Nephrology Web Resources

Daniel Schwartz and Jordan Weinstein are two nephrologists from the Division of Nephrology at the University of Toronto who have launched a number of interesting medical education projects recently:

QxMD Nephrology for Blackberry
A medical calculator for "all MDs using the RIM Blackberry, not just Nephrologists." They are also developing QxMD Cardiology, QxMD Gastroenterology, QxMD Endocrinology, and QxMD General Medicine. All of them for Blackberry handhelds.

Nephrology Now
A free service to stay up to date with new developments in Nephrology: "Keeping up to date in Nephrology can be difficult - in fact, it has recently been shown that half of all evidence is published in non-renal journals. Each month, subscribers will receive a 'meta-journal' of the most important articles published in the field of Nephrology in the last month."

UKidney
"An Internet school of nephrology" with house staff manuals, copies of lecture slides, rounds, "YouTubule" videos, and more.

Nephrology Pearls
"Those trainees who sign up to Nephrology Pearls will receive an email each weekday that contains a clinical question and/or problem."

Links via KidneyNotes.
Image source: Wikipedia, GNU Free Documentation License.

Gene Genie: A New Blog Carnival About Genetics

Gene Genie is a new blog carnival on genes and gene-related diseases. Their plan is to cover the whole genome before 2082 (it means 14-15 genes every two weeks). The first issues is hosted at ScienceRoll.com.

There is a link to a cool YouTube video by medical students which also explains a thing or two about genetics.

State of the Cleveland Clinic is Good, CEO reports

Cleveland Clinic CEO Dr. Delos “Toby” Cosgrove released the annual "State of the Clinic” report which is an interesting reading and an excellent example of how transparent an organization should be.

Although the hospital is the site of many "firsts" in healthcare, Dr. Cosgrove points to a survey which reveals that Cleveland Clinic has just 25% national name recognition as compared to 80% for Mayo Clinic and 90% for Johns Hopkins. The free Google Trends tool shows a similar picture.

Having an academic appointment at the Clinic and working there full time, I think it has a very good chance of being rated the top hospital in the country in not too distant future, surpassing its 2 biggest competitors :)

The Wikipedia article about the Clinic has also been expanded substantially recently.

Update 3/30/2007:
Added links to the PDF of the report and a video interview with Toby Cosgrove.

References:
Clinic's state good, CEO reports. Crain Communications.
Cleveland Clinic capacity crunch. Plain Dealer.
Cleveland Clinic, from Wikipedia, the free encyclopedia.

Related:
Cleveland Clinic outlines successes, predicts good year for 2008. Cleveland Plain Dealer, 02/2008.

Updated: 02/28/2008

Will Google Apps be a Game-changer for Doctor Practices?

Google Apps (applications) for business has launched this week. The Apps (Google.com/A) include Google Docs & Spreadsheets, email, calendar, IM messaging, page creator, etc.

I think the idea has a promising future. Google Docs & Spreadsheets has completely changed the way I, and many academic physicians I know, write abstracts and articles. I rarely use MS Word anymore -- Google Docs is just so much more convenient.

Of course, the Fortune 500 companies and many hospitals feel nervous about outsourcing their IT departments. They would like to protect their valuable company information which is understandable. HIPAA issues aside though, we may by surprised by how shortsighted this thinking is. Not outsourcing your files to Google (or other Internet giant), may one day feel just as weird as running your own phone company in order not to outsource your phone calls.

SF Bay Pediatrics, a medical group in San Francisco uses Google Apps and their Chief Information Officer recorded a video testimonial:

"When it comes to our email systems, our doctors don't have the time or the budgets to deal with managing technology or defending against spam. With Google Apps we don't have to worry about downloading the latest spam filters or navigating unwieldy servers – this is where we let Google do what it does best, so we can do what we do best – help our patients."



Google Apps can certainly help a doctor run a lean practice with low (or minimal) overhead. Yesterday, WSJ published an interesting article about the so-called micropractices:

"Dr. Moore estimates that his overhead costs make up 35% of his revenue. That compares with a figure of about 60% for other small primary-care group practices."

Dr. Moore does not use Google Apps but the ideas are similar. Google Apps do not include electronic health records.

Update 4/17/2007:

Google Apps product manager shows in a 17-minutes video how to use Google Apps in a company or organization. Link via Google Operating System.




Google Apps Team Edition

References:
Google Docs & Spreadsheets Could Replace Word & Excel for the Average User
Google Calendar for Doctors: Help Patients See Your Practice Schedule and Make Appointments
How Can a Doctor Use Google Page Creator?
Google Apps vs. Microsoft Office. Geeking with Greg.
Google Apps grows up. Google Blog.
Google Apps Goes Premier. Nathan Weinberg.
No Competition for Google Docs & Spreadsheets. Google Operating System.
"Can I Just Email My Doctor?", Your Patient is Asking the Receptionist
Faltering Family M.D.s Get Technology Lifeline. WSJ.
Livin' la Vida Google: A Month-Long Dive Into Web-Based Apps. Michael Calore, Wired.com, 4/18/2007.
Google Apps for Your Domain in Education. Lucie deLaBruere, 11/2007.

Updated: 11/24/2007

Textbooks Based on Clinical Cases in Medicine, Surgery and Subspecialties

More and more teachers and students realize that case-based lessons are very valuable in teaching "real-life" medicine. We did our small share by launching an online case-based curriculum of clinical medicine, ClinicalCases.org, in 2005.

There has been a recent surge in the publication of case-based books:

Core Clinical Cases in Medicine and Surgery. A Problem-Solving Approach.

Blueprints Clinical Cases in Medicine

250 Cases in Clinical Medicine (MRCP Study Guides)

The Cleveland Clinic Internal Medicine Case Reviews

References:
Medical Schools Which Link to Our Project Clinical Cases and Images

Image source: OpenClipart.org, public domain.

Allergy Podcasts and Videocasts by ACAAI

The American College of Allergy, Asthma & Immunology (ACAAI) has started publishing free podcasts/videocasts from the 2006 Annual Meeting:

"Every second week, the College will post a new 30-minute Vodcast (video podcasts) of a key presentation from its 2006 Annual Meeting on-line. Each vodcast will contain the original audio and presentation slides and can be viewed from a computer or downloaded to a portable media player (like an iPod)."

Cleveland Clinic has had free podcasts for both patients and health professionals for a while.

References:
Free Audio and Video Podcasts for Health Professionals by Cleveland Clinic
Cleveland Clinic Offers New Podcasts
Video Podcasts by The Cleveland Clinic

Using Web Services to Enhance a Medical Education Course

The Cleveland Clinic Annual Intensive Review of Internal Medicine is in its 19th edition this year and since members of the Section of Hospital Medicine actively participate in the course, we started to think of ways to make it more Web-friendly. I was appointed a director of web-based development for the project.

The course already has an accompanying book and CD-ROMs which were reviewed very favorably in JAMA.

I was asked recently to be the director of web-based development for the 19th edition of the course. We are looking for some "Web 2.0 ways" to make this well-established course more interactive and closer to the minds of the new generation of physicians who see the world through "Google eyes."

I listed below a few services we are considering for future use, feel free to add your comments and suggestions.

1. Google Video to host course lectures

We could upload most of the course lectures on Google Video/YouTube and make them freely available and searchable. Additional options include allowing videos to be embedded in other sites and blogs, and downloaded to video iPods. If content owners do not agree to provide lectures for free, we could probably charge a reasonable price of $ 2-5 per video to watch and download.

A similar approach is already used by UC Berkeley and by our own Health Edge team at the Cleveland Clinic.

2. Google Groups for question-and-answer sessions

The new version of Google Groups has morphed into an online collaboration platform which can be used for question-and-answer sessions between course attendees and faculty. A simple website can be built within Groups using Google Page Creator, and up to 100 MB of files can be hosted on Groups.

Google Groups design can be customized to fit the Cleveland Clinic brand and logo requirements.

3. Video iPod with course lectures

We could offer individual Cleveland Clinic-branded video iPods with all the lectures pre-loaded and available for education on-the-go, when exercising or traveling.

A similar approach is used by The Arizona Heart Institute to educate patients about cardiovascular disease and surgery. Cleveland Clinic Center for Continuous Medical Educations already features free audio and video podcasts for health professionals. The series started with the Sessions from the 18th Annual Intensive Review of Internal Medicine. You can either listen/view podcasts online or subscribe with iTunes.

4. PicasaWeb to host clinical images and EKGs

PicasaWeb slide shows automatically adjust to the monitor size of the user. I already use this service for our procedure-teaching articles.

5. Convert PowerPoint presentations to online Flash slide shows

Course attendees may not need PowerPoint installed on their computers to view the course presentations. Slideshare.net converts PowerPoint files to Flash slide shows which can either be embedded in web sites/blogs or shared via email.

References:
Attend Conferences Without Being There. LifeHack.org.
Video iPod for Your Heart
Video Podcasts by The Cleveland Clinic
UC Berkeley Free Webcast Courses
18th Annual Intensive Review of Internal Medicine
The new Groups experience
Convert Powerpoint Presentations to Flash Slideshows with Slideshare. Amit Agarwal.
Free Audio and Video Podcasts for Health Professionals by Cleveland Clinic
Building a Site in the Times of Google. Google Operating System, 01/2007.
BioMed Central's You Tube channel: videos from BioMed Central's authors and editors, 09/2007.
Image source: OpenClipAart.org (public domain)

Related:
Most Popular Educational Technologies. Life as a Healthcare CIO, 04/2008.

Updated: 04/15/2008

Medical Schools Which Link to Our Project Clinical Cases and Images

Our case-based curriculum of medicine, Clinical Cases and Images, and the related blog, are gradually being incorporated and linked in the web sites of medical schools around the world:

Check the updated list here: http://clinicalcases.org/2002/01/medical-schools-which-link-to-our.html

University of California, San Diego, California
A Practical Guide to Clinical Medicine > Medical Links
Catalog of Clinical Images

University of Michigan
Taubman Medical LibraryPDA > Information on the Web

Feinberg School of Medicine, Northwestern University, Chicago, Illinois
Galter Health Sciences Library > RSS and Atom Feeds

Vanderbilt University Medical Center, Nashville, Tennessee
A Website for Neurology Medical Students > 'Can't miss' Links
Relevant ICU Web Links

University of Texas Southwestern Medical Center
Evidence Based Medicine > Web Resources

University of Utah
The Vault of Attainment - MS2008 Works

University of Alabama School of Medicine, Tuscaloosa Campus
Internal Medicine Clerkship > Educational Resources

University of South Alabama College of Medicine
Medical Association of the State of Alabama > Web 2.0: Tools for Clinical Practice

Indiana University School of Medicine
Site of medical student government > Useful Research Resources

Kirksville College of Osteopathic Medicine, Kirksville, Missouri
Clinical Cases on the Web

McGill University Life Sciences Library, Montreal, Quebec, Canada
RSS Info > Recommended Feeds

Université de Montréal, Quebec, Canada
Bibliothèque des sciences de la santé > Ressources d'Internet en sciences de la santé classées par spécialités > Endocrinologie

National Autonomous University of Mexico
Department of Microbiology and Parasitology > Bacteriology Resources
The largest university in Latin America, founded in 1551.

Karolinska Institutet, Sweden
Clinical Case Studies Grand Rounds
The largest single institution of higher education in medicine in the world, founded in 1810.

Division of Community Health Sciences, St George’s, University of London, UK
Primary Care Electronic Library (PCEL)

Queen's University Belfast, Northern Ireland
Clinical Skills Education Centre > Useful Links

University of Helsinki, Finland
National Library of Health Sciences - Terkko > Feed navigator

As a main editor of ClinicalCases.org, I would like one more time to highlight the great work of all contributors involved in the project.

Update 4/23/2007 - added:

Baylor College of Medicine, Texas
Education Resource Center (ERC) > Web Digest > Web 2.0: Are you ready for it?

University of Missouri Medical School
J. Otto Lottes Health Sciences Library > Electronic Resources

Update 06/02/2007 - added:

Duke University Medical Center Library
New Clinical Tools Page > Multimedia > Physical Examination Videos

University of North Carolina at Chapel Hill
Health Sciences Library, UNC-Chapel Hill > Clinical Reference

Update 06/22/2007 - added:

University of Ulm, Baden-Württemberg, Germany
eCurriculum > eLearningCases

Image source: OpenClipArt.org (public domain).

Updated: 08/15/2007

Phipps Conservatory and Botanical Gardens in Pittsburgh, Pennsylvania

See the the slide show on PicasaWeb.

Phipps Conservatory and Botanical Gardens is a complex of buildings and grounds set in Schenley Park, Pittsburgh, Pennsylvania. The gardens were founded in 1893 by steel and real-estate magnate Henry Phipps as a gift to the City of Pittsburgh (source: Wikipedia).

Click for more photos.


Phipps Conservatory and Botanical Gardens in Pittsburgh, Pennsylvania

Not to be outdone, the city of Cleveland has the Rockefeller Greenhouse, a hidden gem in the heart of the city, and the Cleveland Botanical Garden. The greenhouse was a part of John D. Rockefeller's estate and is now free to the public.

An Optician Needs Anger Management

An enraged optician, investigated for fraud, spits on a 75-year-old reporter from CityNews, Toronto, Canada, then throws snowballs.

Direct link to the full-lenght CNN video. Another YouTube video.

The American Psychological Association's page Controlling Anger -- Before It Controls You would be very helpful to this particular optician in the future. It is the number one hit on Google for "anger management" for a reason.

Related:
Teacher caught yelling at kids. CNN Video, 02/2008.

Updated: 02/27/2008

Interesting Links

A video about Web 2.0 by a professor of anthropology

Created by Michael Wesch, Professor of Cultural Anthropology at Kansas State University. Link via DavidRothman.net.


Sample Letter to Request Health Records by The Patient's Doctor:

[Your name]
[Your address]
[Date]

[Name of care provider or facility]
[Address]

RE: [Your medical identification number or other identifier used]

Dear

The purpose of this letter is to request copies of my medical records as allowed by the Health Insurance Portability and Accountability Act (HIPAA) and Department of Health and Human Services regulations.

I was treated in your office [at your facility] between [fill in dates]. I request copies of the following [or all] health records related to my treatment.

[Identify records requested, e.g. medical history form you provided; physician and nurses' notes; test results, consultations with specialists; referrals.]

[Note: HIPAA also allows you to request a summary of your medical records. If you prefer a summary, you should agree to a fee beforehand.]

I understand you may charge a “reasonable” fee for copying the records, but will not charge for time spent locating the records. Please mail the requested records to me at the above address. [If you request that the records be mailed, you may also be charged for postage.]*

I look forward to receiving the above records within 30 days as specified under HIPAA. If my request cannot be honored within 30 days, please inform me of this by letter as well as the date I might expect to receive my records.

Sincerely,


[Your signature]
[Your name printed]

Lasix and NSAIDs for Thoroughbred Race Horses

Barbaro was a young American thoroughbred horse that won the 2006 Kentucky Derby. On May 20, 2006, he ran in the Preakness Stakes as a heavy favorite, but he fractured three bones. Barbaro underwent surgery but he soon developed laminitis in his left rear leg. While his right leg eventually healed, a final risky surgery on it proved futile because the colt soon developed further laminitis in both front legs. It then became clear he could not be saved, and Barbaro was euthanized (source: Wikipedia, image: Godolphin Arabian).

A NY Times article comments on drug use in horse racing and different training styles used on both sides of the Atlantic:

"Horses racing in America are allowed to be injected with various drugs on race day, the most common being Lasix, a powerful diuretic, and phenylbutazone, an anti-inflammatory medication.

“A horse will try his hardest,” Dr. Stewart, head of veterinary regulation for the Hong Kong Jockey Club said, “and if he can’t feel pain he will run through it, increasing the risk of injury.”

Barbaro was running on Lasix in the Preakness, and there is no evidence that this had anything to do with his accident. But his story became a rallying point for improving safety for thoroughbreds."

As an interesting fact, all modern thoroughbreds carry the genetics of three Arabian stallions imported to England from the Middle East in the 17th and 18th centuries: the Darley Arabian, to whom 95% of today's thoroughbred pedigrees trace, the Godolphin Arabian, and the Byerly Turk. (Source: Wikipedia).

References:

I’m Not Barbaro, for Lots of Reasons. NY Times.
Death and Disarray at America’s Racetracks -  24 horses a week die at racetracks around the country - NYTimes, 2012.
Veterinarian Says Goodbye to a Patient. NY Times.
Barbaro from Wikipedia, the free encyclopedia.
Still Caring for Barbaro. NYTimes, 05/2007.
Image source: Wikipedia, public domain.

Anonymous Medical Blogger? Not Anymore

I have written before that it is probably better to show your name and email on your blog rather than blogging under the cloud of anonymity. First, it gives more credibility when your readers know who you are, and second, smart people can find who you are anyway.

How?

One way is checking the domain registration. For example, you can see that I registered CLINICALCASES.ORG with my work address.

Quick Online Tips blog writes that you can type the URL of any (hosted) blog in Whois.sc and see the personal details of the person who registered that domain name.

Of course, this excludes people who blog on free services like Blogger.com or Wordpress.com. If you want to protect your confidential information when registering a website, you can opt in for a private domain registration.

Update 2/1/2007

I wrote this post 10 months ago, in March 2006, and never got around to publish it. MSSPNexus Blog just pointed my attention to Dr. Anonymous who was recently featured on Fox News and soon after that has discovered that he's not so anonymous after all:

1. FoxNews.com features Doctor Anonymous

2. Is Dr. A a quack?

3. Dr. A Revealed

4. The Myth of Anonymous Blogging

He has posted 2 videos explaining why he is "blog-aholic" and why he wants to remain anonymous. Well, if you want to stay anonymous, posting your video is probably not the best move, but who am I to judge others...

References:
Why Private Domain Name Registration is Essential. Quick Online Tips.
Simply Fired - How NOT to Blog About Your Job. Especially If You Are a Doctor

Related:
Great moments in Amazon packaging: Updated and Bumped. GruntDoc, 03/2008: "...this is a semi-anonymous blog, and within a day of posting Amazon figured out who I was without any trouble whatever. Don’t think you’re anonymous on the internet."
Doctors in Social Media Shouldn't Be Anonymous. 33 Charts, 2009.

Anonymous Blogging 101: a Quick and Dirty Primer. ProBlogger, 2010.

Updated: 06/30/2010

Clinical Question: Neulasta or Neupogen for AIDS-related Neutropenia?

A 40 yo AAM with end-stage HIV/AIDS has a WBC of 1.66, ANC 498, Hgb 13.7, platelets 61. ID suggests starting G-CSF. Which one should you choose? Neulasta or Neupogen?


Neutropenia and thrombocytopenia in AIDS

Read more on ClinicalCases.org.

Acid-base Balance Cases and Calculators

Clinical Cases

Acid-Base Practice Cases from the University of Connecticut.
Acid-Base Physiology Example Cases. AnaesthesiaMCQ.com.
An approach to complex acid-base problems. Can Fam Physician. 2005 February 10; 51(2): 226–232.

Calculators

MedCalc: Acid-Base Calculator. Calculates the compensation and suggests if the primary disorder is acute or chronic.
ECG: Arterial Blood Gases. Steve Anisman.
MDCalc: Anion Gap (w/Delta Gap)
Cleveland Clinics shares their Algorithms for Medical Intensive Care Unit (ICU)

Mnemonic: ARMADA - acid-base balance work-up in 6 steps by answering 6 questions

1. A cidosis or Alkalosis?
2. R espiratory disorder? – acidosis or alkalosis – check PaCO2
3. M etabolic disorder? – acidosis or alkalosis – check HCO3
4. A nion Gap?
5. D elta AG?
6. A ssess compensation

References:
Online Acid-Base. American Thoracic Society.
A stepwise approach to acid-base disorders. Postgraduate Medicine, 2000.
Top 10 Clinical Pearls in Acid-base Disorders. Resident and Staff Physician, Jan 2007.
Acid-Base/Electrolytes. UCSF Hospitalist Handbook, 2002.

Assessing acid–base disorders. Kidney International (2009) 76, 1239–1247.
Image source: OpenClipArt.org, public domain.

Related:
Audio: Answer to new acidosis case. DB’s Medical Rants, 10/2008.
Student lecture on Acid-Base Balance. Precious Bodily Fluids, 02/2009.
Introducing the Acid-Base Machine. Precious Bodily Fluids, 04/2009.
On ABGs. DB’s Medical Rants, 09/2009.
Acid Base Disorders. John Doyle, MD.
Pulmonary Puzzle #007. Life in the Fast Lane, 2010.

Acid Base Handout (Student)

Publish at Scribd or explore others: Study Guides Academic Work osmolar gap delta gap

Updated: 01/11/2010