fit into place.

And pretty soon, everybody who wants to use the cool new services offered by Google has to register an account with them. Microsoft should have thought of that when they tried (unsuccessfully) to impose their "Passport" log-in to all users in the past: make people want to register instead of forcing them to do it. Hmm... "Don't be evil" motto seems even more important nowadays when Google will have (most of) your information.

Related:
An easy way to add new features to Google. Matt Cutts: Gadgets, Google, and SEO, 02/2008.

Updated: 02/26/2008

Perioperative beta blockers may not benefit patients with diabetes (if not used properly)

BJM editorial note: "The DIPOM Trial randomized 921 diabetic patients to either 100 mg metoprolol (Toprol XL) or placebo, given from the day before surgery and continued for up to eight days. During a median follow-up of 18 months, all cause mortality, acute MI, unstable angina, or CHF occurred in 21% of the metoprolol group and 20% of the placebo group."

I took the liberty to add "if not used properly" to the title because the study did not follow the protocol for optimal use of beta blockers in the perioperative period of noncardiac surgery.

According to the protocol used at the Cleveland Clinic, beta blockers should be started at least 2 weeks before the surgery and continued for at least 2 weeks after the surgery.

In addition, as Dr. Aneja from the Section Hospital Medicine pointed out before, we believe that beta-blockers appear most likely to be beneficial in patients with a high RCRI (Relative Cardiac Risk Index >2) , i.e. not all patients will benefit from beta blockade in the perioperative period. Indeed, for some patients at low risk, beta blockers may even be harmful.

Revised Cardiac Risk Index (RCRI, Circulation. 1999;100:1043-1049):

Ischemic heart disease
History of congestive heart failure
History of cerebrovascular disease
Insulin therapy for diabetes
Preoperative serum creatinine >2.0 mg/dL

4CD is a mnemonic to remember the risk factors in RCRI:

CAD
CHF
CVA
CKD
DM

In the UK news: Beta-blockers not to be used to treat hypertension in most patients

The National Institute for Health and Clinical Excellence (NICE) and the British Hypertension Society (BHS) have issued new recommendations NOT to use beta-blockers to treat hypertension, except in a few specific cases. The rationale for the recomenndation was that beta-blockers are not more effective than ACEi and CCB and can carry a higher risk (up to 30%) of provoking type 2 diabetes. Beta-blockers should still be used in hypertensive patients with a previous MI or CHF.

References:
Perioperative blockade may not benefit patients with diabetes. BMJ.
Effect of perioperative blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial. BMJ.
Q&A: Beta-blockers. BBC.
Perioperative Beta-Blocker Therapy for Noncardiac Surgery. Medscape.com.
Image source: OpenClipArt.org, public domain

Updated: 03/31/2008

Adam Lasnik: "What I like about being an American and living in America"

4th of July link:

Adam Lasnik has recently been appointed as an external/internal communications representative of Google:

"I'm offering a few things below (in no particular order) that make me happy to be an American and living in America . I know that not all of these things are unique to my country or nationality, but I think-- in combination -- they highlight a positive uniqueness:

What I like about being an American and living in America"

References:
Independence Day (United States) from Wikipedia, the free encyclopedia.

Fastest and Slowest - Cheetahs and Turtles at Cleveland Zoo

See my Tabblo

Directory of Medical RSS Feeds

Comprehensive directories of medical RSS feeds:

• FeedNavigator by the University of Helsinki
• RSS4Medics
• Medworm

You can subscribe to a combined "specialty" field or to individual journals.

Tame The Web and The Krafty Librarian have commented on RSS use by physicians. Tame The Web quotes David Rothman:

"I personally dislike email distribution of TOCs and encourage other medical librarians to abandon them in favor of RSS. Here are the reasons (off the top of my head) why: I have met too many doctors that end up feeling overwhelmed by the flood of emails in their inbox and eventually give up. One of the advantages of RSS is that you can be more specific (if needed) than TOCs. Example: A gastroenterologist specializing in IBD might not WANT every article from J. Gastroenterology. He/she might prefer just to get articles that contain the terms "Crohn's", "colitis" or "inflammatory bowel disease" that appear in that journal. It is much easier and quicker to manage the contents of an aggregator's reading list than an inbox - especially when the inbox is used for purposes beyond receiving TOCs."

Well, when you have 1858 unread items in your Bloglines aggregator, as I often do, you start to feel a little... overfed with RSS feeds... :-)

References:
Recap: My notes on RSS for Clinicians. DavidRothman.net.
A really simple guide to a powerful tool: RSS. BMJ Career Focus 2006;332:244.