Friday, August 31, 2007

Peel My Love Like an Onion - #12 done!

From the defunct Babes and Books blog where a bunch of friends challenged each other to read twenty books in one summer:

Ana Castillo is one of the funniest writers I have ever read. The ironic thing is that she writes some of the most heart-wrenching stories ever. This is my second Castillo novel this summer. I didn’t plan it out that way, it just happened.


The novel tells the tale of a polio-stricken woman who dances Flamenco, falls in love with two men, and then has to deal with life when polio makes it almost impossible for her to dance anymore. Oh and it’s set in Chicago. Carmen also has to deal with being the only daughter in her pretty typical working-class Mexican family.

Castillo’s ability to describe the truth in life is spot on:
  • You put on your cross-trainers assembled in a foreign land by women and children at slave-wages so you try not think of what you paid for them, and begin to talk the streets of your city at sunset.
  • We couldn’t so much as stand on the lawn for a minute, just pass through quickly on the way to throwing the garbage out in the cans in the alley. You’re nice Mexicans, our land lady would say with a phony smile of old and missing teeth. She distinguished us from the not nice ones I suppose by always praising us for making ourselves as invisible as possible.
Castillo’s feminism is even better. At one point Carmen is teaching suburban women how to dance and she makes this observation:
Look at me…I cupped her chin and her eyes went left, right, and then down. Look at me, I said again. When she did I let go of her chin…You keep that pose when you are on the street…when your husband comes home. You keep your head up. Dignity is the sexiest thing a woman can learn.
While I’ve never read a drugstore romance novel, somehow I imagine that this romance novel kicks their asses. I never thought that I’d enjoy a romance novel the way this one plays out.

A Wikipedia wizard and blogger... and I happen to know him

BMJ Career Focus profiles Bertalan Mesko who "combines being an editor and administrator of Wikipedia with medical student studies."

Bertalan is the author of the popular blog ScienceRoll.com which often features new Web 2.0 tools for medical education. He is also is the founder of a blog carnival about Web 2.0 and medicine called -- what else -- Medicine 2.0.

References:
A Wikipedia wizard and blogger. BMJ Career Focus, 08/2007.
Interview With Medical Blogger Berci Mesko. TiroMed.com, 11/2007.
Image source: BMJ Career Focus.

Related:
Listen to Berci Mesko: After the Dr. Anonymous Show. ScienceRoll.com, 03/2008.

Updated: 03/07/2008

Thursday, August 30, 2007

Who owns See Jane?

Have you ever wondered why we don't see more girls as lead characters in children's movies and shows? Have you ever stopped to figure out the ratio of boys and girls as characters period? Well earlier this year, Dads & Daughters, released a study through the See Jane program, about gender and racial disparity in TV shows. In 2006 they released a studies about gender, gender roles for boys, and occupation in G-rated movies. All fabu work!

The See Jane program was touted with Geena Davis' name attached on press releases and fund raising efforts. When I first saw all this, I thought two things: WOW! About time! and Go Geena!
But today I read a story via the Chronicle of Philanthropy that Geena is now suing for ownership of the See Jane program. It boils down to who came up with the idea.

In 2004, Davis allegedly conceived the See Jane program, for which she has since raised $750,000, according to the suit. She actively promoted the program while working with Dads and Daughters.

See Jane's mission initially focused on research. According to a See Jane-sponsored study released in March, the way gender is portrayed on television can critically impact a child's development, particularly the "task of integrating what it means to be male or female into their own personalities."

According to her suit, Davis always maintained "complete and exclusive control of the See Jane concept."

I love both See Jane and Dads & Daughters, so I hope that they can come to a good conclusion without bankrupting D&D. They are doing such great work together and I hope that this is just a tussle and they can go back to viewing what our children are watching through that gender lens.

I know that it's very hard to conceive an idea, hand it over to someone else to run with, and then see things not going as well as you had hoped. I have no idea if this is what is really happening though. As I said, I just want them to go back to the research that makes us go Hmm....

Here are some findings from the various research reports:

  • In the 101 studied films, there are three male characters for every one female character.
  • Fewer than one out of three (28 percent) of the speaking characters (both real and animated) are female.
  • G-rated films show few examples of male characters as parents or as partners in a marriage or committed relationship.
  • Almost twice as many non-white males (62%) as white males (37.6%) are portrayed as physically aggressive or violent.
  • In...G-rated movies, whether animated or live-action, the most common occupation for female characters is white collar work, such as clerical and secretarial positions.
  • The top three jobs for male characters are white collar, blue collar and military.
  • Three quarters of all the single, speaking characters on children’s television were White, giving young television viewers a distorted ethnic worldview.
  • In live-action children’s TV (shows using human actors), 53.9 percent of characters were male and 46.1 percent were female. This translates into a ratio of 1.17 males to every 1 female—the most balanced ratio among forms of children’s electronic entertainment.
There are more reports due out, including one on the hypersexualition of children. I canNOT wait for that one.

X-posted at the Red Thread at Chicago Parent

Technorati tags: feminist, Das and Daughters, Geena Davis, See Jane, movies

Prolonged immobilization increases risk of DVT -- how do you define prolonged immobilization?

Acquired risk factors for deep vein thrombosis (DVT) can be summarized in the mnemonic SICC PT:

Surgery
Immobilization
Cancer
Contraceptives

Pregnancy
Trauma

Prolonged immobilization can cause circulatory stasis which is one of the predisposing factors for DVT described by Virchow in his famous triad: endothelial injury, stasis and hypercoagulability.

How do you define prolonged immobilization?

According to the literature search I did:

- For travelers, prolonged immobilization is defined as a flight longer than 6-10 hours (most studies use a cut-off of 8 hours)

- For nursing home residents, the definition of prolonged immobilization varies between less than 15 days (increased risk of DVT) and/or longer than 3 months (no increased risk)

Nursing home residents with DVT

According to one study, the most powerful risk factor for DVT in patients older than 65 years was prolonged bed rest for up to 14 days, with a 5.6 times greater risk of DVT.

Travel-associated DVT

In a trial of previously healthy patients who traveled at least 8 hours per flight (median duration 24 hours), duplex ultrasound showed an asymptomatic DVT in 10 % of participants. In other studies, the reported risk of symptomatic DVT after flights of more than 12 hours was 0.5%. According to a 2006 Lancet study, activation of coagulation occurs in some individuals after an 8-hour flight.

Prevention of travel-associated DVT

A review of 10 randomized trials concluded that the use of compression stockings on flights lasting 4 hours or more led to a substantial reduction in asymptomatic DVT. There is no evidence that aspirin is helpful in this setting.

References

Risk Factors for Deep Vein Thrombosis in Inpatients Aged 65 and Older: A Case-Control Multicenter Study. Journal of the American Geriatrics Society 52 (8), 1299–1304, 2004.
Overview of the causes of venous thrombosis. UpToDate, 15.2, accessed 08/28/2007.
Literature Review of Deep Vein Thrombosis in Air Travellers. The Internet Journal of Surgery. 2007. Volume 10 Number 1.
Coagulation May Be Activated by Prolonged Air Travel. Medscape, 2006.
Travel and the risk of symptomatic venous thromboembolism. Thromb Haemost. 2003 Mar;89(3):499-505.
Is prolonged immobilization a risk factor for symptomatic venous thromboembolism in elderly bedridden patients? Results of a historical-cohort study. Thromb Haemost. 2004 Mar;91(3):538-43.
Image source: Saphenous vein, Gray's Anatomy, 1918 (public domain)

Further reading

Massive Lower Extremity DVT Treated with Thrombolysis
Suspected DVT - To Treat or Not to Treat?
INR 17 and Hematuria: What To Do?
Who is at risk for venous thrombosis on long haul flights?. Retired doc's thoughts.
The risk of VTE (blood clots) is 3 times higher in passengers on long-distance flights than in the general population http://goo.gl/Tk45Z
Exercises for air travel — Cleveland Clinic Journal of Medicine http://goo.gl/YYZHy

Wednesday, August 29, 2007

Online Case Book by Yale School of Medicine

The Case Book by the Yale University School of Medicine covers several areas:

Doctor Patient Encounter > Interview Skills Cases
Internal Medicine Clerkship
Modules > Renal Cases
Primary Care Clerkship > Cardiothoracic cases
Surgery Clerkship

The Internal Medicine Cases are most well developed but since they are clearly written for teaching purposes during the rotation, there are only questions but no answers. The cardiothoracic cases provide both.

Image source: Case Book by Yale University School of Medicine.

Tuesday, August 28, 2007

Dr. Wes Interviewed by Healthcare Blogger Code of Ethics

I am a regular reader of Dr. Wes' blog described as "musings in the life of an internist, cardiologist and cardiac electrophysiologist."

Westby G. Fisher, MD, FACC (Dr. Wes) practices at EvanstonHealthcare and is an Associate Professor of Medicine at the Feinberg School of Medicine, Northwestern University, Evanston, IL. He was interviewed recently by Rob Lamberts of Healthcare Blogger Code of Ethics:

"Describe yourself.

I started as a science and computer geek who became a biomedical engineer, then doctor in a subspecialty that combined my interests. I work, I play, I care, like everyone else."

You can read the whole interview at Healthcare Blogger Code of Ethics.

Medical blogging is hard work - Dr Wes spends 60-90 minutes most early mornings writing or researching new posts (http://goo.gl/PFsZV).

Further reading:

Why I Have the Best Job in the World. Dr. Wes, 09/2007.
The Dr. Wes Interview. Doctor Anonymous, 01/2008. Check out the archived copy.
Image source: Dr. Wes' blog

Monday, August 27, 2007

Allergy to Mustard

Mustard allergy is reported relatively rarely but is a growing concern, at least in Europe. According to a 2003 editorial in the European Journal of Allergy and Clinical Immunology, mustard was the fourth most prevalent food allergen in children, behind eggs, peanuts, and milk.

Boston Globe has recently published a case of a 3-year-old girl who is allergic to mustard -- read more on AllergyNotes.


Mind map of food allergy. Source: Food Allergy: A Short Review, AllergyCases.org.

Image source: Wikipedia, GNU Free Documentation License.

MedCalc Has a Windows Mobile Version Now

The venerable free medical calculator MedCalc for Palm now has a Windows Mobile version as well. MedCalc was my PDA calculator of choice during residency but since I switched to Pocket PC (now called Windows Mobile), I had to use Archimedes instead.

It is nice to see that MedCalc is still alive and getting updated. I have assembled a long list of free PDA software here: Free Medical Programs for Windows Mobile / Pocket PC.

Image source: MedCalc.

Sunday, August 26, 2007

Ohio Summer Festivals: Cuyahoga County Fair


Rabbits at Cuyahoga County Fair. Click on the images above to see the description about each breed.

Cuyahoga County Fair is just one of the many Ohio Summer Festivals and Fairs.

Related rading:
A Frugal Guide to the Iowa State Fair (or Any Similar County or State Fair). The Simple Dollar, 08/2008.

Updated: 08/09/2008

My Favorite Medical Handbook: Oxford Handbook of Clinical Medicine (OHCM)

I remember Oxford Handbook of Clinical Medicine (OHCM) since its first edition and it looks it has only gotten better. When preparing for USMLE several years ago, I used to refer to OHCM and First Aid for USMLE often and it helped - my scores were 96, 97, 93 on USMLE 1, 2 and 3 (99 is the maximum). The study plan was based on those handbooks, "regular" textbooks, self-made notes, mnemonics and mind maps. It was surprising how long the effect lasted -- my in-service exams scores during the internal medicine residency were 98, 96, 98 during PGY 1, 2 and 3 respectively, and I did not need to study more than 2 weeks to pass ABIM.

Scores are nothing without sound clinical judgment, of course. OHCM was the handbook that I found most useful and reader-friendly. It goes beyond being simply a medical handbook, for a start, it often reminds you that patients are much more than "strokes" or "pneumonias" and there is more to life than medicine. The section Thinking About Medicine -- Your Inner Peace on ClinicalCases.org is named after the first chapter of OHCM -- you can browse through the book on Google Books or download the chapter for free from Oxford University Press here:

Chapter 1: Thinking about Medicine (PDF, 464 KB)

It is nice to see that OHCM now even has an iPhone edition ($44.95).

Mini Oxford handbook of clinical medicine By Murray Longmore, Ian Wilkinson, Supraj R. Rajagopalan from Google Books:



References:
Skyscape books for iPhone. Skyscape.com, 08/2007.
How to Score Well on the Boards? Clinical Notes, 2004.
How to Study, Clinical Cases and Images - Blog, 2007.
Image source: UnboundMedicine.com.

Updated: 08/21/2009

Saturday, August 25, 2007

Fatherhood in the balance

I have to admit that I scoff at fatherhood initiatives. While the PR people might tell dads to buck up and take time for the kid, his work place tells a different story. Well, except that dads are the great winners in the wage gap war. Anywho, another celebrity became a daddy this week - Tom Brady.

The whole world seemed to know that his ex-girlfriend and baby mama was about to give birth. It was reported that Brady asked for some time off to be at the birth (which he missed by minutes) as well as afterwards to be with his child. I cant' find any reports if he's taking paternity leave, but he was back in the game for a pre-season game on Friday. Thus, one of the biggest names in professional sports can't even get a week off to be with his new baby? What kind of message does that send to all the dads & young men watching the game?

In a different show of fatherhood responsibilities, Tony Snow, White House spokesman, has quit his $168,000 job because it's not covering all the bills. Um, yeah...I snorted too when I first read that. Somehow I doubt it's medical bills because, well, unlike millions of Americans, he has health insurance. College tuition? I bet most of the parents of the students I work with don't make that much. Sure, Snow's gonna go back to spewing on the TV for bucks, which I'd do in a second if offered. But come on...at least give us a better reason! One that doesn't make us look at our tiny bank accounts and think, "Dude!" OTOH, maybe by spewing on TV, Snow will have more time to spend with his family.

Ah, celebrity fatherhood.

Technorati tags: Tony Snow, Tom Brady, football, NFL, fatherhood, family leave

Deadly effect of experimental treatment and rules of research conduct

The Washington Post and the WSJ Health Blog comment on the deadly effect of an experimental treatment for arthritis and the breach of guidelines for clinical trials:

"Two fundamental rules of clinical research were violated that day, experts said.

First, (the informed) consent forms are to be taken home and considered, not signed on first sight.

Second, when a patient's own doctor is a principal investigator in a study, someone else is supposed to make the proposal."

Update 11/26/2007:
The following investigation found no evidence the experimental drug caused the death of the patient described above and the clinical trial is set to resume.

References:
Death Points to Risks in Research. Washington Post, 08/2007.
Hope Trumped Skepticism as Patient Mulled Study Risk. WSJ Health Blog, 08/2007.
Gene Therapy Study to Resume After Patient Death. WSJ Health Blog, 11/2007.
Image source: OpenClipArt.org, public domain.

Related:


Informed Consent. Family Medicine Notes, 03/2008.

Updated: 03/31/2008

Friday, August 24, 2007

Impressions of Mayo Clinic Libraries

David Rothman shares his experience with visiting the medical libraries of the esteemed Mayo Clinic:

"As Melissa took me on a tour of Mayo’s many excellent libraries (this took hours and we still didn’t get to a couple of them), I found myself constantly impressed by Mayo’s art and architecture."

David links to some interesting publications by one of the Mayo Clinic librarians:

If you feed them, they will come: A prospective study of the effects of complimentary food on attendance and physician attitudes at medical grand rounds at an academic medical center.
Segovis CM, Mueller PS, Rethlefsen ML, Larusso NF, Litin SC, Tefferi A, Habermann TM.
BMC Med Educ. 2007 Jul 12;7(1):22.

Cool tools: Google, RSS, Podcasts, oh my!
Rethlefsen ML, Segovis CM.
Minn Med. 2006 Nov;89(11):32-6.

According to David, "the Mayo School of Medicine accepts only 42 students per year, so students there tend to be particularly brilliant."

It looks like Cleveland Clinic Lerner College of Medicine of CWRU follows the Mayo medical school footsteps by educating small classes of physician-scientists who graduate with a combined MD/PhD degree. I am happy to be on faculty at the Clinic medical school and have been impressed by the research interest of the students. Just last week, I discussed the groundbreaking glioblastoma multiforme research which one of them was planning and the possibilities the mind maps tools like Bubbl.us offer to visualize the process.

References:
Visit to the Mayo Clinic, 7/18/2007. DavidRothman.net.
Becoming a Clinical Assistant Professor of Medicine and Web 2.0 Projects, Clinical Cases and Images - Blog, 10/2006.

Thursday, August 23, 2007

Practical advice on prostate examination

Tundra PA summarizes a few practical points on prostate examination:

"When I told Dr. H. about the physical exam and my concern that I had felt a nodule in Evan’s prostate, he held out his arm with the wrist extended. Pressing the bony prominence just distal to the radial pulse, he said “prostate nodule.” Pressing the large muscle at the base of the thumb, he said “normal prostate.” Pressing the space on the back of his hand between thumb and forefinger, he said “boggy prostate.”

Update 09/03/2007:
Tundra PA has a follow-up of the story.

References:
A PSA Story. Tundra Medicine Dreams, 08/2007.
Cancer: Digital Rectal Examination for Prostate Problems. WebMD.
Image source: Wikipedia, public domain.

Related:
Prostate Cancer with Bone Metastases and PSA of 900
3 New Diagnoses This Year

Wednesday, August 22, 2007

Embeddable Maps by Google - As Easy as YouTube

This is where I go to work every weekday and many weekends -- one of the best hospitals in the world -- Cleveland Clinic:


View Larger Map

From Google Maps blog:

"Today we're excited to announce a new feature on Google Maps that allows you to add maps to your blog or website just by copying and pasting a snippet of HTML. And once you embed the map, it has all the same functionality of the Google Maps you know and love; it's clickable, draggable, and zoomable.

Adding a map to your website or blog is now as easy as embedding a YouTube video. No programming skills are required, and there's no need to sign up for a Maps API key."

And this is not all -- Google turns Google Earth into a telescope.

References:
YouTube-style Embeddable Maps. Google LatLong Blog.
Sky: The final frontier. Google LatLong Blog.
Google turns Google Earth into a telescope. Googling Google.

WSJ Blog: How I treat high cholesterol in rural Illinois?

Ben Brewer, a family doctor in rural Illinois, tries to get LDL to 100 or lower. For patients with heart disease or diabetes he tries to get it to 70.

He uses generic statins like simvastatin which his patients can afford.

More questions are answered in Dr. Brewer's forum at WSJ.com.

References:
A Family Doc Asks Three Questions About Cholesterol Drugs. Jacob Goldstein, WSJ Health Blog, 07/2007.

Related:
A 33-year-old man has a low HDL level. Should you treat him? Clinical Cases and Images.
Pfizer Discontinues Drug Which Increases HDL Due to Higher Death Rate. CasesBlog, 12/03/2006.
Health: Nothing but a number: Lifestyle changes to control cholesterol. Dr. Sidney Gottlieb, Cleveland Clinic Canada, National Post, 01/2008.
Image source: Cholesterol. Wikipedia (public domain).

Updated: 01/31/2008

Monday, August 20, 2007

Weekly Dermatology Podcast

Dermatology Weekly Update is weekly podcast of the latest research and news in dermatology.

It looks interesting but there is no word on who the authors are, so use it at your own risk. Most web sites should have at least 2 mandatory sections:

- About us
- Contact us

With the latest update of Google Reader, you can play podcasts directly from the application. Alternatively, click the "pop-out" link to detach the podcast player so that you can browse the rest of the feeds while listening.

Link via Medical Lecturer.
Image source: Dermatology Weekly Update.

Vote on Global Health





Voting ends at midnight on August 25th.

Technorati tags: blogheract, health

Sunday, August 19, 2007

Medicare Will Not Pay for Hospital Errors -- How Do You Define a Hospital Error?

According to KidneyNotes:

"Look for the definition of an "error" to be expanded dramatically... Central line infection? C. difficile colitis? Ventilator associated pneumonia?"

The initial six conditions on the Medicare list are:
  1. pressure ulcers
  2. catheter-associated urinary tract infections
  3. Staphylococcus aureus (shown above) septicemia
  4. air embolism
  5. blood incompatibility
  6. object left behind in surgical patient
Number 2 and 3 are hospital-acquired infections and numbers 4-6 were to be called "never events." Besides those on the list for 2008, seven more conditions are under consideration for 2009, according to AMNews.

Further reading:
Medicare Says It Won’t Cover ‘Preventable’ Hospital Errors. NYTimes, 08/2007.
Medicare plans to stop paying for 6 hospital-acquired conditions. AMNews staff, June 18, 2007.
Medicare No Longer Willing to Pay Hospitals for Preventable Medical Errors. MSSPNexus Blog, 08/2007.
Medicare won’t pay for mistakes? Notes from Dr. RW, 08/2007.
An Inexact Science. Musings of a Dinosaur, 08/2008.
Preventable medical errors, from Wikipedia, the free encyclopedia.
Let Me Sprinkle Some Fairy Dust On My Patient. The Happy Hospitalist, 01/2008.
Image source: Wikipedia, CDC.

Updated: 01/15/2008

Saturday, August 18, 2007

Using Blog Software to Create a "Regular" Website

Web blog software can be used for more than writing blogs. The current blog platforms are suitable for creating and maintaining a "regular" web site, i.e. a site which is not a blog (with entries arranged in a reversed chronological order). I have adapted the free Blogger.com by Google to create 4 such web sites:
BloggingPro.com has a nice summary on using the WordPress server installation (not the free WordPress.com version) as a content management system (CMS) rivaling Drupal: Feature: 5 Reasons to Use WordPress as CMS.


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

References:
What I Learned from Making the Website of the Cleveland Clinic Hospitalists, 8/11/2006.
Using Web Services to Enhance a Medical Education Course, 2/20/2007.
Using a Blog to Build an Educational Portfolio, 1/15/2007.
Tips for New Bloggers: Sticky Posts in Blogger, 08/20/2007.

Updated: 08/20/2007

Friday, August 17, 2007

Elvis Presley's personal physician

According to Wikipedia:

George Nichopoulos, also known as "Dr. Nick," was Elvis Presley's personal physician. He began treating Elvis in 1967, and took it on as a full time job in 1970 until Elvis' death in 1977.

In 1977 alone, Dr. Nick had prescribed 10,000 doses of amphetamines, barbiturates, narcotics, tranquilizers, sleeping pills, and laxatives for Presley. He says he did it because he 'cared'

Blood tests showed traces of 14 different drugs in Elvis's body at the time of his death.

In 1995 Nichopoulos had his license permanently suspended by the Tennessee Board of Medical Examiners, after it was revealed that he had been over prescribing to numerous patients for years.

After he was stripped of his credentials in 1995, Dr Nick took a job evaluating medical insurance claims by FedEx employees, where he still works today, paying off his many legal bills.

References:
Doctor Feelgood. The Observer, Sunday, August 11, 2002.
Rock Idol Elvis Presley Dies at 42. Washington Post, Thursday, August 17, 1977.
Image source: Dr.Nick - ο έλληνας γιατρός του Ελβις.

Flickr Images...


Yeah, right.

Source: Xanboozled, a Creative Commons license.

Where are????

A few years ago the big question was where are the women bloggers. And honestly, we still ask that, especially in niche communities and the lack of women A-list bloggers.

I just finished listening to a great podcast by Motherhood Uncensored about blogging parents of color. The whole piece is about parents, mostly mothers, of color, where are they, who are they, and why the hell marketers aren't throwing freebies at our feet?

Thankfully I've been hooked into a few marketing networks and I feel like I'm getting enough freebies to review, at least as many as I can handle. But seriously, I'm not flooded with requests. Since Blogher I've found many a mommy blog that seem to be nothing but product reviews! Oh, my, goddess, but some bloggers are swimming in free shit.

But back to the real topic. When I do think about the other mommy bloggers I read, they are mostly not women of color. Does it matter? I'd say yes. Why? Because I see more and more that race is playing a part of our parenting decisions as our daughter gets older. I've thought and had others remark that we should be 'good' when applying to schools this fall since we get to check the "hispanic" box. Then again, the school we really want her to attend is pretty well full of Latin@s. Our last names give it away as well, so no use in not checking the box either!

I have more thoughts, but I think I'll work on them a bit more. Just wanted to let you all know about this podcast and my initial thoughts.

Technorati tags: mother, blogging, race, bloggers of color

Annals of Internal Medicine Launches Podcast and Audio Summaries

The Annals of Internal Medicine is the latest member of the "Big Five" of general medical journals to launch a podcast. The other four -- NEJM, JAMA, BJM and Lancet -- have been experimenting with portable audio for a while now. Click below to see the coverage of their podcasts on this blog over time:

1. NEJM, 11/2005.
Feed: http://podcast.nejm.org/nejm_audio_summaries.xml

2. Lancet, 4/2006.
Feed: http://podcast.thelancet.com/lancet.xml

3. JAMA, 4/2006.
Feed: http://jama.ama-assn.org/misc/jamapodcasts2006.rss

4. BMJ, 9/2006 (the podcast is not active now).

5. Annals, 7/2007.
Feed: http://media.acponline.org/feeds/annals.xml

Podcasts and text-to-speech programs to convert text to MP3 files can be beneficial to medical education. For example, the podcast/videocast coverage of the 2006 meeting of ACAAI is lively, comprehensive and summarizes most new developments if the field.

Most people subscribe to medical podcasts by using iTunes/iPod/iPhone from Apple. A lesser known fact is that Google Reader can be used as a podcast program as well.

Click here to subscribe to all 4 journal podcasts in your iGoogle homepage.

References:
Stop Going to Conferences for the Lectures. Listen to Podcasts Instead. Efficient MD, 06/2007.
Image source: Annals of Internal Medicine.

Updated: 08/18/2007

Thursday, August 16, 2007

PubMed Suprise: A Researcher with 600 Co-Authors on a Single Article



It is somewhat striking to see a list of several PubMed articles with roughly 600 co-authors under each of them. ScienceRoll suspected that the first author (Aubert B.) must have a lot of friends and asked for an explanation. Here it is.

The last name in the author list is "BABAR Collaboration." A Google search shows that "BABAR is a High Energy Physics experiment located at the Stanford Linear Accelerator Center, near Stanford University, in California. The goal of the experiment is to study the violation of charge and parity (CP) symmetry in the decays of B mesons." According to Wikipedia, a meson is a strongly interacting boson, that is, it is a hadron with integral spin. I hope this makes it clearer :)

The BABAR Collaboration consists of approximately 600 physicists and engineers from 75 institutions in 10 countries. This can probably explain the 600 co-authors.

Related reading:

BaBar experiment from Wikipedia, the free encyclopedia.
500 authors of Grand Rounds 
The "BIG 1-98" randomised clinical trial really is big: 885 authors are listed on this Lancet article http://goo.gl/lKEfw via @JRBtrip

Wednesday, August 15, 2007

Working near a laser printer = Second hand smoking?

Digital Inspiration links to an Australian study which claims that some laser printers release large amounts of small particles in the air which can potentially have adverse long-term health effects:

"If your cubicle is located somewhere near the common office printer, either ask the support staff to move the printer elsewhere or you shift your desk to a different place in the office as in the current setup, the air around you may be highly polluted."

More research is needed before a final recommendation can be made, as usual, but the study results could be something to have in mind. Printing less, potentially saves trees and keeps the air clean. You can save electronic texts online in Yahoo MyWeb, GMail, Google Notebook or any other service you prefer.

References:
Laser Printers in Office Turn Employees into Passive Smokers. Digital Inspiration, 7/2007.
Image source: Wikipedia, GNU Free Documentation License.

Tuesday, August 14, 2007

When the lioness finally rears her head

A recent 'discussion' over homelessness on this site has gripped me like a tick. It won't let go. Not that I'm not reminded of homelessness every day when I pass the McDonald's on Ashland & Fullerton (?) or after work at the expressway ramp. But the homeless population I never see are the families and there's a good reason for that.


According to the report, "Family Homelessness in Our Nation: A Problem with a Solution", by the National Alliance to End Homelessness, families are the hidden homeless population. This is why the city of Chicago's recent 'survey' of homeless is a load of poopy diapers.Add to that, news from the Sun-Times that the Guv, G-Rod, considers homeless shelters 'pork'.

In their report, the National Alliance used Washington, DC, our wonderful nation's capital, as the example, but then also reports state and national data points. Here are some highlights to ponder:

  • 30% of children in the foster care system have a homeless or unstably housed parent;
  • A housing subsidy, at a cost of $6,805 per year, is a significantly more cost effective way of dealing with lack of housing than placing children in foster care at approximately $17,000 per year;
  • 5 million families receive federal assistance to pay for housing, but there are at least twice that many families eligible for such subsidies that do not receive them because of lack of funding;
  • In 1971 there were 300,000 more affordable units than there were low-income families who needed them;
  • In 2001 there were 4.7 million fewer units than families;
Abuse in the home is one reason families become homeless. Despite what naysayers may say, abuse is a very complex cycle to break. Mostly because those being abused are often broken of their will and separated from loved ones. One brave mama tells her story:

I left after a 'minor' beating, meaning no skin breaking/bleeding,and no kicking. He 'just' pushed me into a wall, smacked me really hard several times and knocked me down. This was in response to him coming home and finding me on the phone. He had recently stopped taking the phone with him when he left and allowed me to use the phone again, so I thought it was ok to use the phone when he was gone. I was wrong in that belief and I paid for it that day.


I say this was a minor beating because prior to this much worse had occurred. I had been thrown down a flight of stairs and lost a baby, I had my head banged on the sidewalk leaving me with multiple fractures to my skull, and I had been held hostage, duct-taped, and threatened with a hatchet in front of our child. So why was the 'minor' beating the trigger for me to leave? One reason is it was the proverbial straw that broke the camel's back.


A bigger reason was my daughter I-bop's response. Usually after he beat me he would storm out. I would cry and she, age 3 at the time, would rush to console me, hugging me and patting my face. I lived for those moments of kind touch from someone and felt my daughter was the only person who cared for me in the world. This time she looked at me sobbing and shook her head, and turned away. She actually turned her back on me, hunched her shoulders, and started playing with her toys. Her whole body language conveyed, You are a sorry woman and you get no more pity from me. It was like being doused with cold water. I saw clearly for the first time how it all was negatively affecting her. The hunched shoulders were a clear sign because that was how she was whenever he was around; all hunched over and afraid. It occurred to me that my child was also afraid of...me. and I understood why she would be, because she saw, at 3 years old, that she couldn't depend on me or trust me to keep her safe. She saw that I couldn't even keep my own self safe. I saw clearly for the first time that my child deserved better. My child deserved a chance.

Read the rest.


How fragile is the support system for families? So fragile that word got out that the only shelter for families in Massachusetts had burned down and the blogosphere was a fire with outrage. It wasn't, but it was the only one for a certain population.


Women are keenly aware, even if we live in a state of denial, that we are often living on the edge of poverty. Whether due to losing our job, getting so sick we can't work, losing our partner due to divorce or death, we just know. I have a good paying job, but I couldn't afford to stay here if my partner died (insurance will help). In today's tight economic reality, even couples are one paycheck or accident away from poverty.


Homeless moms and dads are a part of this community. To say that they don't deserve our help or respect is to deny that it could ever happen to us. We who are hard working. We who are highly educated. We who would never chose to be homeless.


As mothers we are even more aware that sacrifice ourselves on a daily basis for our kids. Whether we stay up a few extra hours to get laundry done, bake that last batch of cookies, or skip out on that much needed massage because well, someone needs to cuddle, we sacrifice. We want the best for our kids and society tells us that means two parents and a nice home. Why would we leave that?


I have a friend whose mother chose to be homeless instead of staying with someone who abused her and the kids. And for that, I thank her, because she saved three kids and herself. I thank the shelter who helped them get on their feet. But I hate to think that if she had to make that decision today, my friend and her brothers might be very different people.


X-posted from The Red Thread at Chicago Parent

Technorati tags: homeless, feminism, family

Blogging, Microblogging and Facebook

Steve Rubel of MicroPersuasion comments on a recent trend -- he blogs less and spends more time on Twitter ("microblogging" in 140 characters or less) and Facebook.

It seems like the "influentials" in the tech blogging world are also moving in the same direction. Has the blogging peaked or has it just become relatively more mainstream?

Among medical bloggers, Joshua Schwimmer also uses Twitter and has transformed KidneyNotes into a collection of selected links. He writes 2 other blogs -- Tech Medicine and EfficientMD, and has a profile on LinkedIn.

It will be interesting to see how microblogging (Twitter) and social networking (Facebook) will shape the future of medical blogging as we know it.

References:
When Less is More and More is Less. Micro Persuasion, 07/2007.
Newbies Guide to Twitter. ChrisBrogan.com, 08/2007.
Identity Through Online Lifestreams. Micro Persuasion, 08/2007.
Image source: Twitter.com.

Monday, August 13, 2007

Would you like to see Dr. Google or Dr. Microsoft for your personal health records?

According to the New York Times:

Microsoft’s software powers more than 90 percent of all personal computers, while Google is the default starting point for most health searches. People are increasingly turning to the Web for health information and advice. A Harris poll found that 52 percent of adults go to the Web for health information, up from 29 percent in 2001.

"Today, only about 20 percent of the nation’s patient population have computerized records. Under federal law, people can request and receive their personal health data within 90 days. But the process is complicated, and the replies typically come on paper, as photocopies or faxes."


Adam Bosworth talks about GoogleHealth. Image source: AlphachimpStudio, a Creative Commons license.

More or less, the current equation is as follows:

Microsoft = personal computer
Google = Internet

Both Google and Microsoft are reportedly preparing products aiming at the potentially huge market of personal health records.


A screenshot of Google Health. Image source: Philipp Lenssen, a Creative Commons license.

Microsoft’s offering is scheduled to be announced this fall, while Google’s will probably be introduced next year. The launch of new software products frequently faces multiple delays and missed deadlines -- Windows Vista is a good example. Most likely, "Dr. Google" or "Dr. Microsoft" will not be available to see you before 2008-2009.

Update 10/06/2007:
Microsoft launches an online personal health record portal called HealthVault.com.

References:
Dr. Google and Dr. Microsoft. NYTimes.
Google Health Prototype. Google Operating System.
First Google Health Screenshots. Philipp Lenssen.
Who's your patients' best friend? Google!
Google Finds Correct Diagnosis in 58 % of Cases Published in NEJM
Google, M.D. In Action
Google, M.D. In Action - Part II
"Google, M.D." at the Clinic
Image source: Doctors Using Google by Philipp Lenssen, used with permission.

Related:
Microsoft HealthVault and Google Health - The 'Coke and Pepsi' of Online Health (PHR). ReadWriteWeb, 10/2008.
Google now wants to diagnose your disease, offers differential diagnosis based on 10 sites and Wikipedia http://goo.gl/SD1qM

Birth Control Ninja

The last week was crazy at my house, but things worked out fine and I was able to meet a friend (who moved to the burbs, traitor) Saturday night for The Second City's Girls' Night Out: Touched Up at the Metropolis in Arlington Heights. First, I love Second City. I rarely see improv if my friend from Brooklyn, who is an improv junkie, isn't in town. Second, I met my friend while we were serving on the board of the Chicago chapter of NOW many moons ago. Thus, you have the expectations set. Funny and Feminist. Yes, we are too both!

The audience was 90-95% women, but letmetellya, it was not a man bashing show at all. In fact, I'd say that it was pretty harsh on us gals, so guys, feel free to join your partner at this show. BUT, women, this show was pretty funny and well, the title says "girls night out" and I do believe in following directions.

My favorite skits included a marriage therapy session where the wife tells a story, the husband recounts it, and well all know he isn't really "listening" to her. It goes on and on until a fairly good punch line. But honestly, the best punch line came 10 seconds after we stopped clapping when a woman in front of me asked, "Are we really like that?" Um, yes.

Claudia Michelle Wallace sings an outstanding love song to Barak Obama. Sorry, I didn't take notes, but I remember that I didn't stop laughing.

There was also the skit where the one man in the show talks to his fellow white hetero males aka Republicans (that's what he said, not me!) about voting for Hillary. Yes, Hillary. Why? Because if she wins, us chicks can stop whining about discrimination. Kinda like when people say the country is color-blind because Condi Rice is so powerful. Um, yeah...

The worst skit had to be the pseudo-lesbian aka really drunk hetero BFFs deciding to have sex. It winds its way to a breast cancer scare! Sorry to spoil it, but come on, breast cancer? So wrong on many levels, including having the audience sit far too long in silence before a really bad punchline.

Overall it was a good show and worth the drive out and back. I guess if the suburbanites can drive to North & Wells, I can drive to AH. And you'll have to see the show to figure out the title of this post. Or buy me a martini.

GNO runs August 2 - September 1, 2007 and tickets are $25. Shows are on Thursdays 7:30 p.m., Fridays 8 p.m., Saturdays 7 p.m. Grab your tickets here.

Technorati tags: Second City, Improv, Arlington Heights, Girls Night Out, comedy, feminism

U.S. Life Expectancy Shorter Than 41 Countries

According to the National Center for Health Statistics, the life expectancy in the U.S. is shorter than 41 countries including most of Europe and Japan.

Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation, comments that "something's wrong here when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries."

What are the likely causes?

- High prevalence of obesity in the U.S.
- Racial disparities
- Relatively high infant mortality rate
- 45 million Americans lack health insurance

The life expectancy ranges from 82.6 years in Japan to 39.2 years in Swaziland - see the map. Many of the countries with the lowest life expectancies, e.g. Swaziland, Botswana, Lesotho, Zimbabwe, Zambia, Mozambique, South Africa, Central African Republic, and Namibia, are suffering from very high rates of HIV/AIDS infection, with adult prevalence rates ranging from 10 to 38 percent (source: Wikipedia).


Life Expectancy Falls In Pockets of U.S. WSJ Health Blog. In the the animation, greener equals longer life expectancy.

References:
A color-coded map of the world’s most and least emotional countries http://bit.ly/Ytxx6B
U.S. life span shorter. Associated Press, 08/2007.
List of countries by life expectancy, from Wikipedia, the free encyclopedia.
World’s Best Medical Care? NYTimes, 08/2007.
U.S. life expectancy lags behind other countries'. CNN.
Image source: Wikipedia, GNU Free Documentation License.
How low can you go? Megan McArdle, 08/2007.
Life Expectancy Falls In Pockets of U.S. WSJ Health Blog, 04/2008.

Should mesalamine be stopped prior to noncardiac surgery to avoid bleeding complications?

A 53-year-old Caucasian male with a past medical history of Crohn's disease, hypertension, hypercholesterolemia, osteoarthritis and atrial fibrillation takes mesalamine (Asacol) to control his diarrhea. His other medications include atenolol, warfarin and simvastatin. He also takes oxycodone and acetaminophen prn for hip pain. The physical examination is normal apart from irregularly irregular cardiac rhythm. The electrocardiogram shows atrial fibrillation with heart rate of 67 beats per minute. His exercise tolerance corresponds to 6 METs.

The patient is seen by an internal medicine physician for preoperative evaluation one week prior to surgery for total knee replacement for osteoarthritis of the left hip.

The patient inquires whether she should stop mesalamine to avoid bleeding complications during surgery. His primary care physician told him that non-steroidal anti-inflammatory drugs (NSAIDs) may increase the bleeding risk.

Should we stop mesalamine to avoid bleeding complications during surgery?

No.

Mesalamine (Asacol) does not affect platelets the same way aspirin and other NSAIDs do.

According to one study, there was not effect on platelet aggregation during normal treatment with 5-aminosalicylic acid when given at a dose of 1.5 gm po qd or even after IV administration. All in vivo and in vitro tests were negative for inhibition of platelet aggregation in contrast to the inhibition seen with aspirin (acetylsalicylic acid). Authors concluded that treatment with mesalazine does not constitute a hazard to patients with IBD in regard to prolonged bleeding time caused by an influence on platelet aggregation or fibrinolytic activity.

This is one of the series of perioperative questions I will answer on this web site. They will be submitted as clinical vignettes to the Cleveland Clinic Annual Perioperative Summit next year. This year's summit is in September and several of the perioperative cases in nephrology will be presented as posters and published as abstracts in the Cleveland Clinic Journal of Medicine.

References:
Lack of effect of 5-aminosalicylic acid on platelet aggregation and fibrinolytic activity in vivo and in vitro. Winther K, Bondesen S, Hansen SH, Hvidberg EF. Eur J Clin Pharmacol. 1987;33(4):419-22.
Image source: Wikipedia, Free Documentation License.

Updated: 12/14/2009

Sunday, August 12, 2007

Medical University of South Carolina Launches a Comprehensive Podcast/Videocast Portal

Medical University of South Carolina (MUSC) Health Podcast portal features both audio and video podcasts:

"Our audio podcasts are hosted by various MUSC faculty, physicians and special guests. These podcasts cover a wide range of current health topics, featuring MUSC patients, physicians, and staff. Listen to patient stories, learn about new procedures being offered at MUSC, and hear the latest news on how to stay healthy."

Cleveland Clinic also offers Free Audio and Video Podcasts for Health Professionals and patients.

Link via Medical Lecturer.

Saturday, August 11, 2007

Thursday, August 9, 2007

6 Tips on Staying Up-to-Date in Genetics (and Any Specialty)

Bertalan Meskó of ScienceRoll.com shares 6 tips on staying up-to-date in genetics but they apply to most specialties in medicine and science.

The 6 tips are:

1. Follow the most reliable genetic sites
2. Follow the best genetic blogs
3. Use RSS web feed and follow the genetic journals
4. Use services/tools like UpToDate
5. Follow the blog carnivals
6. Follow the genetic wikis

I would add a few more suggestions:

1. Subscribe to Google News alerts in your field of interest via web feeds.
2. Subscribe to podcasts in your specialty. See our IAMSE abstract on the topic.
3. Use text-to-speech to listen to journal articles. See our IAMSE abstract on the topic.
4. Create an iGoogle page as your own "super journal" powered by web feeds. See our IAMSE abstract on the topic.
5. Search YouTube, VideoJug for related videos.
6. Listen to conferences podcasts/videocasts.
7. Start a blog as an educational portfolio to record your thoughts.
8. Use Google Bookmarks to save interesting articles you find online.

References:
7 Tips: How to be up-to-date in genetics/genomics? ScienceRoll, 2007.
Interesting Ideas from 11th Annual Meeting of IAMSE. Clinical Cases and Images - Blog, 2007.
Using a Blog to Build an Educational Portfolio. Clinical Cases and Images - Blog, 2007.
15 Steps to Cultivate Lifelong Learning. LifeHack.org, 07/2007.
Video presentations: Novel concepts and easy-to-use web tools for researchers. European Molecular Biology Laboratory, 2006.

"Change of Shift" Blog Carnival - Nursing Grand Rounds

The latest edition of Change of Shift: A Nursing Blog Carnival is up.

The carnival is "a place for nurses and other members of the health care team, including students and patients to send their nurse related stories and ideas."

Image source: Emergiblog

Wednesday, August 8, 2007

A Web 2.0 Review in the Medical Journal of Australia Mentions This Web Site

David Rothman links to a comprehensive review of the use of different Web 2.0 tools in medicine in the Medical Journal of Australia: The effect of Web 2.0 on the future of medical practice and education: Darwikinian evolution or folksonomic revolution?

In the section about blogs, the authors mention this web site along with Dean Guistini’s UBC Academic Search — Google Scholar Blog, David's blog, and ScienceRoll.

The article provides a good overview of most of the basics of what I call the 6 axes of medical education in Web 2.0 style:
  1. Web feeds (RSS)
  2. Podcasts
  3. Blogs
  4. Wikis
  5. Custom search engines
  6. Second Life virtual world
Unfortunately, the review failed to mention AskDrWiki which is, in my opinion at least, one of the best medical wikis providing high-quality and unique content. AskDrWiki features more than 140 coronary angiogram videos from the number one heart center in America for 13 years in a row -- Cleveland Clinic.

Such omissions can be fixed in the future by using an approach similar to the newly-launched Google News comments -- if you are included in a news story and you want to clarify a point, comments can be added directly to the news report.


My presentation on Web 2.0 in Medicine from December 2006.

References:
The effect of Web 2.0 on the future of medical practice and education: Darwikinian evolution or folksonomic revolution? Rick McLean, Brian H Richards and Janet I Wardman. MJA 2007; 187 (3): 174-177.
MedLib Blogs (including this one) in the Medical Journal of Australia. DavidRothman.net, 08/08/2007.
Google News Adds (Special) Comments. Google Blogoscoped, 08/08/2007.