health insurance: July 2008

Thursday, July 31, 2008

The Princess & the Frog

The teaser is out! What do you think?

h/t to Lauren at Feministe

Read bfp's take on the movie, who also links to others thoughts.

Macho, Macho Man

Despite the snarky title, I want to spend this time asking you to please take the time to read ALL of bfp's post on machismo in Mexican culture:

Machismo was about putting on a show. About looking really fucking beautiful and representing yourself and your ‘group’ (whether it was a music group, like the mariachis above, or the dancers or bull fighters of old etc) well. It was about attracting a love interest (as in the song above) or demonstrating your bravery. It was about tapping into an ancient past that was strong enough to build a bright future. It was something you did together as a community–how do you show off if there is nobody to watch? But most importantly, machismo was something that you stopped–you took it off and put it away for special occasions. If the special is used every day, then it’s no longer special, right?

That's all! xoxo

Mama Mia - Feminist Movie Madness?

First, I'm soooo glad that I wasn't the only person traumatized by "The Dark Knight." My husband still wants to debate it with me, but I still am unsure of how I feel. And dear goddess, why did you have to take Heath!?

Anywho, go read Sarah Seltzer's take on Mama Mia - warning - chock full of spoilers. The Mr. is a huge ABBA fan, so we'll end up seeing this...perhaps once it is a $5 movie. And I can't wait!!

Angioedema: a 24-hour photo diary by a patient posted on Flickr

Angioedema: a 24-hour photo diary by a patient posted on Flickr

The patient took pictures of herself and uploaded them to the photo sharing website Flickr under a Creative Commons license. She had the impression her symptoms were due to urticaria but since the process affects the subcutaneous tissues (note the upper lip edema), the more likely diagnosis is angioedema and urticaria.

Dr Heinrich Quincke first described the clinical picture of angioedema in 1882, hence the eponym Quincke's edema. Sir William Osler remarked in 1888 that some cases may have a hereditary basis; he coined the term hereditary angio-neurotic edema.

C1 protein, showing subunits C1r, C1s, and the C1q tails. Image source: Wikipedia. Patients with acquired angioedema have low C1q levels AND low C4/C2 levels. In contrast, in hereditary angioedema (HAE) the C1q level is normal.

Classical and alternative complement pathways. Image source: Wikipedia.

Read more about Angioedema at AllergyCases.org.

Link via AllergyNotes.

Wednesday, July 30, 2008

What to Buy Wednesday – Nipples & Pacifiers

Now that title should get me some real traffic from the search engines! haha...

Seriously, I can't tell you which nipple, bottle, or pacifier to buy for your lil one. I say that because I really feel that each baby has its own preference. To illustrate this, let me tell you a story...

Five years ago I was home on maternity leave and poking at my belly. "Hurry up baby! We're wasting precious maternity leave time!" At the same time I was tidying up, getting all the bottles set, onesies washed, etc. The bottles were all cute Winnie the Pooh bottles. While I knew I was going to breast feed, I also knew that the new Papa was going to do bottle duty.

What I didn't plan on was that missy was going to be picky about her bottle nipple AND her pacifier. I think that we went thru at least 3-4 different bottles before landing on the Avent nipple. Which let me tell ya really sucked because I had bought the Medela breast pump. If you don't know, the breast pumps FIT the bottles perfectly. Yes, so I'd pump into one bottle, dump into a Advent and then store in the freezer. UGH!

The moral of the story? Don't buy too many bottles at once cause your kid might not like the cute one or the "perfect" bottle. And yes, it's hard to know which pump to get before the kid tells you which bottle they prefer. Just guess...you'll do that a lot as a mom. Get good at it. ;-)

Technorati tags: What to Buy Wednesday, motherhood, parenthood, gift

NYS Partnership Program

The New York State Partnership for Long-Term Care is a unique program combining long-term care insurance and Medicaid Extended Coverage. Its purpose is to help New Yorkers financially prepare for the possibility of needing nursing home care, home care or assisted living services someday. The program allows New Yorkers to protect some or all of their assets (resources), depending on the insurance plan purchased, if their long-term care needs extend beyond the period covered by their private insurance policy.
If you buy New York State Partnership for Long-Term Care insurance from participating insurers, use the benefits according to the conditions of the program, and you are a New York State resident, you can apply for New York State Medicaid Extended Coverage which may assist in paying for your ongoing care. Unlike regular Medicaid, Medicaid Extended Coverage allows you to protect some or all of your assets, depending on whether you select a Dollar for Dollar Asset Protection plan or a Total Asset Protection plan. However, your income is countable in determining your eligibility for Medicaid Extended Coverage.
The Partnership was created to help New Yorkers finance long-term care without impoverishing themselves or signing over their life savings, with the accompanying loss of dignity. In the long run, the program will help reduce New York's Medicaid long-term care expenditure - over $9 billion in 2003. The Partnership offers New Yorkers and New York State a better alternative.
If you have any question or you would like a free quote please feel free to call Mr.Minter at 716-565-1300 or e-mail mminter@mintcofinancial.com at www.mintcofinancial.com

One more reason why people should have a financial advisor

LAKE CITY, Ga. - More than 1,800 people showed up to help ABC's "Extreme Makeover" team demolish a family's decrepit home and replace it with a sparkling, four-bedroom mini-mansion in 2005.

Three years later, the reality TV show's most ambitious project at the time has become the latest victim of the foreclosure crisis.

After the Harper family used the two-story home as collateral for a $450,000 loan, it's set to go to auction on the steps of the Clayton County Courthouse Aug. 5. The couple did not return phone calls Monday, but told WSB-TV they received the loan for a construction business that failed.

The house was built in January 2005, after Atlanta-based Beazer Homes USA and ABC's "Extreme Makeover" demolished their old home and its faulty septic system. Within six days, construction crews and hoards of volunteers had completed work on the largest home that the television program had yet built.

The finished product was a four-bedroom house with decorative rock walls and a three-car garage that towered over ranch and split-level homes in their Clayton County neighborhood. The home's door opened into a lobby that featured four fireplaces, a solarium, a music room and a plush new office.

Materials and labor were donated for the home, which would have cost about $450,000 to build. Beazer Homes' employees and company partners also raised $250,000 in contributions for the family, including scholarships for the couple's three children and a home maintenance fund.

ABC said in a statement that it advises each family to consult a financial planner after they get their new home. "Ultimately, financial matters are personal, and we work to respect the privacy of the families," the network said.

Some of the volunteers who helped build the home were less than thrilled about the family's financial decisions.

"It's aggravating. It just makes you mad. You do that much work, and they just squander it," Lake City Mayor Willie Oswalt, who helped vault a massive beam into place in the Harper's living room, told The Atlanta Journal-Constitution.

It's a science nerd's heaven

This September Chicago will launch Science Chicago. A whole year's worth of sciencey goodness around the city. Check out the website, sign up for updates, and keep an eye out here when I'll promote events I'll be at! Hey, this science nrrd isn't missing this!

NEJM Invites Students and Residents to IT Horizons Conference

The Editor for Medical Education of the New England Journal of Medicine (NEJM) asked me to inform my readers (2,200 daily RSS subscribers plus 1,500 visitors) that the journal is seeking applications from interested residents and students to join them in Boston from October 24-26th, 2008 to discuss the future information needs of physicians and physicians in training.

The application is available at https://secure.nejm.org/horizons/

NEJM is seeking to bring together a group of visionary medical students and trainees to help NEJM push the boundaries of traditional medical publishing. We are looking for creative minds to join the editors for a weekend to explore what's possible. We anticipate a vigorous dialogue around the ideas that invited participants and other speakers share with the group.
If you are selected to join the conference:

We will cover the cost of round-trip coach/economy airfare to Boston from within North America or from western Europe.
We will cover the costs of room and board at the conference facility for your two-day stay, and transfers to and from Boston's Logan International airport.
You will receive a complimentary subscription to NEJM.org.
You will have a chance to shape the future of NEJM, and meet members of the editorial staff.

References:
NEJM is a Journal (Only) No More

Tuesday, July 29, 2008

The problem with the business of mommy blogging

Blogher has come and gone. The swag has been taken, sorted, trashed or given away. Trinkets and real useful items emblazoned with corporate logos weighed down the shoulders of Bloger attendees. While I did not go myself, there was no lack of swag posts in the momosphere. Last year I gobbled up as much as I could and even made a swag care package for Amy. This year the swag appeared to have jumped a notch or two. One team of mommy bloggers even road tripped their way to Blogher complete with a hybrid Chevy Tahoe and a list of corporate sponsors, including CBS News which got current mom blogger BFF Katie Couric to tape a welcome message for Blogher. As I find myself deeper and deeper in this blogging thing and as I get more and more emails for products and promotions (NOTE: Stop emailing me at my work! That's what the contact me link is for!), I make myself stop and consider the ramifications.

No, I don't think that mommy bloggers are any less smart than techies, music reviewers, or anyone else who blogs and gets freebies tossed at them like we're at a sporting event. I do think that the speed of the mommy blogger boom and the intensity of the swag has been overwhelming for many of us.

Let's take the Blogher Mom Roadtrip moms. I use to write with them and know that they are all intelligent women. I also know that the powers that be over at SV Moms aren't out to do anything sinister. That's why I think it's safe to make them my case study.

There was buzz before the road trip was announced in certain blogging circles that a car company was trying to find the right audience for the offer. I wasn't privy to those conversations, but when I mentioned the road trip to a friend, they nodded and knew it was coming. "They just needed to find the right niche." Add in Zune, Weight Watchers & Six Apart as sponsors and the cross-country road trip appears to have paid for. Yet before they even set out to pay their first toll rumors began to swirl that they were mere shills for the sponsors. On July 10^th Jill Asher blogged a huge disclaimer/fact that the moms involved were not given any guidance/rules on how to blog the trip.

…what you won't see blogged from this road trip is detailed information or opinions about the gear our sponsors have provided to make the trip happen. Instead, we've asked our bloggers to simply chronicle their experiences, the good, the bad, the funny, the plain weird. They can mention our sponsors, but they don't have to. For example, we had a question from one of our bloggers today: can she just say, "I got in the car," or does she have to say, "I got in the Chevy." We told her car is fine.

As I said, I know these women and know them to be honest; especially since many of them are also professional writers. They aren't the stereotypical wide-eyed PJ wearing mommy bloggers. Yet because they were going on a sponsored road trip, their integrity was questioned.

I believe that happened precisely because we are not dumb. We, as a society, as a blogosphere, are leery of corporate sponsors. Even if we get them ourselves, we know sometimes they come with strings or gentle suggestions. I know that at some of us are reluctant to post a bad review of a book, restaurant or product for many reasons. First is the backlash that the company or marketing agency won't tweet us again. Next is having no desire to be "mean" to something someone put a lot of work into, especially books. Another reason is that some of us know too well how much power a small post can wield. Yes, even a blog like mine with a small audience can post a bad restaurant review and bring the chef to his knees. A few of us had this convo at last year's Blogher. One woman got emails from the owners asking her to remove the review! I wrote a bad review many moons ago and the manager offered to give my husband & me a free meal to let us judge again. No, I never took him up on it.

I agree with Diane Farsetta at WIMN's Voices (where I also blog) that I'm not totally sure if this type of partnership is problematic. I do find it problematic that marketers who are getting paid big bucks have figured out a way to get moms to do their work for them. Rather than spend thousands of dollars on an ad buy, they are ship off a few freebies with an information sheet chock full of talking points.

The NYTimes covered Blogher and many bloggers were not happy with the placement (in the Style section where almost all women-centric stories live) nor with the description of women bloggers:

[Blogher] has since evolved into a corporate-sponsored Oprah-inflected version of a '60s consciousness-raising group. … many women at the conference were becoming very Katie Couric about their belief that they are not taken as seriously as their male counterparts at, say, Daily Kos, a political blog site. Nor, they said, were they making much money, even though corporations seem to be making money from them.

And that's just what gets my goat. That so many women, especially mom bloggers appear to be drowning in free samples for their review blogs, yet don't seem to be swimming even in the kiddie pool when it comes to cash flow. Well, unless you're Blogher who just signed a deal with NBC & iVillage to the tune of $5 million. No word yet on where that money will end up. And for the record, the women who put Blogher together deserve a good cash reward…yet so does every review blogger out there. For many of us, this is a business and we need to start acting more like businesswomen not grateful for the crumbs that are thrown at us (myself included!).

Farsetta reminded us that Anne Elizabeth Moore chides us all, bloggers or indie punk folk, that when we shill for companies for free swag or a flat-fee that does not add up to at least a certain amount an hour, we are underselling ourselves.

My mother use to remind my sisters and I that we were a reflection of the people we hung out with so to be careful. I think the same idea can be said about those we partner with on reviews and sponsorships. And because of this, we shouldn't be too hurt when someone questions our integrity if we're tooling around in a free car with free $5/gallon gas and blogging about it – Even if we aren't dropping the make & model name every chance we get. "I'm getting into my Toyota Prius. Wow. My Prius windows are dirty! Time to wash the Prius…"

Study: Future doctors share too much on Facebook. Way too much.

You can always rely on Joshua Schwimmer to find some interesting links and here it is:

Future doctors share too much on Facebook. University of Florida News Desk.

"Would it bother you to know that your physician smokes cigars and likes to do “keg stands”? That your gynecologist was a member of a group called “I Hate Medical School”? That your urologist is a fan of “The Texas Chainsaw Massacre”?

That is exactly the sort of information many people share on social networking sites such as Facebook and MySpace. According to a new University of Florida study, many medical students are sharing far too much."

The study was published in the Journal of General Internal Medicine (again?).

"Facebook is full of bluster and trash talk, and college-age users may feel that these items are not to be taken seriously. Yet patients and future employers, the researchers say, may not have quite so strong a taste for irony.

“Doctors are held to a higher standard,” Thompson said. “There are stated codes of behavior that are pretty straightforward, and those standards encourage the development of a professional persona.

The medical profession isn’t the only career that requires young people to develop a professional identity."

One of the best ways to establish an online identity is to buy a domain for your own name, start a blog and link them together. Then, you can be sure that when people Google your name, they will find you and not "bad_goat457," for example.

A domain name costs $ 10 per year. Most students are short of money but if you decide to place AdSense ads on your blog, the tiny income ($ 2 a month?) will pay for the domain name. Please note: this is not a product endorsement for Google AdSense.

Of course, as a future physician, it is probably better to blog if you have something valuable to say, or if you are planning to create a personal learning archive of sort. Google is already plenty busy indexing those trillions of web pages as it is.

Tips for Medical Bloggers

Write as if your boss and your patients are reading your blog every day
Comply with HIPAA
List your name and contact information
If your blog is work-related, it is better to let your employer know
Inquire if there are any blogging guidelines. If there are, comply with them strictly
Use a disclaimer, e.g. "All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."
Get your blog accredited by the Heath on the Net Foundation

Twitter updates:

Woman gets fired for calling in sick, but employer catches her online at home on Facebook. http://bit.ly/zGQjq
Omaha Herald: "Party busted for underage drinking after event posted on Facebook" http://bit.ly/UESdo

References:
Make Yourself Google-able
How Can a Doctor Use Google Page Creator?
Geek to Live: Have a say in what Google says about you. Lifehacker.com, also image source.
Content of Weblogs Written by Health Professionals: More Bad than Good?
Using a Blog to Build an Educational Portfolio
Becoming a Clinical Assistant Professor of Medicine and Web 2.0 Projects
How to manage your reputation online. Medical Economics, 01/2009.

Updated: 04/27/2009

Monday, July 28, 2008

Piper Reed News

If you recall, I reviewed "Piper Reed Navy Brat" way back in December. I've just been alerted that August is Piper Reed month! Why?

1. Piper Reed Navy Brat came out in paperback this week

2. Piper Reed the Great Gypsy releases on August 19

3. There will be at least six Piper Reed books

4. Each week in August there will be a Piper giveaway

5. Educators will be eligible for the drawing of a classroom set of Piper Reed Navy Brat

Head on over to the Jambalaya blog and get all the details!

Work it, Mom! Monday

It's Monday and you know what that means...

Check out my weekly post at Moms on Issues. This week I report back on my conversation with Hannah Storm!

Bret Michaels, Poison's lead singer has had diabetes since age 6, "rocks diabetes world"

Rockstar Bret Michaels on diabetes type I

Speaking about rock music, I like Deep Purple better than Bret Michaels and Poison but you have to respect Bret for the encouragement he gives young people with diabetes type I. Anything seems possible with the current medical advancements and sensible lifestyle, including being a rock star.

According to Diabetes Health:

"Bret Michaels was only six years old when he was diagnosed with type 1 diabetes. Now 44 years old, he's a twenty-year veteran of the rock and roll scene as the lead singer of the eighties band "Poison."

Now Bret takes three injections a day, at breakfast, again at dinner, and then a little bit at night.

Bret runs around a lot on stage, so he doesn't eat like to eat much before a concert and takes very little insulin before performing. The band has deliberately built two breaks into the show, a guitar solo and a drum solo, just so that Bret can go to the dressing room under the stage and check his blood sugar.

Bret's Stats:
Age: 44
Years with Diabetes: 38
Injections: 55,328
Blood Tests: 110,960
Albums Sold: 25 million"

Smoke on the water by Deep Purple.

References:
Bret Michaels, Diabetic Lead Singer of "Poison," Lives Life Large. Diabetes Health, 2007.
Bret Michaels rocks the diabetes world. USA Today, 2002.

Survivor: After hemorrhagic stroke, followed by TIA, Bret Michaels, who has diabetes type 1, returns to stage with vigor. CNN, 2010, http://goo.gl/NB18

Bret Michaels on being "a really active dad": "Listen kids, hurry up, man. I may lose another organ" http://goo.gl/tkmQ

Updated: 06/20/2010

Sunday, July 27, 2008

This week in Feminista...

I'm suffering from quite the hang over from the PWV training. It didn't help that after my husband picked me up from O'Hare that we went to see "The Dark Knight."

But I do want to let you know that tomorrow's Work it, Mom! - Moms on Issues post will be my interview with Hannah Storm. YES! I got to interview Hannah Storm! And I set it all up. Emailed the PR folks and all. Yes, I'm kick ass. Actually the ESPN folks were super kewl to work with, so I'd say that they were kick ass in working with this interview newbie.

I'm also working on a piece that's been rumbling thru my head for weeks about the business of mommy blogging, integrity, respect, and expectations. Look for that Tuesday...I hope.

Wednesday will bring another edition of "What to Buy" for all the preggy chicks out there. And despite Twitter rumors, I'm not preggers. Did I mention I had a nightmare about that? Seriously, now is not a good time.

Thursday I hope to have a book review for y'all. Which one, not sure yet.

Friday is the kid's 5th birthday.

So that's what I'm working on.

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

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

2. Read the journal on the day it is published online, for example, NEJM on Wednesdays.

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

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

Related:
5 Tips to Stay Up-to-Date with Medical Literature
Make Your Own "Medical Journal" with iGoogle Personalized Page
Share iGoogle Tabs with Medical Journals, Podcasts and Gadgets
Text-to-Speech Programs and Continuous Medical Education
Image source: OpenClipArt, public domain.

Saturday, July 26, 2008

TED Talk by Benjamin Zander: "Classical music with shining eyes"

TED Talk by Benjamin Zander: Classical music with shining eyes.

Personally, I like classical music but whether you like it or not, it does not matter -- this is an amazing talk by a very gifted speaker. It is not only about music but about optimism, leadership and relationship.

From Wikipedia: "Benjamin Zander (born March 9, 1939, England) is an English-American conductor. He is the music director of the Boston Philharmonic Orchestra and a faculty member at the New England Conservatory. He is known for his interpretations of the works of Gustav Mahler and his "popular" pre-concert lectures."

Buffy kicks Superhero ass

The RedEye had a Superhero Tourney and our favorite vampire slayer came out on top.

She beat out Spiderman, Superman, Batman, Silver Surfer, and Thor.

You cannot believe my pride in the Buffster.

Friday, July 25, 2008

Famous "Last Lecture" Professor with Pancreatic Cancer Has Died

"Randy Pausch (October 23, 1960 – July 25, 2008) was an American professor of computer science, human-computer interaction and design at Carnegie Mellon University (CMU) in Pittsburgh, Pennsylvania, and a best-selling author who achieved worldwide fame for his "The Last Lecture" speech on September 18, 2007 at Carnegie Mellon."

WSJ video

The Wikipedia page about professor Pausch details his disease course from the regular updates on his website:

"In August 2006, Pausch was diagnosed with pancreatic cancer. He pursued a very aggressive cancer treatment that included Whipple procedure surgery and experimental chemotherapy; however, in August 2007 he was told the cancer had metastasized to his liver and spleen, which meant it was terminal. He then started palliative chemotherapy, intended to extend his life as long as possible. At that time, doctors estimated he would remain healthy for another three to six months. On May 2, 2008, a PET scan showed that his cancer had spread to his lungs and some lymph nodes in his chest, and that he had some metastases in his peritoneum and retroperitoneum.

On June 26, Pausch indicated that he was considering stopping further chemotherapy because of the potential adverse side effects. He was, however, considering some immuno-therapy-based approaches.

On July 24, on behalf of Pausch, a friend anonymously posted a message on Pausch's webpage stating that a biopsy had indicated that the cancer had progressed further than what was expected from recent PET scans and that Pausch had "taken a step down" and was "much sicker than he had been." The friend also stated that Pausch was "now enrolled" in a hospice program designed to provide palliative care to those at the end of life."

References:
Professor with pancreatic cancer gives his last lesson on life, 09/2007.
YouTube's star lecturer dies at 47. CNN.
A Son's Photo Journal of His Aging Father's Decline - Photo Essays - TIME http://goo.gl/RVCt

WMC Progressive Women's Voices Day One part 2

I'm exhausted...mostly mentally. I also feel incredibly lame for being in my hotel room in NYC watching "Swingtown."

Today we worked on messaging. How to create our message and how to tighten it. We also took turns doing an on camera interview.

As soon as I sat down for mine I knew I was doomed. The first question asked was one that I normally trip over, mostly because I have about 5 different answers for it. I didn't know which one to use and of course I went with the most awkward/hard to say in a concise way. It took me awhile to warm up to the interview as well. While watching myself later was one of the more awkward things I've ever done, the room was filled with uber-supportive women. They all gave some fab feedback on how to strengthen my message.

I knew a lot of the things that were "taught" to us today, as did many of my classmates. The difference was going thru the activities together, getting & giving feedback, and of course having all of us with the same goal - get in the media more with better messages.

Tomorrow we have to tape a 30-second message...that will be then emailed to producers & others who are looking for media sources. *gulp*

What makes a family? Or a marriage?

Here are a few good posts that discuss both questions:

Womenstake takes on how the Census ignores same-sex marriages
Nancy Polikoff cusses how Ohio leaves out same-sex couples from the otherwise progressive move towards paid sick leave.

WMC Progressive Women's Voices Day One

OK, nothing's happened yet. But I wanted to post this photo of my kick ass shoes I bought for this weekend. They match my dress perfectly. Aren't ya jealous?

Don't be. They're from Target...$23.99. You can have them too. I put some gel insoles in them. Cross your fingers that they don't kill my feet! I'm off to the first day of training and we end after dinner tonight. But first, I think I need to fuel up at Starbucks.

I could not have survived high school today

A good friend told me about a co-worker of hers who has been bringing her daughter to work. At first my friend thought the daughter was in trouble, grounded, etc. No...the mom is giving her daughter a few days off from some relentless harassment.

Apparently this 12yo girl kissed a boy. That fact was posted to MySpace and well, it's all over the gawd damn place. Now the boys around her think she's a total slut and go in for kisses because, well if she kissed one guy, she'll kiss them all!

*sigh*

I won't go into vast details, but let's just say that I was in a similar position at about the same age because I didn't kiss a certain guy. I am dense people. I still am. I don't know you're hitting on me until you go in for the kiss or buy me a drink. It's not because I haven't dated since high school, it's because I'm dense. That said, I was too dense to know the guy I was crushing on wanted a kiss one night. He told a bunch of people I was a prude.

Of course when I did start kissing & stuff *ahem* it got around just as quickly.

Thinking back of all the whispers, the in my face accusations, the people who assaulted friends with accusations about me, the boyfriends' moms who didn't like me, and all that fabu stuff from high school...well if I had to add in Facebook, MySpace, Twitter, IMs, text messages...I think I would have killed myself. Or dropped out of school.

Considering that my mother would not have gone for the last option, I might be dead right now.

I have no words of advise for this very young woman. Yes, I could send a message that I've been there, I survived, but really, I can only image the hell she's in...that other girls are in today. Will it pass? Well, there's still college to get thru...

15 years post high school and I still have nightmares about all that happened. I can't recall when the last time I had one, but it's been in the last year.

I can't even allow myself to really stop and plan how I'll deal with this when my daughter is of kissing age. What technological bullying devices will she have to deal with?

Thursday, July 24, 2008

Sarah Conner

Brutal Women had an awesome post about Sarah Conner & other women who kick ass. This is even more interesting in light of Joss' recent Dr. Horrible series and the lack of a strong woman. Damn...lost the link to someone's good critique. If you know of one, please leave in the comments!

I don't have much else to add...just giving ya all a good things to mull over.

Maybe I'll name my new laptop Ripley. Sarah reminds me of the girls I went to high school with and well...

Google Knol Collaborative Knowledge Database = Universal Textbook of Medicine?

Google Knol is a free online collaborative knowledge database or an experts' wiki but not an encyclopedia. Knol is not a direct competitor of Wikipedia, at least not in its current version. Wikipedia is anonymous -- there is no single editor in charge. In contrast, Knol includes the author name in the URL of the article. Google expects multiple knols on one subject rather than the current Wikipedia model of one article on a subject. The term "knol" ("unit of knowledge") refers to both the project and an article in the project.

There is a definite focus on medical topics -- most of the 300 or so starting "knols" are disease-based and authored by doctors. Will Google Knol be the mythical universal textbook of medicine that Wikipedia never became (and was not meant to be)? UpToDate and eMedicine are close to that concept but UpToDate is prohibitively expensive and management-focused while eMedicine is limited in coverage.

Before you get too excited about Knol, the "universal textbook," have a look at its front page which lists a wide spectrum of topics: Type 1 Diabetes, Lung Cancer, Tooth Pain, and then suddenly, "Toilet clogs: Solutions for the most common problems."

Screenshot of Google Knol text editor -- much easier to edit than Wikipedia. Image source: Google Operating System, Creative Commons license.

Search Engine Land says that Knol is a service created by Google's search quality team. "I do believe Knol does solve a search problem. The problem we have, unlocking what people know and bringing it online. This is another tool to help release some of this knowledge," explains Cedric Dupont, the product manager for Knol.

Your name is behind your knol, and it should reflect your unique point of view. Be succinct, but comprehensive on your topic of choice. Provide references, and display your credentials. Readers will want to know who you are and gain context on the knols you are writing."

An expert-written medical knol. Image source: Google Operating System, Creative Commons license.

Selected medical knols:

The Hospitalist Model of Care: The Fastest Growing Specialty In Medical History by Robert Wachter (who else?)

Nasal Polyps by Andrew Murr, UCSF

Seasonal Allergies by Paul Nadler, MD, UCSF

Asthma by John Fahy, UCSF

Chronic Obstructive Pulmonary Disease (COPD) by Stephen C. Lazarus, UCSF

Urticaria by Alan Rockoff

According to Google Blogger Buzz:

"Knol may be used to complement your blog. Blogs are great for quickly and easily getting your latest writing out to your readers, while knols are better for when you want to write an authoritative article on a single topic. The tone is more formal, and, while it's easy to update the content and keep it fresh, knols aren't designed for continuously posting new content or threading.

Except for the different format, you'll get all the things you've come to expect from Blogger in Knol. Like Blogger, Knol has simple web authoring tools that make it easy to collaborate, co-author, and publish. It has community features as well: Your readers will be able to add comments and rate your article, and, if you want, they'll be able to suggest edits that you can then either accept or reject. And, just like in Blogger, you can also choose to include ads from AdSense in your knols to perhaps make a little money.

One other important difference between Knol and Blogger is that Knol encourages you to reveal your true identity. Knols are meant to be authoritative articles, and, therefore, they have a strong focus on authors and their credentials. We feel that this focus will help ensure that authors get credit for their work, make the content more credible.

All in all, we think Knol will be a great new way for you to share what you know, inform people about an issue that is important to you, raise your profile as an expert in your field, and maybe even make some money from ads."

Video: Knol From Google.

References:
Google Knol Is Live. Blogoscoped.
Share Your Expertise in Google's Knol. Google Operating System.

Related:
The Difference Between Google Knol & Wikipedia Encyclopedia. Digital Inspiration.
Google Knol - Quick Start Guide. Digital Inspiration.
Will Knols and Blogs Upend the Cozy World of Medical Publishing? Wachter's World.
Google vs Wikipedia? No. ScienceRoll.
Is Google a Media Company? NYTimes, 08/2008.

Update 2011:

Abandoned Knol - Google Knol homepage says a lot about the current state of the project http://goo.gl/QwHl1

Wednesday, July 23, 2008

Content of Weblogs Written by Health Professionals: More Bad than Good?

It seems like there are few (if any) positive news stories and studies about medical blogs nowadays. Most of the coverage focuses on breaching patient privacy and inappropriate product endorsements rather than on the way blogs can be used for medical education and interactive learning. As a regular reader of 30-40 medical blogs and author of 3, I am first to admit the medical blogosphere has its problems. John Sharp from the IT department of the Cleveland Clinic and I worked on institutional guidelines for medical blogs in 2005-2006 and I gave it quite a bit of thought during the years.

The most current negative story is from the Journal of General Internal Medicine and, as you may have guessed it, none of the authors seems to have a blog:

Content of Weblogs Written by Health Professionals (full-text PDF hosted by Pharmalot).

Tara Lagu, MD, MPH, Elinore J. Kaufman, David A. Asch, MD, and Katrina Armstrong, MD, MSCE.

The authors identified 271 medical blogs. Over half (56.8%) of blog authors provided sufficient information in text or image to reveal their identities. Individual patients were described in 114 (42.1%) blogs. Patients were portrayed positively in 43 blogs (15.9%) and negatively in 48 blogs (17.7%). Of blogs that described interactions with individual patients, 45 (16.6%) included sufficient information for patients to identify their doctors or themselves. Healthcare products were promoted, either by images or descriptions, in 31 (11.4%) blogs.

The authors concluded that blogs risk revealing confidential information or, in their tone or content, risk reflecting poorly on the blog authors and their professions. The health professions should assume some responsibility for helping authors and readers negotiate these challenges.

They give plenty of examples and link to 16 blog addresses. Somehow the study authors missed some of the most popular medical blogs such as Kevin, M.D., Medgadget and GruntDoc. May be because they used commonly acceptable language or were not controversial enough but, really, how can you write about medical blogs and miss Kevin, M.D.? The guy is on the front page of Google results for both "medical blog" and "medical blogs" (we are a little bit down the list but still there). Update from 07/26/2008: Dr. RW pointed out that the authors quoted one of my posts as an example to follow in the article references: How to write a medical blog and not get fired? I guess I could be considered one of the "good guys."

These are a few quotes chosen by the study authors to highlight the content of medical blogs:

“The unwritten definition of proper patient: attached to a
breathing machine, a lot of wires and completely sedated
or even paralyzed.” Adrenalin Rush

“She was a stupid, lazy, selfish woman all of which
characteristics are personal problems, not medical
issues or barriers to care” Panda Bear MD

The quotes are obviously taken out of context but they still sound troubling. However, there are many stories of great patient care, self-sacrifice and compassion published on medical blogs but somehow they escaped the search strategy of the study authors.

Tips for Medical Bloggers

- Write as if your boss and your patients are reading your blog every day
- Comply with HIPAA
- List your name and contact information
- If your blog is work-related, it is better to let your employer know
- Inquire if there are any blogging guidelines. If there are, comply with them strictly
- Use a disclaimer, e.g. "All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."
- Get your blog accredited by the Heath on the Net Foundation

References:
Content of Weblogs Written by Health Professionals. Journal of General Internal Medicine.
Doctor Blogs Reveal Patient Info & Endorse Products. Pharmalot.
Why Physician Blogs Close Down?
Topics Discussed During the Medicine Consult Service Rotation at Cleveland Clinic in March/April 2008
Dr Flea Blogged His Malpractice Trial, Settles When Outed
Using a Blog to Build an Educational Portfolio
Medical Blog Closed Down by Request of Employer
NPR: Doctor Blogs Raise Concerns About Patient Privacy
Simply Fired - How NOT to Blog About Your Job. Especially If You Are a Doctor

Related:
Should physician blogs be held to a higher standard? Kevinmd.com.
Medical blogosphere subject of Journal of General Internal Medicine study. Notes from Dr. RW.
Another medical journal piles on. Notes from Dr. RW, 08/2008.
What is a blog? Robert M Centor, 08/2008.

As A Busy Physician, Why Do I Even Bother Blogging? http://goo.gl/fSF3 - Excellent summary.

Updated: 08/07/2008

What to Buy Wednesday – Baby sling/carrier

The item I miss using the most from when my daughter was a baby is the baby sling & the Bjorn.

I miss having her so close to me; I miss her being small enough to fit into the darn things!

Now baby slings are associated with granola moms or attachment parenting. Sure, they strap their babies to them, but I have to tell you, you are going to want to have that carrier, especially if the baby comes during nice weather (spring – fall). I put my daughter in the Bjorn to take a walk, to walk around the apartment to get her to sleep, and well anytime I wanted to use both my hands, I put her in there.

My daughter certainly lived up to the theory that babies like to be close to you. Heck, she's almost five and she still wants to be next to us.

I also used a wrap sling. It wasn't as easy to use as the Bjorn, but I'm sure that was because I didn't use it enough to learn all the tricks.

In the end, the carrier was quite a life saver. So send your friend this perfect gift.

Technorati tags: What to Buy Wednesday, motherhood, parenthood, gift

Clinical Case: Antibiotics for Periodontal Disease (Gingivitis)

A 37-year-old male with moderate periodontal disease asks his physician about antibiotic treatment.

What are the indications and antibiotic options?

Read the rest here: Antibiotics for Periodontal Disease (Gingivitis) at ClinicalCases.org.

Image source: Cross-section of a tooth with visible gums, or gingiva, Wikipedia, GNU Free Documentation License.

Tuesday, July 22, 2008

Work it, Mom Monday on Tuesday

Apologies for not posting until today, but Monday was jam packed with work & fun.

You can see this week's Work it, Mom post where I ponder whether or not moms really can be green. Being a mom myself I know that convenient-sized items really do make a difference in my life. Can I cut them out? Can others?

I also posted to Chicago Parent about why I applied to the Progressive Women's Voices program.

I am freaking about what to wear this weekend. Thankfully I did get a haircut on Friday, a new work tote on Sunday, I'm getting my nails done today, and Cinnamon's putting the finishing touches on a new purse for me. Um yeah…I was already in the process of a "grown up make-over" and this trip just put that plan into high gear. I love my totes & messenger bags I do have (seriously, see how loved they are!), but I know that I needed to upgrade for work.

And this video is sooooo me. Love it!

Book Review: You’re Amazing!

If you could be 13 again, would you?

I would if I could bring You're
Amazing! A No-Pressure Guide to Being Your Best Self by Claire Mysko with me. I'm not exaggerating or sucking up to Claire, whom I met at WAM!. I don't think high school would had been too much different, but I would had felt far less lonely.

Mysko discusses body image, stress and stereotypes with the sensitivity of a loving big sister or that cool older cousin. She opens each chapter with data from the Girls Inc. The Supergirl Dilemma report (Girls Inc produced this book). While it is a source of many depressing moments (e.g. 84% of girls said that girls are under a lot of pressure to dress the right way.), it does set a starting point. Mysko goes on to discuss strategies for the girls in order to overcome obstacles and meet challenges. She also includes conversation starters for approaching trusted adults. The book is frank and doesn't talk down to the girls. Like any good "self-help" book it has activities to reach out adults and include BFFs in the discussion.

The only qualm I had with the book was within the discussion on bullying. One example of being bullied included being called "gay". While this is a top slam on the playground, I fear that a questioning girl may wonder if it really is the ultimate put down. Thankfully there is a listing for the Gay, Lesbian, and Straight Education Network in the resource section.

If you are a parent and thinking of buying this for your daughter – DO IT. I would suggest either reading it first or buying yourself a copy. Mysko suggests ways for the girls to start conversations with you – Be Prepared. The questions may be as simple as "What did you want to be when you were my age?" or as difficult as "How did you handle peer pressure?" I will advocate for using honesty and not to dodge the conversation because that's what I am for with my daughter. Yet I also know sometimes we do a little of both – some truth, some dodging. Do your best and treat her with respect.

I know raising girls is a tough guy, hopefully You're Amazing will make the uncharted territory a bit less scary.

You can purchase You're Amazing through an indy bookseller, Powell's, or Amazon.

Disclaimer: The only payment I received for this review was the review copy of the book.

Girls Incorporated is a national nonprofit youth organization dedicated to inspiring all girls to be strong, smart, and bold. With roots dating to 1864, Girls Inc has provided vital educational programs to millions of American girls, particularly those in high-risk, underserved areas. Today, innovative programs help girls confront subtle societal messages about their value and potential, and prepare them to lead successful, independent, and fulfilling lives.
This post was scheduled to post on the 17th, but somehow didn't...so it's being reposted now.

Johns Hopkins Reality Series Available for Free Online Streaming from ABC

ABC has made available the full episodes of the short series "Hopkins" filmed at Johns Hopkins Hospital in Baltimore:

Hopkins, Episodes 1-5

Some time ago, I had the chance of interviewing (and being offered a position) at Johns Hopkins and my impression of the institution was very positive. The faculty seemed very focused on education. I have not visited the Mayo Clinic yet but after working at the Cleveland Clinic for a while, one have to admit that there is something special about the top 3-5 hospitals in the U.S. Obviously, they are doing something exceptional to stay at the top for so many years in a row.

Google Trends and Top Hospitals According to U.S. News and World Report

References:
Google Trends and Top Hospitals According to U.S. News and World Report
Image source: Commons.wikimedia.org.
Link via David Rothman.

Monday, July 21, 2008

Why you should look for an Independent financial advisor

Financial advice is plentiful but finding a good, independent financial adviser is a more difficult task. Not all of those who offer financial advice are independent, and even those who are often appear to be more interested in selling products than giving all-round financial advice.
So how do you find a good one? Most banks and building societies are happy to provide advice but they are tied agents, so they can only sell you the products of one company.

Tied Agents can advise only on the products of one provider.

Many people buy financial products through multi-tied agents or single tied, such as the sales staff who work at their bank or building society. When they want a pension or investment product, they often find it easier just to nip into their bank and accept what is sold through that organisation’s relationship with one or a few financial product providers.

The person providing you with product information are acting on behalf of the company they are employed by or have a tied relationship with. Many people buy products this way, usually because they feel more comfortable buying from a big-name organisation and assuming, sometimes incorrectly, that they are bound to get a good deal. What they are actually getting is limited information from a small selection of products.

So how do you find a good INDEPENDENT FINANCIAL ADVISOR?

If you choose to seek independent financial advice, don’t just go to the first Financial advisor you stumble across in a telephone directory. It is crucial to take more control of the process right from the start, to be sure you end up with the right independent financial advisor.

Here a list what you should do:

1. List and prioritize your financial needs and goals – retirement, college planning, investing.

2. Seek Referrals: Referrals from family, friends...

3. Set Up an interview: Once you have about 2 financial advisors from your selection, set up an interview: keep in mind your financial needs and goals.

4. Request a ADV Form: It means the advisor should have a Certificate of an Independent Financial Advisor (CFA or CFP).

5. Select the right Advisor for you and your family: Remember this person will be with you and will deal with your family in case you pass away. You should be confortable talking about your financial issues and, trust him/her.

Another issues you should consider:

Areas of Expertise: Some advisers focus on particular product areas, so take care to choose the right one for your specific needs. Some solicitors offer independent financial advice, as do stockbrokers and accountants, but you should realise that accountants, for instance, will probably be strongest on tax issues. If you know what sort of advice you require, then select an adviser who specialises in this area. If you want advice across a range of products, then select one who has strengths across the board.

Qualifications: You can select an Independent Financial Advisor based on their advanced qualifications across a range of products or across a particular product area.

You want an advisor that understands your goals, can recommend securities to fit your needs, that will help you allocate your assets, who possesses the proper credentials, and above all, someone in whom you can place your confidence.

What did they mean? Excerpts from discharge summaries, SOAP notes and more

Discharge Summaries

"Patient was a heavy alcoholic but now drinks a pint of whiskey every day."

"Final diagnosis: Foot drop secondary to mononeuropathies (cranial nerve)"

"Review of Systems: The patient refused to dress sometimes."

"The physical exam shows an alert, obese woman who is drowsy."

"She has a history of hypertension, of diabetes and recurrent DVT, even when fully anticoagulated with Coumadin, and for this reason she has had 11 surgeries including a right tibial fracture at age 16."

Job Interview

During a phone interview, a residency candidate replies to the question What made you study medicine?: "Initially, I really wanted to be a very good human being, but after that I chose medicine."

Diagnostic Dilemma

A nurse urgently pages a medical resident: "Mr. Doe's left half of the body is yellow!"

The resident was just about to order LFTs for jaundice workup over the phone when he realized that something did not sound right...

The patient had just returned from a left shoulder surgery and the "left side of the body" was cleaned with iodine.

Image source: OpenClipArt, public domain.

Sunday, July 20, 2008

Kos knows how to dance! The FISA dance that is..

Thanks to Yikes for showing me this video. Friends know that I have a "thing" about Kos and the fauxgressives that follow him.

Genetically Engineered Plants and The Future of Food Documentary

The Future of Food - Introduction

The Future of Food is a 2004 documentary film which looks into unlabelled, patented, genetically engineered foods that have made their way onto grocery stores in the United States for the past decade. Source: Wikipedia.

Interviews with Deborah Koons Garcia, producer of the documentary film The Future of Food are available from Google Video and YouTube. Ms. Koons is the widow of the late Jerry Garcia (August 1, 1942 – August 9, 1995) who was the leader of the legendary rock band the Grateful Dead.

The Future of Food: What Every Person Should Know with Deborah Garcia, 57 min, Nov 21, 2006, The Massachusetts School of Law at Andover.

Saturday, July 19, 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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From All Walks of Life — Nontraditional Medical Students and the Future of Medicine.
NEJM, Volume 359:224-227 July 17, 2008 Number 3

"When I entered medical school at 26, I was considered to be a nontraditional student — but I was hardly alone."

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Long-Term Medical and Social Consequences of Preterm Birth: Significant.
NEJM, Volume 359:262-273 July 17, 2008 Number 3

Advances in perinatal care have increased the number of premature babies who survive. There are concerns, however, about the ability of these children to cope with the demands of adulthood. In a cohort of 903,402 infants in Norway, the risks of medical and social disabilities in adulthood increased with decreasing gestational age at birth.

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Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet.
NEJM, Volume 359:229-241 July 17, 2008 Number 3

Mediterranean and low-carbohydrate diets (Atkins) may be effective alternatives to low-fat diets. There was a more favorable effects on lipids with the low-carbohydrate diet, and on glycemic control with the Mediterranean diet.

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Moderate-to-Vigorous Physical Activity From Ages 9 to 15 Years: Decreasing.
JAMA. 2008;300(3):295-305.

Decreased physical activity plays a critical role in the increase in childhood obesity. At least 60 minutes per day of moderate-to-vigorous physical activity (MVPA) is recommended. In a study cohort of 1000 children, measured physical activity decreased significantly between ages 9 and 15 years.

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Lipids, lipoproteins, and apolipoproteins as risk markers of myocardial infarction in 52 countries (the INTERHEART study): a case-control study.
The Lancet 2008; 372:224-233.

Whether lipoproteins are better markers than lipids and lipoproteins for coronary heart disease is widely debated. In a study of 12,461 AMI cases, the non-fasting ApoB/ApoA1 ratio was superior to any of the cholesterol ratios for estimation of the risk of acute myocardial infarction in all ethnic groups, in both sexes, and at all ages, and it should be introduced into worldwide clinical practice.

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Effect of dimebon on cognition, activities of daily living, behaviour, and global function in patients with mild-to-moderate Alzheimer's disease: a randomised, double-blind, placebo-controlled study.
The Lancet 2008; 372:207-215.

Dimebon was safe, well tolerated, and significantly improved the clinical course of patients with mild-to-moderate Alzheimer's disease. Dimebolin Hydrochloride (Dimebon) is an antihistamine drug which has been used clinically in Russia since 1983.

Ginkgo biloba and fish oils through lecithin and vitamin concoctions supposed to aid concentration, improve memory, and boost IQ. Sadly, a cool look at the evidence suggests that none are particularly helpful.

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Statins for children?
The Lancet 2008; 372:178.

The American Academy of Pediatrics has issued new guidelines on cholesterol screening and treatment recommendations in childhood: a fasting lipid profile is recommended between the ages of 2 and 10 years for children with a family history of high cholesterol or premature heart disease.

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The First Use of Penicillin in the United States.
Ann of Int Med 15 July 2008 | Volume 149 Issue 2 | Pages 135-136

The first use of penicillin in the United States occurred in 1942 and saved a moribund patient who had β-hemolytic streptococcal sepsis.

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Prehypertension during Young Adulthood Leads to Increased Coronary Calcium Later in Life.
Ann of Int Med 15 July 2008 | Volume 149 Issue 2 | Pages 91-99

High blood pressure in middle age is a well-established risk factor for cardiovascular disease, but the consequences of low-level elevations during young adulthood are unknown. Prehypertension during young adulthood is common and is associated with coronary atherosclerosis 20 years later. Keeping systolic pressure below 120 mm Hg before age 35 years may provide important health benefits later in life.

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Bullous pemphigoid and pemphigus vulgaris—incidence and mortality in the UK: Increasing.
BMJ 2008;337:a180.

The median age at presentation for bullous pemphigoid was 80 years, and 61% of patients were female. The median age at presentation for pemphigus vulgaris was 71 years, and 66% of patients were female. Incidences of bullous pemphigoid and pemphigus vulgaris were 4.3 and 0.7 per 100 000 person years. Incidences of bullous pemphigoid and pemphigus vulgaris are increasing. Both disorders are associated with a high risk of death.

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Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study.
BMJ 2008;337:a171.

In this cohort of 970 patients with acute low back pain in primary care, prognosis was not as favourable as claimed in clinical practice guidelines. Recovery was slow for most patients. Nearly a third of patients did not recover from the presenting episode within a year.

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Studying medicine in China.
Student BMJ 2008;16:235 | 18.

A British medical student discovered some surprising similarities on a recent visit.

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Relation of iron and red meat intake to blood pressure: cross sectional epidemiological study. BMJ 2008;337:a258.

Non-haem iron has a possible role in the prevention and control of adverse blood pressure levels. An unfavourable effect of red meat on blood pressure was observed: red meat intake was directly associated with blood pressure; 102.6 g/24 h (2 SD) higher intake was associated with 1.25 mm Hg higher systolic blood pressure.

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A time efficient way 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. Subscribe to the RSS feeds of the 5 major medical journals (NEJM, JAMA, BMJ, Lancet and Annals) plus 2-3 subpecialty journals in your field of interest.