Top 25 Web Celebrities According to Forbes

Forbes.com has compiled a list of the Top 25 Web Celebrities. As expected, no medical bloggers made the list but two of the top 10 web celebs have linked to CasesBlog in 2006: Jeff Jarvis of BuzzMachine and Glenn Reynolds of InstaPundit.

Jeff has atrial fibrillation and has commented on it in the past. Glenn's wife, the forensic psychologist Dr. Helen Smith, had a heart attack at the age of 37 and had a defibrillator implanted. According to her blog, she recovered well and feels fine now.

References:
The Web Celeb 25. Forbes.com
"Women Don't Have Heart Attacks." So Wrong
Welcome from Forbes, but… Scobleizer.com.

Medical Wikis May Change the Way We Study Medicine

A wiki is a web site which allows the visitors themselves to easily add, remove, and otherwise edit available content. The most famous wiki-based projects is Wikipedia, the world-largest free encyclopedia with more than 1.5 million English-language articles, which can be edited by anyone. Few studies have explored the effect of this new medium on medical education.

AskDrWiki by Cleveland Clinic Cardiology Fellows

Quite a few things have happened since the last time I wrote about AskDrWiki:

- I emailed Dean Giustini about AskDrWiki and he referenced the site in his landmark BMJ editorial How Web 2.0 is changing medicine

- I met the wiki editor, Ken Civello, who is an electrophysiology fellow at the Cleveland Clinic and a really smart guy

- Both Ken and I wrote the abstract "A Wiki-based Web Site as an Educational Tool for Cardiology Fellows" which will be presented at the meeting Medical Education for the 21st Century at the Case Western Reserve University School of Medicine Annual Education Retreat on February 8, 2007. I like this line the best: "The pockets of your lab coat are only so big and what you remembered last month, you may not remember next year. The ability to have access to the "collective online memory" of a fellowship program may help fellows enhance their education, and ultimately, provide better patient care." I will upload the poster here next week.

In the meantime, Ken and his collaborators have added some useful new features to AskDrWiki:

- Videos of Coronary Angiograms which are now searchable on Google Video
- Videos of Echocardiograms
- EKGs

JTF (Just the Facts) Wiki at the University of Michigan

JTF (Just the Facts) Wiki is a "Manual for the Interns Online" by medical students and residents at the University of Michigan and Ann Arbor VA Hospitals. The manual was started in 1991 and is in its 13th edition (?!) now. JTF has a well-done procedure section and some good videos of central line placement which I will upload in a separate post.

Summary

I think medical wikis will change the way we study and teach medicine. In the foreseeable future, their role is not in creating "the most authoritative textbook" ever but rather in creating a "collective online memory" for a group of learners. Where these new web tools will lead us in the future, as usual, nobody knows, and this is the beauty of the amazing medium that the Internet is.


Mike Cannon-Brookes has a nice presentation on Organisational Wiki Adoption on SlideShare (link via DavidRothman.net). This may convince your department or hospital to start a wiki, if you do not already have one.


Wikis in Plain English

References:
Wiki from Wikipedia, the free encyclopedia.
AskDrWiki -- A Collaborative Medical Encyclopedia
Do We Need a Free Medical Encyclopedia?
Which Wiki is Right for You? School Library Journal, 5/1/2007.
Elsevier’s WiserWiki. DavidRothman.net, 11/2007.
Medpedia Project from Harvard Medical School.

Further reading:
Web Watch: Living in the brave new world of medical wikis. ACP Internist, 01/2008.
ACP Internist on Medical Wikis. DavidRothman.org, 01/2008.

Updated: 01/12/2008

Map directions: Make 200 U-turns to get to New Jersey

A bug in Google Maps directed a driver to make more than 200 U-turns in order to get from Pennsylvania to New Jersey (click the image on the right). Google quickly fixed the error and now the same search points to the correct driving directions.

200 U-turns?! That driver's head is still spinning...

In both real and online world, a reality check is always a good idea.

Update 3/29/2007:
Google Maps Shows Funny Directions. Google Operating System.

References:
Google Maps Runs In Circles, Invaded From Space. InsideGoogle.
Image source: Search Engine Roundtable.

Related:
Google Maps Cartoon from Xkcd.com.

Updated: 08/14/2008

How I Did It: The "Confession" of a Zyprexa Drug Representative on YouTube

The former pharmaceutical representative Shahram Ahari describes the tactics he was supposedly advised to use in order to convince doctors to prescribe Zyprexa (olanzapine).



On October 20th, 2006, Mr. Ahari gave a talk at Georgetown University School of Medicine entitled “Confessions of a Drug Rep”

According to a New York Times article published on December 17, 2006, Eli Lilly has engaged in a decade-long effort to play down the health risks of Zyprexa, its best-selling medication for schizophrenia, according to internal Lilly documents and e-mail messages among company managers (source: Wikipedia).

Links via PharmedOut and Kevin, M.D.

References:
Zyprexa Sales Rep on YouTube: A Video You Must See. Alliance for Human Research Protection.
Eli Lilly Said to Play Down Risk of Top Pill. NYTimes.
Olanzapine from Wikipedia, the free encyclopedia.

Related:
Lilly Considers $1 Billion Fine to Settle Case. NYTimes, 01/2008.

Updated: 01/31/2008

Central Line Placement Videos on YouTube

The videos below show "practical tips and tricks for central line placement in the ED." ClinicalCases.org has our own step-by-step procedure guides with photos:

Central Line Placement - Procedure Guide

Central Line Placement with Ultrasound Guidance - Procedure Guide

Without a doubt, videos are better than still photos in many ways. Photos have the advantage of being able to see clearly what is going on though. It is similar to comparing Flickr to YouTube (or Google Video) -- both are needed for a complete visual experience.


Central Line Placement, Part 1


Central Line Placement, Part 2


Central Line Placement, Part 3


Central Line Placement, Part 4


Central Line Placement, Part 5

Link via JTF wiki.

References:
Central Venous Catheterization: Concise Definitive Review. Medscape, Critical Care Medicine, 05/16/2007 (free registration required).
BioMed Central's You Tube channel: videos from BioMed Central's authors and editors, 09/2007.
NEJM Videos in Clinical Medicine. These are high-quality professional videos but they require a subscription to NEJM:
Central Venous Catheterization - IJ vein
Central Venous Catheterization - Subclavian Vein
Central Line

Related:
YouTube as a Source of Health Misinformation. Highlight HEALTH 2.0, 02/2008.
YouTube as a source of information on immunization: a content analysis. Keelan et al. JAMA. 2007 Dec 5;298(21):2482-4.

Updated: 02/06/2008

Sign of the Times: NYTimes First Video Obituary

The Pulitzer Prize-winning writer Art Buchwald announced his own death in the first NYTimes video obituary: "Hi, I'm Art Buchwald and I just died."

According to the newspaper:

"Last February doctors told him he had only a few weeks to live. “I decided to move into a hospice and go quietly into the night,” he wrote three months later. “For reasons that even the doctors can’t explain, my kidneys kept working.”

Refusing dialysis, he continued to write his column, reflecting on his mortality while keeping his humor even as he lost a leg. He spent the summer on Martha’s Vineyard and published a book “Too Soon to Say Goodbye.”

Art Buchwald died on January 17, 2007.

References:
Art Buchwald, 81, Columnist and Humorist Who Delighted in the Absurd. NYTimes.
Buchwald Announces Own Death In First 'NYT' Online Obit Video. Editorandpublisher.com.
Messages from the grave. CNN.
Link via KidneyNotes.com

Never Too Old For Blogging

Micro Persuasion writes that Marriott Hotels CEO Bill Marriott does not use a computer but he started a blog (by dictating posts). He will soon be 75.

Never too old to blog, I guess. This is just the right age to share wisdom with the world.

Studies show that staying intellectually active as we grow older, preserves "brain power" and delays onset of dementia. A new Canadian study indicates that knowledge of more than one language (lifelong bilingualism) delays the onset of dementia by 4 years (via Slashdot).

References:
An Old Dog Learns to Write a New Blog. Washington Post.
Marriott's CEO Blogs. Micro Persuasion.
J.W. Marriott, Jr. from Wikipedia, the free encyclopedia.
Bilingualism as a protection against the onset of symptoms of dementia. Neuropsychologia
Volume 45, Issue 2 , 2007, Pages 459-464.
Image source: Openclipart.org

Further reading:
The Long Road Ahead. FatDoctor.org, 09/2007.

Updated: 09/27/2007

Arm Wrestling Can Lead to Humerus Fracture

A clip posted recently on Google Video shows a serious injury associated with arm wrestling: spiral fracture of the humerus. These fractures often require open reduction and internal fixation with a metal plate and screws, and recovery can take months.

British Journal of Sports Medicine has an excellent case report which describes a Broken arm wrestler:

"Usually the musculotendinous structures are the limiting factor in arm wrestling, but in this particular case they were not, either because the proprioceptive awareness of the patient was reduced because of the alcohol and late night and/or he wasovermuscular for his bony size, in the sense that, although he was generally muscular, he did not have the humeral cortical bone hypertrophy to match his muscularity because he was not a regular arm wrestler.

This type of arm wrestling injury tends to occur when one arm wrestler tries to force the match in an effort to win or to change the tide of the contest. As the offensive wrestler continues with the attack, the defender's internalrotator shoulder muscles suddenly and passively stretch and change from their maximally concentric contraction to an eccentric compensatory contraction, resulting in an intense rotational force with subsequent humeral fracture."


Video: An arm wrestler breaks his arm during a match at the Empire State Golden Arm Tournament of Champions in New York City. There is a clearly audible snap in the video when the humerus breaks.

John Brzenk, who is considered the best arm wrestler in the world, responds to a fan question regarding how often (professional) arm wrestling leads to fractures:

"To be honest over the last 15 years of arm wrestling I’ve seen maybe a handful of broken arms and all of them in the upper arm."

Any fracture is serious. If you engage in arm wrestling, please have the cases above in mind, exercise properly and take every precaution to prevent similar injury from happening to you.

References:
Broken arm wrestler. Br J Sports Med 2000; 34:461-462.
Interview with John Brzenk. ArmWrestling.com.
Image source: Arm wrestling from Wikipedia, the free encyclopedia.

Related:

Ed Goljan, M.D., professor of pathology and top notch arm wrestler

Updated: 07/23/2010

A "Killer" Cookie?

Family Medicine Notes links to the nutrition info a "killer" cookie offered by Dunkin' Donuts: it contains 65% of your daily allowance of saturated fat.

And not only that, the "killer" cookie is loaded with 48 g of sugar AND 550 mg of sodium. Is sodium there to temper the sweetness, or just to increase blood pressure? The recommended total daily intake of sodium is 2000 mg, so this cookie certainly goes a long way in ensuring that everybody who eats it hits the maximum daily dose of sodium they can take...

References:
Illegal food? Family Medicine Notes
Image source: Wikipedia

Using a Blog to Build an Educational Portfolio in Academic Medicine

What is an "educational portfolio"?

Let me explain. I am an academic hospitalist at the Cleveland Clinic. The goal of our section is to be the best academic hospitalist group in country. "Academic" means that we devote a significant amount of our time to research and teaching. This time has to be accounted for and for that purpose each of us builds an educational portfolio -- a collection of research ideas, projects, presentations, manuscripts and published articles. A blog can be the perfect solution to building an electronic educational portfolio.

Collecting your research ideas (and asking for feedback) is actually a very valuable exercise not dependent on your current position -- a medical student, resident, academic or private practice physician. Medicine is all about life-long learning, isn't it?

How to use a blog to build an educational portfolio?

All blogs place a time stamp on the posts and are in a reverse chronological order, thus placing the newest ideas on top. Reading a recent Scoble post, I realized that Google makes it really easy to find what you have written weeks or even months ago: just search for a particular topic adding your blog name to it: example. Scoble's example is naturally not related to medicine at all but the idea is what is important there:

One of the first things I learned about blogging back in 2000 was it is an awesome way to stick things into Google. If you find a new restaurant, for instance, and they don’t yet exist in Google, if you write about it on your blog invariably it’ll be there within a week.

I regularly write about things for the SOLE purpose of putting them on Google. Same thing with my link blog.

It’s very easy to pull them back out, too. Just add your blog’s name to a Google search.

For instance, I remember I wrote about a coffee place in Redmond. Forget the name? Just ask Google for it back out. This works consistently well.

You can choose whether to make you blog accessible to everyone (recommended, since it invites feedback) or confidential. Currently, the best and easiest service to start a blog seems to be Blogger.com, owned by Google.

Related reading:

"One of the best decisions I’ve made in my career was to start a blog and a wiki, leaving a paper trail of ideas" http://bit.ly/GX7Z6C
The power of blogging on Google. Scobleizer.
Blogs Are Increasingly Venues for Scholarship. Open Medicine Blog, 01/2008.
Developing a virtual personal network. BMJ Career Focus 2007;334:13-15.
Web 2.0 in Medicine 2006-2007 (PowerPoint file).
Feature: 5 Reasons to Use WordPress as CMS. BloggingPro, 2007.
How To Use Your Blog To Make 2008 Your Best Year Ever! LifeHack.org.
Video presentations: Novel concepts and easy-to-use web tools for researchers. European Molecular Biology Laboratory, 2006.

Blogs as Web-Based Portfolios Part 2. Thinking Stick, 2010.

Blogs as Web-Based Educational Portfolios - free eBook PDF http://goo.gl/BXCF

As A Busy Physician, Why Do I Even Bother Blogging? http://goo.gl/fSF3 - Excellent summary.
Beautiful example of how blogs can disseminate medical information much more efficiently than journals, NEJM included (http://goo.gl/rOvNq).

Note: After working at the Cleveland Clinic and Case Western Reserve University as a Clinical Assistant Professor for Medicine for 3 years, I moved to Creighton University to complete an Allergy and Immunology fellowship. I now work as an Allergist/Immunologist and Assistant Professor of Medicine and Pediatrics at the University of Chicago. This blog post was written during my work at the Cleveland Clinic.

"Medical Breakthrough" in Treatment of Seborrheic Keratosis

Medscape's MedGenMed eJournal features an amusing video editorial by his Editor-in-Chief, George D. Lundberg:

I Use Fingernail Surgery to Remove My Seborrheic Keratoses (free registration required):

"So, now I take my seb keratoses off while they are still small with my fingernails, usually the one on the third finger of my right hand. Am I kidding you? No."

A very special dog: Skidboot

A heart-warming segment from Texas Country Reporter (8 min). There may never be another Skidboot -- the smartest dog in the world, according to Jay Leno, at least.

Related:
See more videos at Skidboot.com.
Link via FatDoctor.

How a Doctor Almost Killed Her Dog - ibuprofen, the key ingredient in Motrin, poisons dogs. NYTimes.

Schmedley is Another Web 2.0 Start Page

I thought Netvibes was probably the slickest Web 2.0 start page (web desktop?) until I saw Schmedley.

As you can see from the screen shot on the right, Windows Live Search still has some catching up to do when you search for "clinical cases"...

Read the full review complete with useful screen shots on Go2web2.

References:
Schmedley: More Than Just A StartPage. Go2web2.
NetVibes is an example of what a web 2.0 desktop might look like
Pageflakes: The Teacher Edition. ScienceRoll, 12/2007.

Updated: 12/08/2007

Something you have never seen before -- a rare central line complication in NEJM

A man had a central line inserted by a cardiologist through the left subclavian vein. Six months later, the patient presented with posterior neck pain. A guide wire was protruding from the back of his neck... Continue reading: Complication of Central Venous Catheterization. NEJM, 2007.

Our own images of central line complications simply pale in comparison to this NEJM case.

You can get more cases and images if you subscribe to the free NEJM image feed which is syndicated in the right sidebar of this web site: http://rss.nejm.org/imagecast.xml

References:
Complication of Central Venous Catheterization. NEJM, 2007.
Complications of Central Line Placement - Pneumothorax, Arrhythmia, Hematoma

Improper placement of the central venous catheter - case one and case two from the Annals of Emergency Medicine

Medical News

Former Italian premier Silvio Berlusconi had a pacemaker implanted at the Cleveland Clinic

According to the International Herald Tribune, a pacemaker was implanted in the heart of former Italian Prime Minister Silvio Berlusconi at Cleveland Clinic’s Heart Center on Dec. 18. Andrea Natale, a Sicilian-born physician and a Section Head of Electrophysiology & Pacing, performed the surgery "to correct a problem with the heart rhythm." Berlusconi was hospitalized at the Clinic for 4 days and returned to Italy on Dec. 22.

The 70-year-old Berlusconi collapsed while giving a speech in Tuscany on November 26, his aides and doctor blamed the episode on a sharp drop in blood pressure.

References:
Clinic: Ex-Italian Premier Berlusconi doing well after operation. IHT.
Surgeon: ex-Italian Premier Berlusconi doing well following surgery to implant pacemaker. IHT.
Silvio Berlusconi from Wikipedia, the free encyclopedia.
Image source: Wikipedia, public domain.

Related:
Cleveland Clinic names chair of new Heart and Vascular Institute. Cleveland Plain Dealer, 10/04/2007.


EarthLink CEO Dies of a Rare Tumor

According to a company press release, Charles (Garry) Betty, a President and CEO of EarthLink has died from complications of adrenocortical carcinoma on January 2, 2007. He was only 49. Before joining EarthLink, Betty served as CEO of Digital Communications Associates, Inc. (DCA) and became the youngest CEO of a NYSE listed company.

Adrenocortical carcinoma (also adrenal cortical carcinoma or adrenal cortex cancer) is a neoplasm of the cortex (outer layer) of the adrenal gland. It is a vary rare malignant tumor with an estimated incidence of 1 in 1.5 million people.

References:
Charles (Garry) Betty, from Wikipedia, the free encyclopedia.
Adrenocortical Carcinoma. Medscape.
Adrenocortical carcinoma, from Wikipedia, the free encyclopedia.
EarthLink CEO passes away at age 49. CNN.
Garry Betty, 49, Chief of the Internet Provider EarthLink, Dies. NYTimes.

Updated: 10/04/2007

2006 Medical Weblog Awards: Polls Are Open

Clinical Cases and Images - Blog is nominated in two categories: Best Clinical Sciences Weblog and Best Medical Technologies/Informatics Weblog.

Many of my favorite blogs, for example Kevin, M.D. and KidneyNotes (just to name a few), are also nominated, and they are truly excellent.

Thank you for your support and nomination. Let the best blog win :)

Update 1/19/2007:

And the winners of the 2006 Medical Weblog Awards are... (click here to see the winners on Medgadget.com).

CasesBlog did not win in either category it was nominated for but it deserved a special mention by the judges in the Best Clinical Sciences Weblog category:

"Special mention goes to Clinical Cases and Images, a Ves Dimov's website felt by many judges to be an excellent resource on all things clinical. Congratulations!"

References:
Nominate Best Medical Blogs of 2006
The Best Medical Blogs of 2005 on Medgadget.com

Interesting Links

Evidence Based Medicine Resources. New Media Medicine Blog.

A long list which seems both useful and comprehensive. I will send it to my residency program director, he is a devoted follower of evidence-based medicine and I am sure many residents will find something interesting to read when they prepare for a journal club.


Alcohol Consumption and Risk for Coronary Heart Disease among Men with Hypertension. Annals of Int Med, 1/2/2007.

One of our hospital medicine fellows recently presented a noon conference about the health effect of alcohol. He mentioned that "the body of evidence supporting the beneficial effects of alcohol is so large that there is almost no doubt at this point." This study adds just a little bit more and MedPundit comments on it.


UpToDate Founder Talks About Starting the Project in 1992

Burton D. Rose, MD, the founder and editor-in-chief of UpToDate, is interviewed by MDNetGuide.


Medical ultrasound cases with images

A collection of videos and clinical cases by Dr. Joe Antony, a radiologist in South India.


Mozilla Discloses 2005 Revenues: $53M. GigaOM.

If nothing else, we should be happy that Google allows Firefox and Opera browsers to be distributed and used for free. How is that possible? The integrated search box in those browsers covers the cost handsomely and it actually makes money. This is not surprising, considering the fact that Google reportedly makes 2o cents from every search query. Yahoo! lags behind, making "only" 10 cents per search. Yes, we live in a different world since Google launched AdWords/AdSense, at least from the perspective of the Internet economy.

Maps of Visited Countries and States

Visited Countries

11 countries (4%):
Hungary
France
Romania
Czech Republic
Serbia
Greece
Bulgaria
Italy
United States
create your own visited countries map

Visited States

23 states (45%):
Florida
Louisiana
Massachusetts
New Jersey
North Carolina
Rhode Island
West Virginia
California
DC
Georgia
Illinois
Michigan
South Carolina
Texas
Virginia
Wisconsin
Delaware
Indiana
Maryland
Minnesota
New York
Ohio
Pennsylvania
create your own visited states map

Source: Visited Countries. Douweosinga.com.

Updated: 11/17/2007

Echocardiograms and Cases on YouTube

There are a few users/cardiologists who upload echocardiogram videos and relevant case descriptions on YouTube:

A Cardiology Teaching File

SoundWaveImager Channel


Normal echo

Google Video and YouTube (which will probably be merged one day) broaden the educational tools available to health workers and are typical examples of Web 2.0 use in medicine. The authors of AskDrWiki upload coronary angiograms on YouTube.

I would like to remind all doctors posting any type of patient information on the web to follow the HIPAA requirements and to omit the 18 unique identifiers from all text, images and videos. This includes the date of the echocardiogram which can still be seen in some YouTube videos. Apart from these problems, I can already see the title of a future ACC abstract for 2008: Using YouTube for Cardiology Education.

References:
Case Reports and HIPAA Rules
Builth & Llanwrtyd Medical Practice YouTube Videos
YouTube for Your Business. PC World, 06/2007.
Video tutorial: How to get yourself on YouTube, for business or pleasure. ComputerWorld, 06/2007.
BioMed Central's You Tube channel: videos from BioMed Central's authors and editors, 09/2007.
How to: Get Exactly What You Want From YouTube via RSS. DavidRothman.net.
Click to play: YouTube and similar sites have more doctors getting ready for their close-ups. AMNews, 01/2008.

Related:
YouTube Feeds. Google Operating System, 01/2008.
YouTube as a Source of Health Misinformation. Highlight HEALTH 2.0, 02/2008.
YouTube as a source of information on immunization: a content analysis. Keelan et al. JAMA. 2007 Dec 5;298(21):2482-4.

Updated: 02/06/2008

AskDrWiki -- A Collaborative Medical Encyclopedia

AskDrWiki.com is a medical encyclopedia based on a wiki platform. The authors were one of the first to use YouTube to upload medical videos. Dean Giustini and I discussed this fact a few weeks ago, and he wrote about it in his landmark BMJ editorial How Web 2.0 is changing medicine, linking to AskDrWiki.com.


Coronary Angiograms: Coronary Dissection

Ganfyd is another medical Wiki community, created in November 2005 by a group of doctors working in the UK. It is intended to become a large on-line textbook of medicine (source: Wikipedia).

Graham shares his concerns about medical wikis in his post "I Will Never Trust Dr. Wiki… because I will never trust malicious teenagers."


Mike Cannon-Brookes has a nice presentation on Organisational Wiki Adoption on SlideShare (link via DavidRothman.net). This may convince your department or hospital to start a wiki, if you do not already have one.


Wikis in Plain English

References:
Do We Need a Free Medical Encyclopedia?
British Medical Journal Features Clinical Cases and Images - Blog, Again
I Will Never Trust Dr. Wiki… Grahamzon.com.
Medical wikis. DavidRothman.net.
Lots More Medical Wikis. DavidRothman.net.

Updated: 10/03/2007

Tiger Roams Siberian Village, Chased by Little Dog

A surveillance camera video shows an Amur tiger in Zavodskoy village, Primorsky Krai, Russian Far East, 2005-2006 winter.

Link via English Russia, "just because something cool happens daily on 1/6 of the Earth surface."