Wednesday, April 30, 2008

Hospitalist News by Elsevier Launches, Editorial Board Includes Founder of Clinical Cases and Images

Hospitalist News is an independent monthly newspaper for specialists in hospital-based medicine produced by the publishers of Internal Medicine News:

http://www.ehospitalistnews.com

"Articles are written by professional journalists who attend hundreds of medical meetings each year, monitor the deliberations of the Food and Drug Administration advisory committees, and talk with the thought-leaders in patient care."

Frank Michota, the founder of the Section (now Department) of Hospital Medicine at Cleveland Clinic, is the Editor-in-Chief of Hospitalist News.

Two former members of the Department are on the Editorial Advisory Board:

Daniel Brotman, director of the hospitalist program at Johns Hopkins Hospital in Baltimore, and Amir Jaffer, service chief, medicine, at the University of Miami Hospital and division chief of hospital medicine at the University of Miami.

Dr. Jaffer and Dr. Michota are also the founders of the annual Perioperative Summit at Cleveland Clinic.

I am honored to be on the editorial board of Hospitalist News among such prominent members of the academic hospitalist community.

References:
Meet the Editorial Advisory Board of Hospitalist News, Hospitalist News, Volume 1, Issue 1, Page 5 (April 2008).
Welcome to Hospitalist News. Hospitalist News, Volume 1, Issue 1, Page 5 (April 2008).
What I Learned from Making the Website of the Cleveland Clinic Hospitalists, 8/11/2006.

Tuesday, April 29, 2008

Doctors crying with patients: Appropriate bedside manner?

Doctors are only human, nothing more and nothing less. The NY Times published a piece about physicians crying at the bedside: At Bedside, Stay Stoic or Display Emotions? and Dr. Centor of DB’s Medical Rants wrote an interesting comment on the article:

"As I consider my career, I do not remember crying at the bedside. Does that make me cold? Which behavior is more appropriate?

Delivering bad news is painful. Before each session I prepare myself using a self visualization technique. I have learned over the years the art of these conversations. Each one drains me both because I empathize and I care. However, crying would detract from my ability to do the complete job of helping the patient.

Perhaps men, and men of my generation are better at compartmentalizing. Perhaps our maturation process included not openly crying.

I think about my patients. I do care. Displaying raw emotion does not work for me.

If I let me emotions take over, then I believe my effectiveness will diminish."

Some patients prefer their doctors to have a "warm and fuzzy" personality while others opt for a doctor with a more technical approach -- "just fix the problem." Luckily for all, there are physicians to represent both ends of the spectrum and in between.

References:
At Bedside, Stay Stoic or Display Emotions?. NYTimes.
Appropriate bedside manner. DB’s Medical Rants.
Image source: Shaylor's photostream, Creative Commons license. The image is not related and does not show the patient.

Monday, April 28, 2008

This Latina is still a feminist

As a woman of color I've always occupied an awkward place in this large movement called feminism. Yet at the same time, I've always occupied an awkward place in life itself. Friends & long time readers know that in high school, my academic track was made up of 95% Caucasian students and the 5% of us who weren't were rarely in each other's classes. And perhaps that is why my feminism was created in a place where race was an issue, but not the focus either.

I will always claim to be born a feminist. I can't remember a click moment and always had this intrinsic knowledge that being a girl did not mean that I had to sit on the sidelines. Any discrimination I felt growing up centered around being a girl or being working class. In my world it was mostly a gender & class thing to fight against. When my feminist consciousness was being formed in high school, I was leading our Amnesty International chapter. Women's rights was about human rights. Black, white, Latina, Chinese, whatever...it was all the same in my head. That's not to say that I didn't acknowledge racism in the world and around me...It just never seemed to be that racism was holding me back. Being placed in a lower math class in 7th grade? Sexism. Having to drop out of Model UN? Classism. Perhaps I enjoyed being the only Latina in my circle of classmates too much to notice the racism? When we picked a name for our Rube Goldberg team we went with something about a bunch of Asians, Caucasians, and then there was Vern. Vern was my high school nickname. Enter college at a very diverse campus and where women's studies was taught from a global perspective. We really did the whole "Think Global, Act Local" thing in terms of feminism.

So watching the implosion of feminism online with the two Marcotte fiascos, the two Seal Press debacles, and the blog-icides (can't recall which blog I read that term on) is totally heartbreaking to me. But what is most heartbreaking and heart wrenching is the dismissal of feminism by women of color.

After college and I entered the real world and got a job (in a feminist office) and starting volunteering off-campus with feminist groups, that's when the racism shit started to fly. So I've been there. Been the token who works her ass off and gets shafted in the end. Was accused to stealing a speaking engagement when the group specifically asked for me. La-de-da, Ms. JD.

So what keeps me coming back to feminism?

It's my home. Despite its flaws, calling myself a feminist is the truth. Each movement has its own devils to wrestle with - but that is an individual thing. Feminism the philosophy, transcends the bullshit and comforts me. And I refuse to let racism define feminism for me.

I refuse to be run out of the movement.
I refuse to let racists have total access to the soapbox, even if their soapboxes are larger, cooler, and get more ears.
I refuse to be silenced.

That said, the attacks on my fellow WOC bloggers have gone so ugly that I do not begrudge them from taking a break. I do not hate them for throwing off the feminist cape. To each their own. I just know that it's tad bit lonelier here than a few weeks ago.

I am thankful for my anti-racist friends who see the issues and have my back. Allies are essential to this movement.

Bottomline...I think that feminism will save the world. No other movement can hold racists and hyper-masculinists (is there a better term for that?) accountable at the same time. No other movement can look at the crap that we're getting in the Democratic primary and tsk BOTH sides equally.

And honestly...if I left feminism, I don't know how I would survive, where I could go, because seriously, feminism frames almost everything in my life. I do not see the world thru a feminist or gender lens, I see it thru a feminist eye implant. It's there and can't be removed.

Technorati tags: feminism, racism, classism, WOC, women of color

Work it, Mom! Monday!

This week's post deals with just two ways to get ready to reenter the work force.

The basis for tome’s like Linda Hirshmans Get To Work and Lisa Bennett’s Feminine Mistake may appear to be nothing more than telling women what to do but if you can ignore the horrible presentation, the real issue is that Hirshman, Bennett and others are seriously tired of seeing women make up the majority of those living in poverty. Not just making up a large percentage, but that women end up there because we take time out of work to care for our family members.

* Women comprise 56% of Americans over 18 who live in poverty. [cite]
* In 2004, 28.4 percent of households headed by single women were poor. [cite]
* Nearly two-thirds of white women who are poor in old age have not been poor in the earlier years. This demonstrates an increased risk or a newly emerging risk of poverty for many white women. [cite]
* Old age poverty for African-American women reflects economic disadvantages in their earlier years compared with white women. [cite]
* In the United States, the share of elderly women living in poverty is highest among divorced or separated women (37 percent), followed by widowed women (28 percent), never-married women (22 percent), and married women (10 percent). [cite]


5 Tips to Stay Up-to-Date with Medical Literature

"How do you eat in elephant? In small bites." The same rule probably applies to staying current with the ever expanding avalanche of medical literature. One can try the following approach:

1. RSS Feeds for Journals.

Subscribe to the RSS feeds of the "Big Five" medical journals (NEJM, JAMA, BMJ, Lancet and Annals) plus 2-3 subpecialty journals in your field of interest. You can choose either Google Reader (a powerful RSS reader) or the simple iGoogle personalized page (if you subscribe to less than 10 feeds). PeRSSonalized Medicine by Webicina.com was one of the first services to arrange the medical journal feeds in a visually appealing way and make RSS consumption user-friendly.



Medical Journals tab: A screenshot of iGoogle with RSS feeds from the major medical journals.

Try to read the journal on the day it is published online, for example, NEJM and JAMA on Wednesdays, BMJ in Fridays, etc.

2. Podcasts.

Listen to journal podcasts. Click here to subscribe to the podcasts of 4 major journals in iGoogle.

3. Persistent Searches.

Subscribe to RSS feeds for "persistent searches" in Pubmed and Google. For example, choose a search term in your field of interest, run the search in Pubmed, then subscribe to the feed for the search. The same process can be repeated with Google News and Google Alerts.


Image source: U.S. National Library of Medicine.

4. Text-to-speech (TTS).

Use text-to-speech to listen to articles you do not have time to read.

5. Blogs and Twitter accounts.

Subscribe to high-quality medical blogs in your field of interest -- they often review most of the important new articles.

Related reading

Make Your Own "Medical Journal" with iGoogle Personalized Page
How to stay up-to-date with RSS in medicine - presentation from the free Social MEDia Course http://j.mp/Hale12
Not a Medical Course, but a Life Course (somewhat vague advice) http://goo.gl/mDMsr - Here are 5 practical tips:  http://goo.gl/n5rbw
Share iGoogle Tabs with Medical Journals, Podcasts and Gadgets
Annals of Internal Medicine Launches Podcast and Audio Summaries
Text-to-Speech Programs and Continuous Medical Education
Medical journals that use social media (spreadsheet). Body in Mind, 2011.
Image source: OpenClipArt, public domain.

Sunday, April 27, 2008

Bitch Magazine is coming to Chicago

Please welcome Debbie Rasmussen, publisher of Bitch: Feminist Response to Pop Culture, on her Midwest fundraising trip stop in Chicago!

DATE: May 6, 2008
TIME: 8 PM
PLACE: Heartland Cafe at 7000 N Glenwood in Chicago.

Joining Bitch will be local go-go troupe The Revelettes, and BELMONDOS, an acoustic experience relying on rich European and American influences.

It'll be a night of celebration, fun, and fundraising for a good cause!

Sliding scale $10-$20 - all proceeds go to the nonprofit organization B-Word, publishers of Bitch, the magazine you know and love.

To RSVP, add your name to the evite!

Technorati tags: Bitch Magazine

Carpenter Allergic to Wood -- What to Do?

Change the wood type.

From BBC:

"A banker quit his £80000 a year job to live his dream of being a carpenter - only to discover he has developed an allergy to African hardwood.


African Mahogany at Helena Hardwoods. Image source: Flickr, Creative Commons license.

But Mr Hill refused to return to London where he had worked as an investment banker for UBS for nearly eight years.

He started using Welsh oak wood instead of African hardwoods - and realised it was one type of wood he isn't allergic to."


Oak wood. Image source: Flickr, Creative Commons license.

Luckily, the well-known medical blogger GruntDoc does not have any of those problems with his fun project: hardwood chair mat.

Read more from Allergy Notes: Would-be Carpenter Develops Wood Allergy.

Saturday, April 26, 2008

My Guidelines for Book Reviews

While my traffic isn't anywhere near where other blogs are, I know that I'm getting more and more traffic from book review seekers and maybe even some authors who would like me to review their books. So I thought that I'd take a moment from my insanely hectic day to put up some brief guidelines. Here they are:

  1. Don't expect a positive review. On the whole I'm a nice person and I don't want to write a review that your book sucked or you are a lousy writer. I mean, come on, I'm not a trained literary reviewer and I know my reviews won't end up in the NYTimes.* But I won't also gush about your book unless it really moves me. A tepid review is just about as far as I think I'd go...unless you send me a total piece of poop.
  2. I like to consider myself an expert on women in science studies, a lover of feminist science fiction, and a seeker of feminist and/or cute children's books. I also love biographies, Latina-centric and thinking mama-lit books. Essentially, anything feminist is fair game.
  3. I don't want to try reviewing self-help books. I still haven't read Gloria Steinem's self-help book and it's on my book shelf.
  4. Everything else is a crap shoot. Pitch me your book and I'll get back to you as quickly as possible. I'm open to other genres, really I am.
  5. My technorati rating is not in the triple digits, but I feel that this undervalues my real reach in the blogosphere. (To readers, help me out here...link me and favorite me!)
  6. To reach me, please leave a comment or send an email to my first name.last name @ gmail.com. Please do NOT send email to my work address. They'd very cool about things, but I'd rather not start getting email for this blog at work. Thank you so much! added June 3, 2008
While my to-read-pile is not shrinking, I do my best to read your books as fast as possible. And I always, always make my deadlines.



* Unless the NYTimes decides to start syndicating blog reviews instead of using professionals that is.


Technorati tags: book review

Council of Contemporary Families - Should They Stay

Live Blog from CCF Blogging Session

Deborah & I are showing how to post to a blog and add a category.


Council of Contemporary Families - Cohabitation: Is it Good for Love or Marriage?




Technorati tags: feminism

Tips: How NOT to Give a Presentation


Alexei Karpetev successfully covers the basics of how not to give a PowerPoint presentation. Luckily, he also offers some tips on making a good one.

If everything else fails, remember to follow the proven advice of the former BMJ editor Richard Smith on How not to give a presentation. The article has some invaluable pearls of wisdom like:

"Bad slides are the traditional standby of a bad presentation. There must be far too many. They must contain too much information and be too small for even those in the front row to read. Flash them up as fast as you can, ensuring that they are in the wrong order..."
BMJ 2000;321:1570-1571 (23 Dec)

Check out an alternative approach to PowerPoint/Keynote presentations by Lawrence Lessig.

Google Docs can be used to host your presentations and to embed them in websites. Google Presentations has an integrated online chat to communicate with viewers in real time. An integration with Grand Central VOIP would be the next logical step.

References:
Link via Communication Nation.
How Not To Give a Presentation
The Lessig Method of Presentation
Embed Google Presentations in Your Website

Related:
How to create a great powerpoint without breaking the law. Medical Education Blog, 04/2008.
How to Convert PowerPoint Presentations to Video Files (with Sound). Digital Inspiration, 04/2008.
25 years of PowerPoint http://bit.ly/uZWEq

Friday, April 25, 2008

Viva La Feminista in Ms.

Don't get too excited folks, I didn't get my feature in there...not yet! But I did write up my post about their investigation into Ward Connerly as a letter to the editor and they published it.

Since I subscribe I got the issue on Monday, so hopefully other subscribers are finding their way here by now. And those of you who buy yours on the news stands, be on the look out. This issue also looks pretty spiffy. A review will be forthcoming...as always.

To my new readers...Welcome! Comment, lurk, but stay awhile. This week has been pretty busy, but I'll be back to my usual spunky self any day now. Today I'll be Twittering from the Council on Contemporary Families Conference. Tomorrow I'll live blog. Who says Saturdays are slow days in the blogosphere?

Technorati tags: Ms. magazine, feminism

Cardiology Fellowship Blog and Videolog

The Heart.org just launched a cardiology fellowship blog with videos (videolog). Some of moderators are cardiology fellows at the Cleveland Clinic:

"Our new blog engine will facilitate discussion on issues specifically geared toward cardiovascular fellows. We look forward to ongoing lively, focused and relevant discussions on issues like training, research and career planning."

One of the first posts is an 18-minute interview with Valentin Fuster, director of Mount Sinai heart center in New York City: From fellow to the real world.

Another interesting interview is Pursuing a career in academic medicine?

"Drs Galla and Cuffe address the thorny issues surrounding contract negotiations, job definition, and advancement. Find out why Dr Cuffe had to apologize to division directors all over the US for divulging many negotiating secrets of "the other side."

Thursday, April 24, 2008

TMI Panda peeps!

On days like today when I'm a bit overwhelmed, I peek over at the panda-cam at the National Zoo. Today's update read like a medical chart with far too much info than I was prepared to handle. But here's to more baby pandas!

March 25

As we reported last week, Mei Xiang ovulated on March 19. She has continued to show estrous behavior, bleating at her keepers and walking backwards with her tail up when she sees Tian Tian through the window that sits between their yards. Tian’s internal scent analysis tells him that her estrogen has waned and she deserves barely a glance. However, he still chooses frequently to rest near her on the other side of the fence line. We will continue to do daily vaginal swabs until her cells return to their normal everyday composition. Externally, her genitals look almost normal again, only the faintest blush of pink remains and the swelling is just about gone. One has to wonder, if in the wild, very young male pandas would gain valuable experience interacting with females in estrus that have been abandoned by bigger and wiser males.


Trigger Found for Anaphylaxis Deaths Due to Contaminated Heparin

More than 60 deaths during a 14-month period that began in January 2007 were caused by allergic reactions to a heparin-like contaminant.


Heparin structure.

A recent report from NEJM identifies the trigger in the heparin-related anaphylaxis as oversulphated chondroitin sulphate (OSCS).


Chondroitin sulphate.

OSCS directly activated the kinin–kallikrein pathway in human plasma, which can lead to the generation of bradykinin, a potent vasoactive mediator. In addition, OSCS induced generation of C3a and C5a, potent anaphylatoxins derived from complement proteins.

Complement system is a cascade of enzymes which leads to a membrane attack complex (MAC) which causes osmotic lysis of cells. Different fragments of the complement cascade act as inflammatory mediators.

There are 3 pathways for activation of complement:

CAM

Classical
Alternative
Mannose-binding lectin (MBL)

The 3 pathways (CAM) converge at the point of cleavage of C3. Then C3b becomes an acceptor site for C5, and C5-9 form the membrane attacking complex (MAC). Thus, CAM leads to MAC:

CAM --> MAC


A complement protein attacking the cell membrane. Image source: Wikipedia.


Classical and alternative complement pathways. Image source: Wikipedia.

Oversulphated chondroitin sulphate is a complex sugar molecule, similar to heparin, and hence it had not been possible to distinguish the two substances in ordinary screening tests done previously.

Read more in Anaphylaxis Due to Contaminated Heparin Causes Multiple Deaths, Trigger Found from Allergy Notes.

References:
Contaminated Heparin Associated with Adverse Clinical Events and Activation of the Contact System. NEJM.
Trigger in heparin deaths confirmed. Nature.
Innate Immune System: A Short Review. Allergy Cases.
Images source: Wikipedia, public domain.

Dental Wiki by Case Western Reserve University Dental School

The eHealth blog linked to Cleveland 2.0 - an initiative begun by Case Western Reserve University to apply Web 2.0 to all kinds of non-profit initiatives in Cleveland.

While checking the links, I found a dental wiki featured by one of the presenters: "Ben Schechter of Case School of Dentistry will comment on migrating content to a wiki platform. He will discuss the evolution of the Case Dentistry clinical manual, its journey from print to its current manifestation, why MediaWiki is the appropriate software, how it is being used, and ways to support editorial review":

CASE SCHOOL OF DENTAL MEDICINE CLINIC MANUAL



The website looks like a useful resource for dental education. I should probably have considered using a wiki rather than Blogger.com when I launched ClinicalCases.org in 2005 but then, again, Blogger is free, easier-to-use and there are no hosting charges or setup.

Joshua Schwimmer is currently considering a wiki platform for The Efficient MD - Lifehacks for Healthcare project and we will see how this one works out.

Related:
A medical school dental manual -- in Wiki form. Chris Seper, The Plain Dealer, Cleveland, 05/2008.

Updated: 05/09/2008

Wednesday, April 23, 2008

Lilly Ledbetter Fair Pay Act of 2007 - Roll Call

First of all -
  • Clinton AND Obama made the vote.
  • Reid voted no in order to bring the vote back up later this session
  • McCain MISSED the vote
  • All Dems voted yes (outside Reid) including all independents. Yes, Lieberman voted yes.
Now for the roll call:

Alphabetical by Senator Name
Akaka (D-HI), Yea
Alexander (R-TN), Nay
Allard (R-CO), Nay
Barrasso (R-WY), Nay
Baucus (D-MT), Yea
Bayh (D-IN), Yea
Bennett (R-UT), Nay
Biden (D-DE), Yea
Bingaman (D-NM), Yea
Bond (R-MO), Nay
Boxer (D-CA), Yea
Brown (D-OH), Yea
Brownback (R-KS), Nay
Bunning (R-KY), Nay
Burr (R-NC), Nay
Byrd (D-WV), Yea
Cantwell (D-WA), Yea
Cardin (D-MD), Yea
Carper (D-DE), Yea
Casey (D-PA), Yea
Chambliss (R-GA), Nay
Clinton (D-NY), Yea
Coburn (R-OK), Nay
Cochran (R-MS), Nay
Coleman (R-MN), Yea
Collins (R-ME), Yea
Conrad (D-ND), Yea
Corker (R-TN), Nay
Cornyn (R-TX), Nay
Craig (R-ID), Nay
Crapo (R-ID), Nay
DeMint (R-SC), Nay
Dodd (D-CT), Yea
Dole (R-NC), Nay
Domenici (R-NM), Nay
Dorgan (D-ND), Yea
Durbin (D-IL), Yea
Ensign (R-NV), Nay
Enzi (R-WY), Nay
Feingold (D-WI), Yea
Feinstein (D-CA), Yea
Graham (R-SC), Nay
Grassley (R-IA), Nay
Gregg (R-NH), Nay
Hagel (R-NE), Not Voting
Harkin (D-IA), Yea
Hatch (R-UT), Nay
Hutchison (R-TX), Nay
Inhofe (R-OK), Nay
Inouye (D-HI), Yea
Isakson (R-GA), Nay
Johnson (D-SD), Yea
Kennedy (D-MA), Yea
Kerry (D-MA), Yea
Klobuchar (D-MN), Yea
Kohl (D-WI), Yea
Kyl (R-AZ), Nay
Landrieu (D-LA), Yea
Lautenberg (D-NJ), Yea
Leahy (D-VT), Yea
Levin (D-MI), Yea
Lieberman (ID-CT), Yea
Lincoln (D-AR), Yea
Lugar (R-IN), Nay
Martinez (R-FL), Nay
McCain (R-AZ), Not Voting
McCaskill (D-MO), Yea
McConnell (R-KY), Nay
Menendez (D-NJ), Yea
Mikulski (D-MD), Yea
Murkowski (R-AK), Nay
Murray (D-WA), Yea
Nelson (D-FL), Yea
Nelson (D-NE), Yea
Obama (D-IL), Yea
Pryor (D-AR), Yea
Reed (D-RI), Yea
Reid (D-NV), Nay
Roberts (R-KS), Nay
Rockefeller (D-WV), Yea
Salazar (D-CO), Yea
Sanders (I-VT), Yea
Schumer (D-NY), Yea
Sessions (R-AL), Nay
Shelby (R-AL), Nay
Smith (R-OR), Yea
Snowe (R-ME), Yea
Specter (R-PA), Yea
Stabenow (D-MI), Yea
Stevens (R-AK), Nay
Sununu (R-NH), Yea
Tester (D-MT), Yea
Thune (R-SD), Nay
Vitter (R-LA), Nay
Voinovich (R-OH), Nay
Warner (R-VA), Nay
Webb (D-VA), Yea
Whitehouse (D-RI), Yea
Wicker (R-MS), Nay
Wyden (D-OR), Yea



Technorati tags: fair pay act, Lily Ledbetter, roll call

This & That on writing

  • You'll notice that the anthology button is gone. The project is on hiatus and there are many reasons why I totally support this move. I don't know what the future holds for the piece I wrote, but until I figure that out, it's in Adele's trustworthy hands.
  • I purposely missed a deadline because the piece that I ended up writing was far more personal that I had intended. While I think on the whole most of what I wrote is already "out there" in the universe, seeing it all in one package was damn scary. Don't fret, I didn't trash it like I did my high school journals (gawd damn I wish I still had those!).
  • A deadline that I accidentally missed was extended to the end of this month. I need to revisit where I left off and wrap that baby up. It will also be pretty personal, but one that I feel is ready for the world to read...that is if it is chosen.
  • I have a few more deadlines hovering but on top of some work deadlines, I'm not sure if I'll make them. I feel like I need to hit while the iron (and my passion) is hot or else all of this will wither away.

My lame and late Earth Day post

Yesterday was super busy in Feminista-land and in lieu of some tree-hugging goddess worshiping Earth Day post, I bring you word from Patriarchyland (via Feministing - I don't link to anti-feminist sites) that you, you working mom, are the cause of global change. Moms like Dawn, who stay at home and home school, are the saviors and we must all model her.

Indeed, stay-at-homes moms save the state's highway infrastructure from meltdown, especially since a "nanny" often drives to the working mom's house, putting three cars on the road where otherwise one would do.

Homeschooling moms further ease the strain on the ecosystem by keeping their kids off the road. The California judged who ruled that "parents do not have a constitutional right to homeschool their children" obviously did not prepare an environmental impact statement before doing so.


Of course, despite my sarcasm, I do hope to model Dawn one day....without the home schooling thou. Seriously, my daughter & I might kill each other.

Medical Blogger Writes Op-Ed for USA Today

Kevin, M.D. is easily the most famous medical blogger on this side of the Atlantic (NHS Blog Doctor is his counterpart in the UK). I was reading his blog for 6 months before I started my own site(s) in 2005, thinking "if Kevin can do it, so can I." Needless to say, I was wrong. The closest I got to Kevin's fame was blogging on his site as an invited guest when he was on vacation... :)

This morning, Kevin has an op-ed published on the USA Today website about defensive medicine entitled "Wasted Medical Dollars":
Defensive medicine is "a phenomenon in which doctors order tests to avoid the threat of a malpractice lawsuit.

At $210 billion annually, defensive medicine is one of the largest contributors to wasteful spending, and it can manifest in many forms: unnecessary CT scans, MRIs, cardiac testing and hospital admissions. A 2005 survey in the Journal of the American Medical Association found that 93% of doctors reported practicing defensive medicine."

The medical blogging community is gaining increasing traction and now includes the so-called "official blogs" sponsored by professional organizations such as the American College of Emergency Physicians. Even our CEO here at the Cleveland Clinic has a blog. It looks like the "blog fatigue" has not spread to the medical field yet.

Robert Centor, the immediate past president of SGIM, is another medical blogger who had written an Op-Ed for the USA Today in the past.

References:
Another Milestone: Two Million Page Views for Clinical Cases and Images
"Official" Medical Bloggers
Has Blogging Peaked?
Image source: Kevin, M.D.

Newseum Shows Front Pages of 600 Newspapers from Around the World

The Newseum is an interactive museum of news and journalism in Washington, D.C.

The website of the museum features the front pages of 627 newspapers from around the world. It looks like a great way to check the pulse of the world - from Italy to India, and from Sweden to South Africa:



Today's Front Pages from Newseum

A Suggested Approach to Reading Multiple Front Pages

The front pages of 30 newspapers are bookmarked together as a "session" in my Opera browser and I usually open them all at the same time in 30 tabs. I tried the same approach in Firefox with "Bookmark All Tabs" but since Firefox uses more memory than Opera, it slows down the browser considerably.


"Opera Sessions: Do you have a lot of sites you browse every day?
Save a collection of open pages as a session and open them at a later time or in the middle of another session with just one click." Image source: Opera.


An ad you wouldn't have seen — or understood — 30 years ago: This is your brain when reading the Financial Times. Links via Kevin, M.D. and Book of Joe.

Related:
10 Features You'll Find Only In Opera. Google Operating System.

Tuesday, April 22, 2008

Council on Contemporary Families Conference

This Friday & Saturday is the Council on Contemporary Families annual conference at UIC. I'll be there both days soaking up the info. I'll also be helping out Deborah Siegel, aka Girl with Pen, with her blogging session on Saturday. If you're in Chicago, stop on by! The conference schedule is here as a PDF.

And yes, please send me strength in not acting like a total idiot in front of Stephanie Coontz, fabulous author of The Way We Never Were and many others. She also teaches at the college I really wanted to attend (sorry, UIC) but didn't have the money to attend. *sigh* Would it be tacky to wear my Evergreen t-shirt?

Oh and yes...I'll be a Twittering this conference as well as another attempt at live-blogging.

Technorati tags: Council on Contemporary Families, feminism, family

Epocrates, maker of popular medical PDA programs, files for IPO


Epocrates on iPhone

According to the blog 24/7 Wall St:

"Epocrates Inc. submitted an SEC filing to come public via an IPO. The filing shows a proposed maximum aggregate offering price of $75 million. They applied to trade on the Nasdaq Global Market under the symbol “EPOC.”

Epocrates provides medical information support tools to healthcare professionals. The company has strong brand recognition and over 500,000 healthcare professionals actively subscribe to use their product, including 1 in 4 doctors and 1 in 3 medical students. The technology allows healthcare professionals to access medical information on various devices, such as Blackberries, Palms, iPhones, desktops and PC’s. The company generated enough in 2007 to pull it out of the red and into the green."

The market for health-related companies is not bad right now. The WSJ recently reported that many cities are closing factories and opening (or expanding) hospitals.

One of the largest private hospitalist companies IPC The Hospitalist Co. launched IPO this year. According to MarketWatch: "The North Hollywood, Calif. provider of inpatient care raised $83 million by offering 5.2 million shares in the middle of its $15-$17 price range. In a sign of health, the company increased the size of the offering from 4.7 million shares." Click here to see the current stock price chart from Google Finance.

I used the Epocrates Pharmacopeia daily as a resident along the excellent handbook of Medicine (updated yearly) by Current Clinical Strategies.

The basic version of the program is free both online and as a PDA/smartphone download. More sophisticated versions like Epocrates SxDx cost around $ 80-100 per year. Epocrates is ranked at number one on our list of Free Medical Programs for Windows Mobile / Pocket PC.

Google Subscribed Links allows you to add "trusted sources" to your online search, including Epocrates. I like the way it shows the Epocrates subscribed link in the first few results when searching for medications.

References:
Epocrates Online Pharmacopeia is Now Free
A doctor asks which portable computer/PDA/smartphone to choose
Review of Epocrates on the iPhone. Tech Medicine, 07/2008.

Updated: 07/18/2008

Monday, April 21, 2008

Work it, Mom! Monday!

This week I ask us to ponder not just our own paychecks, but the paychecks of those hard working women who care for our children during the day.


From NWLC:

In 2006, child care workers earned an average of just $9.05 an hour, or $18,820 annually. In comparison, baggage porters earned an average of $21,580 annually and pet sitters earned an average of $20,230 annually. Child care workers are also often denied other important and necessary benefits, such as health care and sick leave. Because of the low wages and limited benefits associated with child care work, many women in the industry are forced to take on second jobs.

Come on and join the conversation!

Technorati tags: motherhood, feminism, caregiving, child care, wage

Has Blogging Peaked?

Blog Fatigue or Dying Art?

Blogging takes time and could be hazardous to your health. Newer Web 2.0 services are either easier-to-use (Twitter, tumble logs) or more personalized and media-rich (Facebook).

"Why would anybody bother to write a blog anymore?" seems to be the question many popular tech bloggers like Scoble have been asking recently. This is not "blog fatigue" but a general feeling that the blogging has peaked and it is time to go beyond its limited benefits.

According to Russell Beattie: "... your blog is also sort of a home-base - a social-network independent profile page where others can come to learn more about you. From this point of view, having *just* a blog nowadays is somehow incomplete. It would be like a social-network profile without any images, video, links, etc."

Has Blogging Peaked in Medicine?

Generally speaking, medicine is a conservative field and adoption of new technology is slow. Blogging is just beginning to be recognized by hospitals and medical journals, and we have not reached the peak of medical blogging yet.

Why to Blog?

Maintaining a blog is simple, and if one enjoys the experience, there are few reasons to stop. For example, I use this blog as an educational portfolio and since education is a life-long process, it should be around for foreseeable future.


This Google video shows that it takes 2 minutes to start a blog on Blogger.com.

References:
Bored with my blog. Russell Beattie’s Weblog, 04/2008.
Death by Blogging?
Another blogger quits due to "blog fatigue"
Using a Blog to Build an Educational Portfolio
Why Do I Blog?
How to write a medical blog and not get fired?
Image source: Wikipedia

Related:
The pressure of posting. Doctor Anonymous, 04/2008.

Sunday, April 20, 2008

Interesting Articles: A Weekly Review of the "Big Five" Medical Journals

This is a collection of articles I have found interesting in the weekly editions of the "big five" medical journals: NEJM, JAMA, Annals, Lancet and BMJ (a few more journals are included occasionally). The review is a weekly feature of Clinical Cases and Images - Blog. Please see the end of the post for a suggested time-efficient way to stay up-to-date with the medical literature.

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Statins reduce blood pressure? Arch Intern Med. 2008;168(7):721-727.

Statins modestly but significantly reduced BP relative to placebo, by 2.2 mm Hg for SBP and 2.4mm Hg for DBP. Reductions in SBP and DBP extended to normotensive subjects. These modest effects may contribute to the reduced risk of stroke and cardiovascular events reported with statins.

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DASH-Style Diet Reduces Risk of Coronary Heart Disease and Stroke in Women. Arch Intern Med. 2008;168(7):713-720.

The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to lower blood pressure, but little is known about its long-term effect on cardiovascular end points. In this study, adherence to the DASH-style diet was associated with a lower risk of CHD and stroke among middle-aged women during 24 years of follow-up.

This is a suggested mnemonic:

DASH
Diet
Decreases risk of CAD and CVA

CAD and CVA are 2 of the RCRI components used to evaluate perioperative risk. 4CD is a mnemonic to remember the risk factors in RCRI:

CAD
CHF
CVA
CKD
DM

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Don't discharge too fast: Short Length of Hospital Stay Increases Postdischarge Mortality in Patients With Pulmonary Embolism
. Arch Intern Med. 2008;168(7):706-712.

The optimal length of stay (LOS) for patients with pulmonary embolism (PE) is unknown. In this study, patients with a very short LOS (4 days or less) had greater postdischarge mortality relative to patients with a typical LOS (5 to 6 days), suggesting that physicians may inappropriately select patients with PE for early discharge who are at increased risk of complications.

According to the current ACP guidelines for treatment of VTE, selected patients with PE do not need to be admitted to the hospital at all and can be treated as outpatients.

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Pharmacist Care of Patients With Heart Failure. Arch Intern Med. 2008;168(7):687-694.

Pharmacist care in the treatment of patients with HF greatly reduces the risk of all-cause and HF hospitalizations.

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The Lancet Seminar: Prevalence, pathogenesis, and causes of chronic cough and Management of chronic cough. The Lancet 2008; 371:1375-1384.

In 2001, while studying for USMLE, I made up a mnemonic for differential diagnosis of cough - BAD CAT TOM:

Bronchitis or pneumonia
Asthma
Drugs, e.g. ACEi

Cardiogenic, e.g. mitral stenosis
Aspiration, e.g in achalasia, foreign body
TB

Thyroid enlargement, e.g. goiter
Other, e.g. PE
Malignancy, e.g. lung cancer


Mind map of differential diagnosis of cough. See more Allergy and Immunology mind maps here.

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150 years of Gray's Anatomy: Breathing life into Gray's Anatomy. The Lancet 2008; 371:1327-1328.

Gray's Anatomy is now one of the world's best known medical books, having been constantly in print since its birth 150 years ago.

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Can you pay people to be healthy? The Lancet 2008; 371:1325-1326.

Examples of success include a US program which boosted the number of people with depression who attend counseling appointments by offering $10 per session; money, transport vouchers, and food baskets to improve completion of tuberculosis treatment in Russia and Latin America.

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Good deeds and Google. The Lancet 2008; 371:1310.

Google and the UN High Commissioner for Refugees (UNHCR) launched an online site that enables users to get a bird's eye view of displacement camps in Chad, Darfur, Iraq, and Colombia. Read more from PC Magazine and Google.


USHMM Crisis in Darfur in Google Earth

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Related:
Make Your Own "Medical Journal" with iGoogle Personalized Page
Share iGoogle Tabs with Medical Journals, Podcasts and Gadgets
Annals of Internal Medicine Launches Podcast and Audio Summaries
Text-to-Speech Programs and Continuous Medical Education
Image source: OpenClipArt, public domain.

Saturday, April 19, 2008

Spain's defense minister: When motherhood comes at an inconvenient career moment

From Boston Globe:

"You didn't have to know anything about Spanish politics to be fascinated by the striking photo that came out of Spain this week: The new defense minister, 37 and seven months pregnant, reviewing her troops in a chic maternity outfit.

In Spain, some were questioning whether Carme Chacon should be able to take her state-mandated 16 weeks of paid maternity leave, given the importance of her job.

For most American women, of course, the idea of 16 weeks paid leave is a mere dream. The United States is one of a handful of countries with no guaranteed paid maternity leave policy, researchers found last year."


Video: Carme Chacón's first day in office

The Spanish prime minister José Zapatero was re-elected on March 9 and appointed more women than men to his cabinet.

Ms. Chacon lacks military training but that did not stop her from taking a 10-hour flight to Afganistan to visit the Spanish troops there. She was accompanied by her gynaecologist, an anesthesiologist and a pediatrician.

It looks like she also finds time to keep her Flickr page updated.

References:
When motherhood comes at an inconvenient career moment. Boston Globe.
Spain's Pregnant Defense Minister. Time.

Stream Online Medical Grand Rounds for Free

One of my daily reads, the hospitalist blog Notes from Dr. RW, has expanded his excellent list of online Grand Rounds that can be watched for free via streaming video. Podcasts are also available.

UTMB/JSC Aerospace Medicine Residency

University of Washington Television (Health and Medicine)

University of Nebraska

University of Florida

UC Davis

UA Birmngham

McGill

Dartmouth-Hitchcock

DAVE Project gastroenterology

FERNE presentations on neurological emergencies

UT Galveston

Wayne State University

Johns Hopkins Arthritis Center

University of Miami

NIH Clinical Center

UT Houston

UT Memphis

University of Arizona (until May 2007)

University of Arizona (After May 2007)

Ohio State

Drexel University

Heart Podcasts

POEM of the week podcast

Meharry Medical College

Medkast

UT Memphis podcasts


Related:
Podcasts from Conferences of University of Tennessee IM Residency Program
Watch Medical Grand Rounds Online
Image source: OpenClipArt.org, public domain.

Friday, April 18, 2008

Happy Fair Pay Day!

Blog for Fair PayToday is Friday, April 18th...the 109th day of the year. Why does that matter? Because Equal Pay or Fair Pay day marks the day when women have finally earned enough money to equal what a man made in the previous year.

In other words, if the dude in the cubicle next to you made $50,000 last year and on average you made $38,5000. That is 77 cents on the man's dollar....it would take you until today to equal his $50,000. Of course, he's still earning, so you're super behind for this year.

Of course my example is compared to a white man's dollar and that woman earning 77 cents on the dollar are white women. What about us Latinas?

Minority women fare significantly worse. In 2006, the median earnings of African American women working full-time, year-round were $30,3525 compared to $48,4206 for white, non-Hispanic men; the median for Hispanic women was only $25,198.7 This means that an African American woman earned just 63 cents for every dollar earned by a white, non-Hispanic man, while a Hispanic woman earned only 52 cents on the dollar compared to her white, non-Hispanic male counterpart.8 In both cases, this pay gap for women of color was only marginally smaller than it was in 2004. [link]
52 cents? Pinche 52 cents?

Instead of just getting all pissy about us getting the shaft there is something to be done! The Lilly Ledbetter Fair Pay Act will be voted on at any moment. Contact your Senators!! Of course you known one of mine and he better get his hopeful ass off the campaign trail to make that vote, close or not. NOW describes the bill and why we need it passed:

The Ledbetter Act was drafted to overturn the Supreme Court's May decision in the case of Ledbetter v. Goodyear Tire & Rubber Co., which dealt a near-fatal blow to underpaid workers' ability to use the protections of civil rights laws to remedy pay discrimination.

Lilly Ledbetter had worked at Goodyear for 19 years when she discovered she was being paid significantly less than every single one of her male counterparts. A jury agreed that she had been paid unfairly, and awarded her $223,776 in back pay, and over $3 million in punitive damages, but a judge cut that to only $300,000 because of a 1991 law that limited a company's liability for damages — even when found guilty of willful wage discrimination.

In an "off with her head" moment, the U.S. Supreme Court took away every penny of the back pay and damages awarded to Lilly Ledbetter, saying incredibly that the 180 day filing limit had begun way back when the very first paycheck showed lesser pay. Eighteen years of continuing wage discrimination against Ledbetter by Goodyear held no sway with the Roberts court.

Fair pay is one reason why I push young women and girls into science & engineering. Women in some of these fields are earning a fair pay, for the most part, and sometimes are in such demand that they earn MORE than the white dude next to them. Go ahead and use that the next time your daughter tries to talk you into blowing off her math homework.

Women in the construction industry, for example, earned median weekly wages that were only 86% of what their male counterparts earned. And women in computer and mathematical occupations had weekly earnings that were 85% of the wages paid their male counterparts. [link]
Technorati tags: fair pay, equal pay, feminism, work, latina, National Women's Law Center

Opera Mini: Probably the Best Browser for Your Phone

The iPhone has its own Safari browser but for most other phones the free Opera Mini browser is a good alternative which offers the feel of a desktop browsing experience. The program size is only 52 KB because most of the processing is done on Opera servers which convert web pages into a simplified format that can be displayed by the application. The video below shows some features of the browser:


Opera Mini 4.1

Opera Desktop and Opera Mobile browsers are other useful programs by the same company which I use daily.

A new generation of phones powered by the Google Android OS is expected this fall.

References:
Upload Files from Your Mobile Phone Using Opera Mini. Google Operating System.
Mobile Web Browsers Have Nowhere To Go But Up. Web Worker Daily, 04/2008.
Opera Mini 4.1 (beta). PC Magazine, 04/2008.

Thursday, April 17, 2008

New Blog -- My Voice, My Choice

The Chicago Abortion Fund has launched a new blog for their My Voice, My Choice leadership project. It's still brand-spanking new with only 3 posts, but make sure that you bookmark them, grab their RSS feed, or add them to your blogroll.

This blog will be THE place to hear from young women of color who have had abortions, aren't afraid to tell their stories, and tell the stories of others.

I've been in many, many meetings where feminists wring their hands and scratch their heads and wonder, "Where are the women of color?" "How can we get them to the table?" Well folks, they are right over at the CAF blog and they set their own table. Why don't you please join them?


Technorati tags: abortion, women of color, feminism, women's health, Chicago Abortion Fund

Next Phase in Procedure Training: Wireless, Sweating, Breathing, Bleeding Mannequin

Live from ShowCASE: iStan











Chris Seper of the Cleveland Plain Dealer continues his excellent coverage of the annnual Case Western Reserve University Research ShowCASE:

"Meet iStan, a wireless, sweating, breathing, bleeding training mannequin on display at the Case Western Reserve University Research ShowCASE. It's used at the Mt. Sinai Skills and Simulation Center, and is slowly deploying nationwide."

I am proud to be part of the event -- we are presenting a total of 6 posters this year.

Do not forget to check our own procedure guides for central line placement and thoracentesis. They are richly illustrated with full-size photos with captions. The procedure guides are completely free and can be downloaded to a smartphone or a PDA, or accessed through Picasa Mobile on the go.


Screenshot of Thoracentesis - A PDA Procedure Guide from MeisterMed.

References:
Case Western Reserve University ShowCASE to Highlight Research Projects - Web 2.0 Included
Central Line Placement: A Step-by-Step Procedure Guide with Photos
Thoracentesis: A Step-by-Step Procedure Guide with Photos
Procedure Guides Step-by-Step
Free Procedure Guides for Pocket PC/Windows Mobile and Palm

Wednesday, April 16, 2008

Friday is Blog for Fair Pay Day!

Join me, won't you?

Can Blogging Be a Profitable Small Business?

Believe it or not, blogging could be a profitable endeavor. And this does not apply only to owners of blog networks with 30-40 blogs like Gawker Media run by Nick Denton.

The WallStreet Journal featured one of the most popular parent blogs -- The Blogger Mom, In Your Face:

"The 32-year-old at-home mother's irreverent, occasionally profane and often hilarious musings on prosaic topics from potty-training to postpartum depression have propelled her blog, Dooce.com, to No. 59 among the Web's top 100 blogs, according to Technorati, a blog search engine. The Salt Lake City resident enjoys enviable influence and enough ad revenue that her husband Jon quit his job in 2005 to manage advertising for Dooce (rhymes with moose).

Ms. Armstrong's fan base is a powerful lure for advertisers. Neither she nor her husband will discuss ad revenue, but they and the Internet rating service Quantcast say that Dooce draws about four million page views per month. In a "quick back-of-the-envelope guesstimate," , Technorati's vice president, business development, estimates the site could yield $40,000 a month in revenue from companies coveting her traffic, such as BMW and ."

The USA Today recently reported that some 'Gray Googlers' strike gold:

"As an independent handyman at the mercy of weather patterns near Hartford, Conn., Jerry Alonzy had always made a decent income that rarely grew.

Then he found Google, and his life changed. Alonzy, 57, now makes $120,000 a year from the ads Google places on his Natural Handyman website, and he couldn't be more thrilled."

I don't know of any physician-blogger quitting his job to devote his time exclusively to blogging but who knows, with declining reimbursement, and increasing page views and ad revenues for popular blogs, this time may come.

There is an alternative to making money from ads:


Cartoon author: Hugh Macleod, Creative Commons license.

More examples of successful bloggers:

- Amit Agarwal, the author of the tech blog Digital Inspiration, located in India, made so much from Google AdSense that he was able to buy a brand new Honda CRV

- The author of the blog Fund my Mutual Fund raised $1.19 million from readers to create a real mutual fund from scratch:

January 7, 2008 = $75K total raised
February 19, 2008: $766K total raised
March 18, 2008: $994K raised
April 16, 2008: $1.190M raised

Related:
Google AdSense and Blogging Brought Me This Car. Digital Inspiration.
Tax Deductions for Bloggers. About.com.
Blog Owner Makes One Million Per Year from Google's AdSense

Image source (top right):
Heather Armstrong, from Wikipedia, the free encyclopedia, licensed under Creative Commons Attribution 2.0 License.