Main Cleveland Newspaper Features a Cleveland Clinic-based Wiki

The Plain Dealer is the major newspaper in Cleveland and we are lucky to have Pulitzer-winning journalists writing for it. I especially enjoy the Friday section which lists many "things to do" for the weekend: festivals, museums, etc.

On Thursday, the front page of The Plain Dealer featured AskDrWiki, a medical wiki created by 4 cardiology fellows at the Cleveland Clinic. I know Ken Civello and Brian Jefferson and I think that they are incredibly bright and have a great future in front of them.

The medical wiki in question has unique, high-quality content, for example, more than 90 free videos of cardiac catheterizations. I can see web sites like AskDrWiki, maintained by experts, becoming competitors to UpToDate and other paid resources. UpToDate is useful but it charges "an arm and a leg" for individual subscriptions. Few companies can compete with free, if the quality is comparable. Look what happened to the once mighty encyclopedia Britannica -- it is gradually becoming irrelevant, out shined by the ever growing Wikipedia.

Medical wikis have several limitations to overcome to be recognized as trustworthy, and we have discussed them many times with Ken and Brian. They have one quality which likens them to Sergey Brin and Larry Page of Google - they attentively listen to requests and advice by users. For example, after David Rothman suggested a tighter control on who can edit the wiki, Ken and Brian introduced registration to insure that only medical professionals are registered as contributors. This is just on of the many problem solutions along the way of making medical wikis mainstream but it is a step in the right direction.

I do stay by my quote in The Plain Dealer article: "Sites like AskDrWiki will change the way we study and teach medicine."

For additional coverage (positive and negative) of AskDrWiki, please check:

Ask Dr Wiki vs medicine in Wikipedia.ScienceRoll.

Cleveland Plain Dealer on Medical Wikis. DavidRothman.net.

My own opinion is here: Medical Wikis May Change the Way We Study Medicine

Ken, one of AskDrWiki founders, started a blog which he will use to post announcements about the wiki, and most importantly, to ask for feedback from you -- students, physicians, nurses and general readers of medical blogs. Please welcome Ken to the medical blogosphere and Grand Rounds. He definitely has something interesting to say. Featuring interesting EKGs of the week doesn't hurt either.

References:
Same excuses. DavidRothman.net.
Medical wikis: the future of medicine? ScienceRoll.
Medscape interview w/ Bertalan Meskó (Medical Wikis) ScienceRoll.
Technology for the rest of us: Easy to use wikis. Tobias Buckell, BloggingStocks.

Image source: DavidRothman.net, The Plain Dealer.

Key West and Sanibel Island, Florida

These are the latest additions to the travel series Hit the Road - See America and the World. Enjoy.

Key West, Florida

Key West, Florida

Ivan - one of the polydactyl cats at the Hemingway House

Sanibel Island, Florida

Sanibel Island, Florida

Sunset on Sanibel Island

Blog Advice

Every blogger hits a "writing block" every now and then. Most good bloggers overcome it and just go on, stronger and better than ever. Some other good bloggers get stuck in the "writing block" and their web sites join the virtual cemetery of dead blogs respectfully maintained by GruntDoc.

Below are a few links which should help your blog engine keep humming along:

101 Great Posting Ideas That Will Make Your Blog Sizzle. I Help You Blog.

Find Great Free Photos for your Blog. LifeHack.org.

The 4 Motivations for Blogging. LifeHack.org.

Be More Than a Blip in the Blogosphere. Washington Post, 11/2007.


This Google video shows it takes about 2 minutes to start a blog on Blogger.com. Creating a web site has never been easier.

Updated: 11/15/2007

Super Zoom on Google Maps and Advanced Features of Google Earth

Super Zoom on Google Maps

Google Blogoscoped links to super-close zoom satellite photos on Google Maps showing camels in the middle of Africa.



Image source: Google Blogoscoped, license: Attribution-Noncommercial 3.0.

More images:
African Elephants Spotted on Google Earth. Digital Inspiration, 07/2007.
In Pictures: The Strangest Sights in Google Earth. PC World, 2007.

Related:



Africa: The Megaflyover by the National Geographic Channel. Join National Geographic Explorer-in-Residence Mike Fay on a seven-month, transcontinental journey from the southern-most tip of Africa to the northern shores of Morocco.

Advanced Features of Google Earth

A Google employee shows advanced features of Google Earth (layers, etc.) in this video. Link via Google Operating System.

Updated: 12/02/2008

Wife of presidential candidate John Edwards diagnosed with metastatic breast cancer. Campaign goes on

CNN, Greenfield: When Fate steps into the political arena.

"Do you want to hear God laugh? Make a plan.

We fret over the most minute details of our lives, stressing over critical decisions (plasma or LCD for that HDTV? Italian or Asian for that weekend dinner?) while Fate's kindest or cruelest blows are utterly beyond our vision or control.

Nowhere is that more dramatically shown than in the world of politics.

Who gets to ride with the candidate from the plane to the reception; who stands behind her? What food gets served at the fundraiser? Are the pamphlets printed in a union shop on recycled paper?

And then Fate steps in -- and reminds us of one of life's most ineluctable truths.

The Edwards family has had more than its share of hammer blows, from the death of a son in a car crash, to Elizabeth's breast cancer diagnosis that came in the weeks before the election loss in 2004."

In the press reports, metastatic bone cancer has been compared to a chronic disease like diabetes, but many doctors will have doubts about that description, I think.

Kevin, M.D. links to a comprehensive MSNBC report with videos.

As it is becoming customary now, medical blogosphere provides a very good (and naturally, professional) coverage of medical conditions affecting well-known people. For example:

- Kevin commented on the initial diagnosis of Elizabeth Edwards' breast cancer in 2004.

- Respectful Insolence: Elizabeth Edwards and bone metastases from breast cancer

- The Cheerful Oncologist: What Does It Mean to Have 'Relapsed Breast Cancer?'

- Dr. Charles discussed the Vice-President Cheney's blod clot.

- Two weeks later, Dr. Wes wrote why the Vice-President's leg is still causing problems and the likely diagnosis of post-phlebitic syndrome.

- Vice President Cheney Gets Atrial Fibrillation. Dr. Wes, 11/2007.

Stage IV breast cancer is a much more serious diagnosis than an episode of DVT (without PE). I join Kevin in wishing Elizabeth Edwards and her family all the best during this difficult time.

Update 4/4/2007:
Elizabeth Edwards expresses disappointment in reports she'll die in five years, gets good news on treatment. CNN.

References:
Greenfield: When Fate steps into the political arena. CNN.
Wife's illness won’t idle Edwards ’08 campaign. MSNBC.
Edwards shows new face of cancer. CNN.

Updated: 11/26/2007

DVT Awareness on NBC's The Today Show

The chief of our Section of Hospital Medicine, Frank Michota, was invited to discuss DVT awareness on NBC's The Today Show last week. Click to see the video.

Frank was on The Today Show with Melanie Bloom, the widow of David Bloom, an NBC journalist who died suddenly in 2003 in Iraq at the age of 39 from DVT/PE.

Frank and Melanie Bloom were also featured on CNN Larry King Live in 2005. See the transcript.

Related:
Hampton Hump in Pulmonary Embolism
Pulmonary Embolism and Thoracic Aortic Dissection
Massive Lower Extremity DVT Treated with Thrombolysis

Urologist Shares Robotic Surgery Schedule via Google Calendar

I have written about the potential uses of Google Calendar by doctors and other health workers before and I just found another good example yesterday. Dr. Savatta of Robotic Surgery Blog uses Google Calendar to share his surgery schedule:

I found a way to place my robotic surgery schedule online.

I do not add my operations in advance that far ahead, but can is accurate for the upcoming 2 weeks usually. Urologists interesting in case observations can contact me to watch surgery.

References:
Google Calendar for Doctors: Help Patients See Your Practice Schedule and Make Appointments
Google Calendar for Patients: Monitor Your Medical Condition
Interesting Ways to Use Google Calendar
Add Google Calendar to Your Site. Google Blogoscoped, 2006.

Free Procedure Guides for Pocket PC/Windows Mobile and Palm

Two years ago, a colleague of mine and I made several procedure guides illustrating central line placement and thoracentesis with step-by-step photos:

Central Line Placement - A Procedure Guide

Central Line Placement with Ultrasound Guidance - A Procedure Guide

Thoracentesis - A Procedure Guide

These photo guides proved very popular and are currently used for teaching purposes by residents at Cleveland Clinic and Case Western Reserve University/St. Vincent, and are linked in Wikipedia among several other web sites.

Eight months ago, I got an email from Andrew Schechtman, a Clinical Instructor at Stanford University School of Medicine and the founder of MeisterMed, a popular PDA portal for medical references. Andrew wanted to know if I was interested in adapting the procedure photo guides to PDA and distributing them for free. The original idea behind the guides was that they should be free and used by residents and physicians all over the world, and his suggestion to adapt them for PDA fitted that idea perfectly. I thought about it but somehow never found the time to do it.

Anyway, the procedure guides for PDA are now available for free from MeisterMed:

Central Line Placement (with and without ultrasound guidance).
A Chapter in MeisterMed's Procedure Series for PDA.
V. Dimov, B. Altaqi, 2/20/2007.
Click to download (size: 3.7 MB).

Thoracentesis.
A Chapter in MeisterMed's Procedure Series for PDA.
V. Dimov, B. Altaqi, 2/20/2007.
Click to download (size: 1.6 MB)

The guides themselves are free but they need the iSilo program for Pocket PC/Windows Mobile or Palm to work. The full version of iSilo is required to see the images beyond the trial period and that version costs $ 19. The guides are just like Microsoft Word documents -- you need to have MS Word installed on your computer in order to see the documents. Similarly, you need iSillo installed on your PDA to be able to see the photo guides.

Procedure guides are part of the MeisterMed Procedure Series which will be adding more titles in the near future.

A glass of wine daily may prolong life. How can you predict which patient will have a bottle daily though?

A recent study linked by DB's Medical Rants seems to confirm the health benefits of drinking alcohol and specifically red wine:

"Compared with non-drinkers, men who consumed wine, beer, or spirits had a 36% lower risk of all-cause mortality and a 34% lower risk of cardiovascular mortality."

Why don't we prescribe a glass of wine per day to all patients without contraindications then? The answer is simple: because we do not know which one will overdo it.

It is not known if the ER physician Dr. Vavrick was a also patient but he was certainly going beyond the "recommended dose" by drinking a bottle of wine daily. Finally, he showed up at his ER after drinking 2 bottles and was fired:

"Officials say a nurse reported smelling alcohol on Vavrick's breath, and he was confronted by a supervisor and another physician. He did not appear to be impaired, but was asked to take an alcohol test, then allowed to continue seeing patients. The test showed his blood-alcohol level was 0.11 percent, above the state's standard of 0.08 percent for drunken driving. Then, Dr. Vavrick was asked to leave the ER immediately."

He was reprimanded by the state medical board, placed on probation for 5 years, and ordered to participate in a drug and alcohol treatment program for physicians.

References:

Doctor reprimanded for drinking. AZCentral.com.
A Half Glass of Wine Daily May Add Years to Life. MedPageToday.
Alcohol literally kills: Gary Moore had 380mg/dL in his blood, Winehouse 416mg/dL when she died surrounded by 3 empty vodka bottles. Telegraph UK, 2012. 
Red Wine Can Prevent Stroke (in Mice)
Health Blog Interview: CEO, Red Wine in a Pill, Inc. WSJ Health Blog, 11/2007.
Rethinking Drinking - NIH interactive website
Image source: Wikipedia.