Sunday, February 28, 2010

COX-2 inhibitor can prevent "religious headache" during fast

Every year, millions of observant Jews fast on their holiest day, Yom Kippur, and millions of Muslims fast for the month of Ramadan. And every year, as many as 40% of those who fast develop serious headaches.

Yom Kippur headache is a well documented phenomenon but the causes are unclear, but doctors have suspected withdrawal from caffeine, nicotine, oversleeping, and dehydration.

About 36% of subjects who took COX-2 inhibitor etoricoxib (related to Vioxx) developed headaches, compared to about 68% who took placebo. Those who took etoricoxib also had less severe headaches, and they had an easier time fasting.

References:
Could Vioxx cousin prevent religious fast headache? WebMD.
Image source: Etoricoxib, Wikipedia, public domain.

Saturday, February 27, 2010

Changes in the childhood immunization schedule for 2010

From WebMD:

- Gardasil human papillomavirus vaccine is now suggested for boys. Previously recommended only for girls.

- There are 2 new recommendations for boosting the bacterial meningitis vaccine: children at high risk should get the shot as early as age 2 and as late as age 6. Children not at high risk should get the first shot at age 11 or 12 (or ages 13 to 18 if not previously vaccinated).

- Preference for combination vaccines over separate injections of vaccine components.



CDC, Get The Picture: Child Immunizations.

References:
New Schedule for Childhood Vaccines. WebMD.

Friday, February 26, 2010

Google Buzz "antisocial networking" exposed details of “estranged spouses, current lovers, attorneys and doctors”

From Google: Antisocial networking. FT.com:

At the root of the problem is Google’s decision to use Gmail, with its 175m active users, as a launchpad for its latest push into social networking. All users were enrolled as soon as they clicked a link to look at the service, and many found the names of those they corresponded with most frequently by e-mail – usually a private list – became the basis for a public “social network” of contacts on Buzz. That risked exposing the details of “estranged spouses, current lovers, attorneys and doctors”.



Doctors should be very cautious when using social media to communicate with patients. In general, "friending" patients on Facebook, Buzz and Twitter is not a good idea at the current level of social network services, and is best avoided.

It may be irresponsible to answer patient questions on blogs, Twitter, Buzz and Facebook because no complete data for an informed evaluation and decision can be collected.

Chronic sleep loss decreases performance - One night of good sleep is not enough to recover from chronic sleep deficit

On average, a person needs about eight hours a night to preserve performance.

Acute sleep loss is being awake for more than 24 hours in a row and chronic sleep loss is getting only about four to seven hours of sleep per night.

While most people caught up on acute sleep loss with a single night of 10 hours sleep, those with chronic sleep loss showed deteriorating performance for each hour spent awake.

People are largely unaware that they are chronically sleep-deprived but they are more vulnerable to sudden sleepiness, inattentiveness, and potentially, accidents and errors.

Three days is not enough to recover from chronic sleep loss, but they still do not know how many days or weeks may be needed.

References:
Chronic sleep loss hampers performance. Reuters, 2010.
Image source: Sleeping kitten. Wikipedia, Tilman Piesk, public domain.

Thursday, February 25, 2010

Eric Topol: The wireless future of medicine (TED Talks)



Eric Topol says we'll soon use our smartphones to monitor our vital signs and chronic conditions. At TEDMED, he highlights several of the most important wireless devices in medicine's future -- all helping to keep more of us out of hospital beds.

Vehicle Exhaust = Second-hand Smoke?

From the NYTimes:

Exhaust from cars and trucks exacerbates asthma in children and may cause new respiratory illnesses and heart problems in adults, even resulting in deaths.

The meta-analysis included 700 peer-reviewed studies on varying aspects of motor vehicle emissions and health. It found “evidence of a causal relationship,” but not proof of one, between pollution from vehicles and impaired lung function and accelerated hardening of the arteries.

The study found that the biggest effects occurred among people who lived within 300 to 500 meters — about two-tenths to three-tenths of a mile — from highways and major roads. That applies to 30-40% of the population of North America.

“Like the issue of second-hand smoke, it’s very difficult to understand the exact mechanisms that make it bad — but it’s easy to understand that it is in fact bad.”

References:
Report Links Vehicle Exhaust to Health Problems. NYT, 2010.
Worldwide, 40% of children, 33% of male non-smokers, 35% of female non-smokers are exposed to second-hand smoke http://goo.gl/xFGef
Heavy traffic, Wikipedia, GNU Free Documentation License.

Wednesday, February 24, 2010

Physicians and social media - ACP Hospitalist features Dr. Rob

From ACP Hospitalist:

"Dr. Lamberts’ words aren’t just vanishing into cyberspace. His blog, Musings of a Distractible Mind, gets about 20,000 visitors who view 50,000 pages a month, according to his own analytics data. By the end of 2009, his list of Twitter followers numbered nearly 1,500 and counting.

Today’s physicians have an ever-expanding number of social media vehicles through which to express themselves. Tools like Twitter, Facebook and blogging can potentially help physicians better educate and interact with patients, perhaps even humanizing themselves in the process. But mishandling that powerful online megaphone can potentially risk, or at the very least blur, the doctor-patient relationship, according to social media-savvy physicians.

Initially, when he was virtually unread, Dr. Lamberts said he blogged about a few interesting cases, always cloaking the patient details. But he soon halted that practice."

I follow a similar approach described in detail in the website disclaimer:

"There is no real life patient data on this website. Please note: we do not write or “blog” about patients. All case descriptions are fictional, similar to the descriptions you can find in a multiple choice questions textbook for board exam preparation. Cases course and description do not follow real cases."

http://clinicalcases.org/2002/01/disclaimer-and-terms-of-use-agreement.html

Image source: OpenClipArt.org, public domain.

Related:

Why keep blogging on health topics?

Dr. Mike Cadogan, an ER physician and an award-winning medical blogger, in essence asked on Google Buzz: "Why keep blogging on health topics?" See his post and the comments below:

Dr. Mike Cadogan

Some days I worry about being so connected on the web. Some days I feel I should just treat the patient physically in front of me and concentrate the years of contextual learning on the individual consulting me for treatment.

Then I stumble across a pixellated torrent of self-diagnosing, non-contextual, copy-paste tripe (on some website)...

Question: "i am feeling so much…itching in my breast….that i have scratched it and it has converted into a wound….i hav used antiseptic cream also it cured my wound but again i feel itching…plz tell me some solution to get rid of it plz…..and i am so… confused…..plz help me…."


Informed Answer: "If you had breast cancer, you would see and feel a lump (cancerous tumor). You probably just got bit by a bug or something."

...and I feel justified for attempting to join with colleagues in providing open source medical information visually enhanced for contextual learning and iteration...

Ves Dimov, M.D.

Don't make web publishing feel like a job. Slow down. Relax. Enjoy. The work on the web as a physician is extremely important because it provides credible information.

Chris Nickson

I agree - the enormous accessibility of web resources almost makes it a moral imperative to put quality information out there - because, like it or not, people are turning to the web for their information needs.

Nearly everyone in the U.S. carries BPA - the chemical may increase risk of heart disease

From WebMD:

More than 90% of Americans carry the plastics chemical BPA in their bodies. But those with the highest BPA levels have the highest risk of heart disease.

BPA -- bisphenol A -- is one of the world's most heavily produced chemicals used to make PVC pipes, epoxy resins that line food cans, food packaging, and drink containers.

There's no way to avoid BPA entirely: It's in food, water, and air.

Some ways to reduce exposure to BPA:

- Don’t microwave polycarbonate plastic food containers. Polycarbonate containers that contain BPA usually have a No. 7 on the bottom.

- Reduce your use of canned foods. Eating just one canned soup/day for 5 days leads to 1,000% increase in bisphenol A (BPA) in the urine (WebMD, 2011).

- When possible, opt for glass, porcelain, or stainless steel containers, particularly for hot food or liquids.


There are seven classes of plastics used in packaging applications. Type 7 is the catch-all "other" class, and some type 7 plastics are made from bisphenol A monomer. Type 3 (PVC) can also contain bisphenol A as an antioxidant in plasticizers.

Types 1, 2, 4, 5, 6 do not use bisphenol A during polymerization or package forming.

References:

BPA May Be Linked to Heart Disease Risk. WebMD.
Controversy continues over safety of bisphenol A - Type “bisphenol A” (BPA) in PubMed & you get more than 6000 results. Lancet, 2011.
Exposures to dioxins and PCBs are associated with reduced growth during the peripubertal period http://goo.gl/w0WBO
Gestational BPA exposure affected behavioral and emotional domains at 3 years of age, especially among girls. Pediatrics, 2011.
Image source: Bisphenol A. Wikipedia, public domain.

Related:

Tuesday, February 23, 2010

Eyes Can Absorb Antioxidants From Green Tea, Which May Have a Protective Effect (In Rats)

Researchers fed laboratory rats green tea extract and then analyzed their eye tissues.

The results showed that different parts of the eye absorbed varying amounts of catechins. The area with the highest concentration of catechins was the retina, which is the light-sensing tissue that lines the back of the eye.

Antioxidant activity lasted for up to 20 hours after drinking green tea extract.

This is an animal study and we have no evidence that the same effect takes place in humans.
Coffee vs. Tea - Infographic of Health Benefits and Risks http://goo.gl/StIsr
Image source: Green Tea leaves in a Chinese gaiwan. Wikipedia, Wikimol, Creative Commons Attribution ShareAlike 2.5 License.

Study: Protective role of lower body fat is striking, or how pear is better than apple

From Reuters:

People who accumulate fat around the abdomen and stomach are more likely to die of heart disease and other causes than bottom-heavy people.

People with fat in their thighs and backsides may live longer because the fat traps harmful fatty particles and actively secretes helpful compounds.

Fat on the bottom and thighs appears to store excess fatty acids. Pear-shaped people also appear to have lower levels of compounds called inflammatory cytokines.

Leg fat may also be better at producing hormones such as leptin, which are made by fat and affect appetite and metabolism.

References:
Why those fat thighs may help you live longer. Reuters, 2010.
Image source: Williams pear, 1822 printing from the Horticultural Society of London. Wikipedia, public domain.

Monday, February 22, 2010

Health News of the Day

25% of stroke patients die within a year

25 percent of people who had a stroke died within a year and 8 percent had another stroke within a year. They said 50 percent either died or had another stroke or a heart attack within four years.

http://www.reuters.com/article/idUSTRE61E4TD20100215

Girls' involvement in team sports can mean lifelong improvements in educational, work and health prospects. NYTimes.

Counting Sheep Does Not Help You Fall Asleep

Subjects took slightly longer to fall asleep on nights they were instructed to distract themselves by counting sheep or were given no instructions at all. But when they were told to imagine a relaxing scene — a beach, for example — they fell asleep an average of 20 minutes sooner. Don’t count sheep; instead, try picturing relaxing images.

http://www.nytimes.com/2010/02/16/health/16real.html

Non-hospitalized patients dealing with an IBD flare-up are 16 times more likely to suffer a blood clot in a vein

http://www.reuters.com/article/idUSTRE61E4ON20100215

China discovers doughnuts — with salmon

"Patrick Lin is sure he can succeed where others have failed, and get the Chinese hooked on doughnuts. Doughnuts are shaped like pearl bracelets, and toppings include ham and cheese, red spaghetti sauce, salmon, spicy beef and seaweed flakes. "Dunkin' Donuts has dropped the sugar level as the Chinese, like Taiwanese, don't like snacks that are too sweet," she said. "It has also added new varieties, such as one with pork." Chinese newspapers don't have a word for doughnuts and call them "tian tian quan" or "sweet, sweet rings."

http://www.msnbc.msn.com/id/35394535/ns/business-consumer_news

Image source: OpenClipArt.org, public domain.

Subscribe and Connect by clicking on the buttons below:

Using Google Docs to facilitate patient flow in a health center via a shared spreadsheet

From Google Docs Blog:

"It is difficult to keep track of which patients are in which rooms, how many patients are in the waiting room, and how far the doctors are falling behind with their patients for the day. If patients were late, canceled their appointments, or the waiting room was overflowing, the doctor would be the last to know."

As an experiment, Southeast Health Center incorporated the “Check-in Tracker”, a shared spreadsheet on Google Docs, into their clinic flow which you can see a sample of below:


Image source: Google Docs Blog.

"When a patient checks in at the front desk, the clerk types “a” into the slot where that patient was scheduled. Using the “change color with rules” function, that slot turns orange to let everybody in the clinic know that Dr. Mark’s 8:15 AM patient has arrived. If the 8:55 AM patient arrives at 9:15 AM, the front desk types in “L 9:15” into that slot and the slot turns pink. Dr. Mark can look at the Google spreadsheet and type an “x” if he is unable to see the late patient or “ok” if he has time to see the patient. Patients in rooms turn green and indicate which room number. Discharged patients turn blue.

Everybody communicates in real time, because we are all signed into the same account."

References:
Using Google Docs to facilitate patient flow in a community health center. Google Docs Blog.

Friday, February 19, 2010

Winners of 2009 Medical Weblog Awards

Best Medical Weblog of 2009 is Gary Schwitzer's HealthNewsReview Blog.

Best Clinical Weblog of 2009 is Life in The Fast Lane, last year's winner of Best New Medical Blog award.

For the second year in a row, Bertalan Meskó's ScienceRoll is the Best Medical Technologies/Informatics Weblog.

Congratulations to all winners, participants, voters, readers and organizers!

See the winners in the other categories here: 2009 Medical Weblog Awards Sponsored by Epocrates: Meet the Winners!

Image source: Medgadget.com.

AP Video: Chopstick Pierces Toddler's Brain in China (Recovered After Surgery)



A 14-month-old toddler was playing in the kitchen when he fell, sending a chopstick up his nose. Surgeons were able to remove the chopstick.

Superficial Venous Thrombosis Linked to Increased Risk of "Deep" Venous Thromboembolism for Months

Superficial venous thrombosis (SVT) is perceived to have a benign prognosis.

Among 844 patients with SVT, 24.9% also had deep venous thrombosis (DVT) or symptomatic pulmonary embolism.

Among 600 patients without DVT or pulmonary embolism at inclusion who were eligible for 3-month follow-up, 10.2% developed thromboembolic complications at 3 months despite 90.5% having received anticoagulants:

- pulmonary embolism 0.5%
- DVT 2.8%
- extension of SVT 3.3%
- recurrence of SVT 1.9%

A substantial number of patients with SVT exhibit venous thromboembolism at presentation, and some that do not can develop this complication in the subsequent 3 months.

References:
http://www.annals.org/content/152/4/218.short
Image source: Saphenous vein, Gray's Anatomy, 1918 (public domain).

Thursday, February 18, 2010

Tobacco Smoke by Any Other Name Is Still as Deadly: Association of Pipe and Cigar Use With Cotinine Levels, Lung Function, and Airflow Obstruction

In a study of 3528 participants, 9% reported pipe smoking, 11% reported cigar smoking, and 52% reported cigarette smoking.

Self-reported current pipe and cigar smokers had elevated urine cotinine levels compared with never-smokers.

Participants who smoked pipes or cigars had increased odds of airflow obstruction.

Pipe and cigar smoking increased urine cotinine levels and was associated with decreased lung function and increased odds of airflow obstruction, even in participants who had never smoked cigarettes.

References:
http://www.annals.org/content/152/4/201.short
http://www.annals.org/content/152/4/259.short
Image source: Wikipedia, public domain.

3 elements of good health: exercise, nutrition and stress reduction



Mayo Clinic video: Looking to start the new year off healthy? Dr. Larry Bergstrom, an integrative medicine specialist at Mayo Clinic in Arizona, explains the 3 elements of good health:

1. exercise
2. nutrition
3. stress reduction.

Related reading:

Minimum amount of physical activity for reduced mortality and extended life expectancy: 15 minutes a day or 90 minutes a week. Lancet, 2011.

Forming a healthy habit is a marathon, not a sprint - start small, the 66th time's the charm. Chicago Tribune, 2011.

Wednesday, February 17, 2010

Google Buzz from a medical blogger's perspective

The blog post below was brought up by the following discussion:

Ves Dimov, M.D. - Observation: The more seasoned doctors are just joining Twitter at a time when "everybody" is leaving for Google Buzz... :)
Anne Marie Cunningham - I disagree! Twitter is still much more useful for me.
Ves Dimov, M.D. - Twitter is useful because of the great community you can find or establish there. The technical side - not so much.
Jeffrey Benabio, MD - What's your early take on Buzz, Ves?

And here it is:

Google Buzz works surprisingly well for me at this point. Considering that everybody was saying that Google "does not get social media", I did not expect that.

With Buzz, I can finally publish longer micro-blog updates on science and health news that are "blog-able", i.e. they can be used for blog posts later.

Buzz is integrated with Google Reader and has a somewhat more "human feel" than Twitter.

You can edit your posts and attach images. It's a richer media application - for example, BBC podcasts can be played directly from the Buzz update.

The quality of comments is much better on Buzz than on blogs or Twitter one-sentence replies - it is probably because people use their real names tied to a Gmail account.

The Buzz updates are fully searchable - Twitter only searches the last 7 days.

Google Buzz copied some features of Friendfeed, Facebook and Twitter. Google is committed to improving it - it's a very important product for them - make or break, in fact, considering the competition from Facebook. Buzz will be an interesting service to work with.

The adoption rate surpassed all expectations but it is still too early to say - a community is what makes a social network successful. Will see what the future brings.



Comments:

Jeffrey Benabio, MD - Insightful comments. I am stumbling through, but fell Buzz allows for higher quality interaction at "cost" of lower volume.

Arin Basu - Good point, Jeffrey. Also, if you may have noted, you cannot get "buzz" as RSS feeds, cannot mark favourite "buzz"es, cannot hashtag them, etc. Seems to me buzz and tweets belong to two different styles & perhaps each can complement the other. For example, write a longer buzz (or identify a nice buzz, note its url, shorten it, post to twitter, and hastag it for later retrieval). Something like that.

Nicholas Genes - I'm with Ves. Twitter and it's 140-char limit were designed with phones circa 2006 in mind. Buzz was designed with modern smartphones in mind. In a few weeks or months when third-party apps and integration catches up, Twitter will seem hopelessly primitive.

Karin Lewicki - Problem is, I'd been using Twitter for news and it seems perfect for that; 140 is a good limit for a headline and a link. The personal talk, meanwhile, if the most constricted was also the least interesting.

If Buzz takes us back from this new news space into more familiar gossip/chat space, I will be chalking it up as a loss.

People on statins are 9% more likely to develop diabetes according to a meta-analysis

From Reuters:

This small risk is outweighed by the drugs' heart-protecting properties but it could prompt a rethink among those with low cardiovascular risk factors who are tempted to take statins to prevent future heart disease.

"It will stop us putting statins in the water, as it were, and mean we give them when appropriate for the right reasons."

Lovastatin, a compound isolated from Aspergillus terreus, was the first statin to be marketed for lowering cholesterol. Image source: Wikipedia, public domain.

Statins are among the most successful drugs of all time and have been credited with preventing millions of heart attacks and strokes.

This Lancet meta-analysis included 13 large randomised controlled trials involving more than 91,000 patients.

Treating 255 patients with statins for 4 years would result in only one extra case of diabetes.

Giving statins to the same group would avoid 5.4 deaths or heart attacks over 4 years, and nearly the same number of strokes.

Clinical practice in patients with moderate or high cardiovascular risk or existing cardiovascular disease should not change.

References:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61965-6/fulltext

http://www.reuters.com/article/idUSTRE61G00P20100217

Related:
Statins Don't Cause Diabetes. Dr. Mintz' Blog.

Tuesday, February 16, 2010

Commonly used diabetes drug metformin smells bad and this may explain why many patients stop taking it

According to a new study, the diabetes drug metformin smells like fish or dirty socks to some people and this could account for the well-known side effects of the drug, which can make people nauseated.

But the problem could be solved by coating the pills so they do not smell or release the odor into the stomach, where it can be burped up.
Metformin. Image source: Wikipedia, public domain.

References:
http://www.reuters.com/article/idUSTRE61E54H20100215

Twitter vs. Google Buzz for team collaboration in medicine

A few thoughts from my conversation with the Australian ER physician and medical bloggger extraordinaire Mike Cadogan:

Dr Mike Cadogan - Taking advice from @scanman in the short term, and have disconnected Twitter to get a better feel of the Buzz thing. It was interesting to see the initial responses from colleagues about the tweets - but then they just got a bit overwhelmed watching one side fo a conversation and switched off. Instead I am trying to get them to join twitter...will see. Google seem to be highly responsive to change and I am enjoying the fluidity of teh Buzz response team at present

Ves Dimov, M.D. - Twitter is inferior platform to Buzz. Hardly suitable for conversation. Unless the Twitter team changes its structure, it will fade away and be replaced by Buzz and Facebook... I would get your colleagues to join Buzz instead and use the "group broadcasting" feature - it should work great for work collaboration as well.

Dr Mike Cadogan - It does feel nice to be able to add more context in the conversation, I will go that route!

Read more of our extensive coverage of Google Buzz at Web 2.0 and Social Media plus Medicine and CasesBlog.

How to post your Google Buzz updates on Twitter automatically

The 140 characters on Twitter are often not enough for science and medical news. Google Buzz does not have a low-number character limit, hence I am channeling the updates from Buzz to Twitter.

This is how to automatically post your Google Buzz updates on Twitter:

1. Go to your Google profile/Buzz and copy the RSS feed - click the orange icon in the browser address bar.

2. Paste the RSS feed in FeedBurner and "burn" a new feed.

3. Activate the "Socialize" function to Twitter. You must already have a Twitter account that you link to FeedBurner. Click "Publicize" tab at the top and then select "Socialize" from the left sidebar.

5. Choose "Body only" (not "Title") in the "Formatting Options" of the FeedBurner feed.

That's all. All your Google Buzz updates will be now posted on Twitter automatically.

You can find more detailed instructions here:
http://buzzusers.com/showthread.php?62-How-to-Publish-your-Buzz-to-Twitter

Comments:

Arin Basu - Nice suggestions.

I have noted that if you set up to autopost buzz to twitter this way and twitter is connected to buzz in your links area of the google buzz profile, then your buzz as tweets show up in Buzz and then get fed again as tweets (sort of a loop that keeps on going between twitter and buzz). One way to get rid of this is to remove the twitter link from buzz. However, if you then like to bring in your (and favourite ones from other people you follow) tweets into buzz, you cannot do that.

I like to link my twitter and my buzz together. One other thing I do to send my buzzes (and favourite/interesting buzzes) to twitter is to open the comment link, choose the material to email to my posterous (http://www.posterous.com) account. This allows me to send longer pieces as shortened urls to twitter (it maintains a copy on my posterous for occasional review of interesting links for work). I have linked my posterous with twitter, so one post to posterous (public view) allows me to post to twitter as well. However, it is not autopost.

For twitter to buzz is usually by way of retweets that show up in my buzz box.
I think buzz+gmail can be very conveniently used as a central hub of almost all incoming/outflowing communication (RSS, tweets, facebook updates, emails from other people and non-gmail accounts). Buzz with online document storage, & using services like posterous, also saves on bandwidth & data storage, and avoid unnecessary duplication.

Arin Basu - For buzz >> posterous >> twitter connection to work (corrected version),

1) you will need to post to posterous from your gmail account (presumably that has buzz on it).
2) You can just use posterous and simultaneously post to both buzz and twitter if your posterous account is also connected to buzz. To link your posterous account to buzz, do:
a) Add the following to the posterous "bio" section:
Your Name, etc
b) Then add your posterous URL to your google profile and click add
c) Next time when Google spiders your posterous account, hopefully it will add your posterous to your buzz profile and then you are all set
d) check your google buzz profile connected sites and add the posterous site if you want

3) There are a couple of ways to do that:
1) (long way): create a buzz post, then use the comments section to email the buzz post to twitter AT posterous dot com (remember again, your posterous and gmail must be the same)
2) Shorter way (if you have configured your twitter to connect to buzz as well): just send an email to twitter AT posterous dot com; the mail will appear at both buzz and twitter

A point to remember is: using buzz@gmail.com will send only your subject line to buzz.

There are many other ways to channel, pretty much using similar processes. These are quite flexible.

Updated: 02/17/2010

Monday, February 15, 2010

Some health bloggers feel uncomfortable with Google Buzz

@drval: "I'm actually going to stay away from Buzz for a while. I like keeping my email a separate world. Will jump in if it becomes relevant."

ePatientDave: "To me what Buzz means is that Google has permanently shown themselves not qualified to be in health data. Period."

EdBennett: "I'm moving away from all Google apps. it will take time and effort, but this latest gaffe has me worried"

I use Google for most of my online work and I am not planning to change this. However, I do appreciate an alternative point of view.



Comments:

Dean Giustini - Google is throwin' everything at us and I feel buried informationally. I also don't know the point of having Google Wave & Buzz in light of Twitter and all the microblogging aggregators. I never thought it would happen: I've reach info-sat (saturation).

Tim Sturgill - I understand the concern about privacy issue and what occurred with the start of Buzz, but I have some difficulty with the notion that such a wonderful free service (Google products) somehow equates to no personal responsibility. Any privacy "breaches" with the start of Buzz were totally preventable by beforehand looking at and managing your Google profile and reading the instructions that came with the Buzz start. Could Google have done better, sure.

The irony (having had my identity stolen in the hospital I work at and was a patient) -- I'll trust Google with private info, even health info, any day of the week over healthcare entities (without a lot of upfront scrutiny).9:15 pm

Ves Dimov, M.D. - The greatest benefit is that you can actually have a conversation on Buzz, include rich media included and use groups of people to collaborate.

Twitter is an inefficient way of exchanging one-liners. It's probably good for company customer service.

There is a big difference between Buzz and Wave. Buzz is simple micro-blog & network. Google Wave is a powerful collaboration platform in early beta.

Google Wave can replace both Gmail and Google Docs. It is not easy to comprehend for many users though and it is not very intuitive. On the other hand, Google Wave has the functionality but does not have the social network of Buzz and Gmail, hence both services are needed.

The information overload is another topic beyond the scope of this discussion. As I have mentioned, Twitter and Facebook are among the most inefficient ways of information consumption. Google Reader is one of the tools to work with large volumes of info but it is not very "social".

Tim Sturgill - Should have added, any new service (or add on to existing service) should be opt-in not opt-out. So on that score alone I believe Google blew it (but only to the extent you negate any personal responsibility or your persona on the web).

Ves Dimov, M.D. - I agree with you, Tim. Yet, obviously a lot of people feel differently about Google and online privacy in general and their scrutiny is welcome.

Tim Sturgill - Wave goes beyond the web, because of XMPP -- operate independent from the web. A very powerful transport capability is introduced with Wave.

C-reactive protein (CRP) associated with risk of coronary heart disease, stroke, vascular mortality, and death from several cancers and lung disease

Associations of C-reactive protein (CRP) concentration with risk of major diseases can best be assessed by long-term prospective follow-up of large numbers of people.

This Lancet meta-analysis included records of 160,309 people without a history of vascular disease from 54 long-term prospective studies.

Risk ratios (RRs) were 1·23 for coronary heart disease; 1·32 for ischaemic stroke; 1·34 for vascular mortality; and 1·34 for non-vascular mortality.

CRP concentration has continuous associations with the risk of:

- coronary heart disease
- ischaemic stroke
- vascular mortality
- death from several cancers and lung disease

The relevance of CRP to such a range of disorders is unclear. Associations with ischaemic vascular disease depend considerably on conventional risk factors and other markers of inflammation.

Is is still a topic of debate is whether CRP has a causal role in the development of cardiovascular disease.

However, even if CRP might not be involved in the causal pathway of atherogenesis and plaque rupture, it may still be a valuable tool in cardiovascular medicine.

In primary prevention, lovastatin therapy was more cost effective in people with increased CRP concentrations.

The JUPITER trial recently showed that, in people with relatively normal LDL cholesterol concentrations and CRP higher than 2 mg/L, rosuvastatin reduced cardiovascular risk. Even if CRP turns out to be not directly causal in cardiovascular disease, it might be useful to identify individuals at cardiovascular risk and to evaluate the efficacy of our preventing and therapeutic interventions.

References:
C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. The Lancet, Volume 375, Issue 9709, Pages 132 - 140, 9 January 2010.
C-reactive protein and cardiovascular risk: more fuel to the fire. S Matthijs Boekholdt a b, John JP Kastelein b. The Lancet, Volume 375, Issue 9709, Pages 95 - 96, 9 January 2010.
C reactive protein concentration itself is unlikely to be even a modest causal factor in coronary heart disease - BMJ, 2011. http://goo.gl/d5lCH
Image source: C-reactive protein. Wikipedia, GNU Free Documentation License.

Sunday, February 14, 2010

Coronary stent paper manual: All pages "intentionally" left blank



Video showing a Cordis Coronary Stent Paper Manual: There were no instructions in the manual... just pages "intentionally" left blank.

Saturday, February 13, 2010

Health News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in bullet-point format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day:

Junior Doctor Portal by the BMJ Group http://juniordoctor.bmj.com - Good idea but why no RSS feed? It looks like iGoogle or Netvibes.

Presentations and Health Education Videos by UTHSC http://goo.gl/czab

Obesity, glucose intolerance, and hypertension in childhood were associated with increased rates of premature death http://bit.ly/cjCpnp
How to Live 100 Years - TIME special report http://goo.gl/1XmH and http://goo.gl/iyAE - Long read but worth it.

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

Follow me on Twitter:

African trypanosomiasis - killer coma - the evolving story of sleeping sickness (Lancet review)

Human African trypanosomiasis (sleeping sickness) occurs in sub-Saharan Africa. It is caused by the protozoan parasite Trypanosoma brucei, transmitted by tsetse flies.

With 12,000 cases of this disabling and fatal disease reported per year, trypanosomiasis belongs to the most neglected tropical diseases.

Life cycle of the Trypanosoma brucei parasites. Source: CDC, Wikipedia, public domain.

The clinical presentation is complex, and diagnosis and treatment difficult. The available drugs are old, complicated to administer, and can cause severe adverse reactions.

Imagine a disease that starts with a fly's bite and ends in death. The first stage of this disease causes non-specific symptoms such as itching and joint pains. If left untreated, it progresses to the second stage weeks, months, or even years later in which the affected person displays dramatic neurological and psychiatric symptoms before slipping into a fatal coma.

New diagnostic methods and safe and effective drugs are urgently needed. There is no field-friendly diagnostic test.  Until recently, the most effective treatment for the second stage as almost as dangerous as the disease.

Vector control, to reduce the number of flies in existing foci, needs to be organised on a pan-African basis.

References:
[Seminar] Human African trypanosomiasis. Reto Brun, Johannes Blum, Francois Chappuis, Christian Burri. The Lancet, Jan 2010.
Killer coma: the evolving story of sleeping sickness treatment. The Lancet, Volume 375, Issue 9709, Page 93, 9 January 2010.

Friday, February 12, 2010

911 call: Eucalyptus drive?



Call transcript:

Operator: "911, what's your emergency?"

Man: "Yeah, my wife got attacked by a warthog really bad and I need someone to come up with an ambulance and pick her up."

Operator: "Okay sir can you give me an address?"

Man: "Yeah, we're at 1825 Eucalyptus Drive."

Operator: "Okay, can you spell that for me sir?"

Man: "Uh, I'm gonna drag her on over to Oak Street and you can pick her up there."

Source: http://failblog.org

Thursday, February 11, 2010

"Embrace Life" video will convince you to wear your seat belt



An original approach to road safety advertising from the Sussex Safer Roads Partnership.



References:

CNN, Feb 2010.
Road Safety in the UK TV PSA

Related reading:

World's fastest ever crash test: anyone who sees it will think twice about their speed the next time they drive. Daily Mail, 2011.

A Physician with a Smartphone: Endless Possibilities for Patient Care Improvement



"In this video, Ivor Ković, a physician from Croatia, talks about how he uses the iPhone in his daily medical practice. He shows how even simple technology (starting with SMS) changes work behavior of physicians and patients. He goes on to showcase some of the apps he uses and introduces us to "Little Anne". But the most interesting part of the video is possibly where Ivor shows his own innovation on how the iPhone can be used to deliver quality CPR."

There are several health-related talks from Mobile Monday Amsterdam 2010 available on YouTube at http://bit.ly/c0bMF0

Wednesday, February 10, 2010

How to live to be 100 - The Secret of the "Blue Zones"



"To find the path to long life and health, Dan Buettner and team study the world's "Blue Zones," communities whose elders live with vim and vigor to record-setting age. At TEDxTC, he shares the 9 common diet and lifestyle habits that keep them spry past age 100."

A Blue Zone is a region of the world where people commonly live active lives past the age of 100 years.

Five Blue Zones have been identified by Buettner:

- Sardinia, Italy
- The islands of Okinawa, Japan
- Loma Linda, California
- Nicoya Peninsula, Costa Rica
- Icaria, Greece


Venn Diagram of longevity clues from Okinawa, Sardinia, and Loma Linda. Image source: Wikipedia, public domain.

References:
Dan Buettner: How to live to be 100+
Blue Zone. Wikipedia.
Uncovering secrets to a longer life. CNN.

Maps:


View Larger Map


View Larger Map


View Larger Map


View Larger Map


View Larger Map

Video: Eating Healthy on a Budget



Eating Healthy on a Budget, from John La Puma, MD, author of ChefMD.

Tuesday, February 9, 2010

Health News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in bullet-point format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day:

Spending on health care in US is 17.3% of GDP, up from 16.2% in 2008 - largest percentage increase in 5 decades http://goo.gl/IZE4

People who drank 2 or more soft drinks a week had an 87% increased risk of pancreatic cancer http://goo.gl/DcXd

Thirdhand Smoke (tobacco smoke residue) Creates Indoor Cancer Risk. Nicotine reacts with indoor air pollutant to form carcinogenic compounds called tobacco-specific nitrosamines (TSNAs) http://bit.ly/cRpb4r

Mediterranean diet may help prevent dementia - CNN http://bit.ly/a9lGLb

Latrepirdine (Dimebon) - oral medication developed for Alzheimer's - may also help patients with Huntington's chorea http://bit.ly/aAs3Uo

Paroxetine use during tamoxifen treatment is associated with an increased risk of death from breast cancer - BMJ http://goo.gl/9hHn
Crestor (rosuvastatin) Wins Approval as a Drug to Prevent Heart Disease in People with Normal Cholesterol Levels. Cheaper generic versions of Lipitor are expected in late 2011 http://goo.gl/2LLO      

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

Follow me on Twitter:

Cleveland Clinic Adoption of Web 2.0 - Slideshow by John Sharp

"While social media strategy continue to evolve, new opportunities present themselves. Particularly significant shifts are toward participatory medicine and e-patients."

References:
Interview on Social Media by John Sharp.

Monday, February 8, 2010

Faces of America - PBS Series



Faces of America premieres nationally Wednesdays, February 10 - March 3, 2010 on PBS: "What made America? What makes us? These two questions are at the heart of the new PBS series Faces of America with Henry Louis Gates, Jr. who turns to the latest tools of genealogy and genetics to explore the family histories of 12 renowned Americans."

Health News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in bullet-point format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day:

Procalcitonin-guided strategy to treat suspected bacterial infections reduced antibiotic exposure in ICU by 2.7 days http://goo.gl/mws0

Both low and high HbA1c associated with increased mortality in diabetes. Guidelines for minimum HbA1c value may be needed. Survival as a function of HbA1c in type 2 diabetes: U-shaped association, with the lowest hazard ratio at HbA1c of 7·5% http://goo.gl/Lywx

No sedation vs. interrupted sedation in mechanical ventilation was associated with fewer days on the ventilator. Lancet http://goo.gl/OYoe

One Bowl = 2 Servings. Puzzled? F.D.A. Weighs Update to Standard Serving Sizes. http://goo.gl/GQuo

Cymbalta (duloxetine), used to treat depression, fibromyalgia, diabetic nerve pain, may also help low back pain. http://bit.ly/b2Z0Xq

Doctors were 30% more likely to recommend boys for growth hormone treatment compared with girls. http://goo.gl/ngSE

Can Foods Contribute to Infertility? Infertility seems to be more common in people with untreated celiac disease. http://goo.gl/iD27

UTI therapy: backup antibiotics as delayed prescription can help to reduce unnecessary antibiotic use. http://goo.gl/qL14


Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

Follow me on Twitter:

Atul Gawande: "Doctors are human. We miss stuff" - Checklists can help



Atul Gawande on NPR:

Doctors are human, and that their profession is like any other.

"We miss stuff. We are inconsistent and unreliable because of the complexity of care," Gawande says. "I got a chance to visit Boeing and see how they make things work, and over and over again they fall back on checklists. The pilot's checklist is a crucial component, not just for how you handle takeoff and landing in normal circumstances, but even how you handle a crisis emergency when you only have a couple of minutes to make a critical decision."

References:
Atul Gawande's 'Checklist' For Surgery Success. NPR.

Related:

Friday, February 5, 2010

Perioperative Practice: Time to Throttle Back?

From the Annals of Internal Medicine:

The United States spends more on health care than other nations, yet our health outcomes remain inferior to those of many countries.

Many "accepted" perioperative practices conflict with the evidence, for example:

- Routine perioperative stress testing provides no diagnostic yield in patients at low risk for cardiac events
- Indiscriminate perioperative therapy with β-blockers can increase mortality in otherwise stable patients

Perioperative tests and treatments improve outcomes only when targeted at specific patient subsets. Implementation of the American College of Cardiology/American Heart Association perioperative guidelines ensures cost-effective management and promises the greatest benefit for patients.

References:
Perioperative Practice: Time to Throttle Back. Chopra, V., Flanders, S. A., Froehlich, J. B., Lau, W. C., Eagle, K. A. Ann of Int Med, 2009.
Image source: Wikipedia, public domain.

Health News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in bullet-point format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day:

How Many Endoscopic Exams Could You Handle? Volunteers in 6-mo study got 15 endoscopic exams each http://bit.ly/9jGzMN http://bit.ly/9PHKsr

Tens of thousands of American adults die each year from pneumonia, influenza that could be prevented by routine vaccines http://goo.gl/UqiJ

A Wii Fracture Reported in the NEJM http://bit.ly/alIIoy, 3 Years After the First Case of Acute Wiiitis http://bit.ly/dn36Yb

"The government has your baby's DNA" from samples for genetic disease screening - CNN http://goo.gl/OsvS

What Costs $282 Million an Hour? Healthcare in America. WSJ http://goo.gl/FH6y

Acute infection can trigger acute coronary syndromes - The Lancet Infectious Diseases http://goo.gl/u2ec 

Consumer Reports Rates Hospitals http://goo.gl/9COe

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

Follow me on Twitter:

Thursday, February 4, 2010

Health News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in bullet-point format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day:

Have a Medical Question? Text a Group of Doctors - NYTimes http://bit.ly/d7sC9m - Doctors earn $10 per answered question at http://truthoncall.com --  "Some doctors have used Twitter to ask questions about a perplexing case & get responses from doctors they do not know". UnitedHealth offers 10-minute, one-on-one doctor visits over video chat for $45 http://bit.ly/c6Tz7G

After inventing a new disease, Wii-itis, the NEJM continues its fascination with Wii Video Game Injuries http://bit.ly/9KC6qV

Americans are less healthy than 10 years ago, shows national survey - BMJ http://goo.gl/QCZA

FDA approves Auxilium injections for Dupuytren's disease, currently the most common treatment is surgery http://bit.ly/bHE9Pp

A Moroccan 'dentist' displays his instruments at the Djemaa el Fna market in Marrakesh http://bit.ly/aZMdES   

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

Follow me on Twitter:

Health News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in bullet-point format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day:

Only 5% of Americans use email to communicate with their doctors, 51% search for health information online. Women are more likely than men to look up health information on the Internet (58% versus 43%) http://bit.ly/ba889N

Can eating fast food help you lose weight? NYTimes http://nyti.ms/cUofZb - Too many caveats to be considered a viable alternative to typical advice of diet and exercise.

Public swimming increases risk of gastroenteritis http://bit.ly/daos7r

Firm Brings Gene Tests to Masses, screens for more than 100 genetic diseases - NYTimes http://nyti.ms/bemUMP

Measuring hsCRP—An Important Part of a Comprehensive Risk Profile or a Clinically Redundant Practice? http://bit.ly/a1pMtX

Ghostwriting at Elite Academic Medical Centers in the U.S. - only 20% explicitly prohibit ghostwriting http://bit.ly/avjPjh

Ten Misleading Drug Ads - Forbes.com http://bit.ly/bYG50F and http://bit.ly/aI9tVY     

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

Follow me on Twitter:

30% of doctors have changed a patient's treatment as a result of an Internet search

From AMedNews:

86% of physicians use Internet to access health information. Why not 100%?

72% of physicians start their health information search with a search engine, 92% of those using Google.

A third of doctors have changed a patient's treatment as a result of an Internet search.

Consistent with other search engine research findings that users tend to click the most prominent links, 92% of physician searchers clicked on the links appearing at the top of the page, 46% clicked those in the middle of the page, and 24% clicked on those on the bottom. Also, 8% clicked on sponsored links.

References:
86% of physicians use Internet to access health information. AMedNews.
Image source: Doctors Using Google by Philipp Lenssen, used with permission.

Wednesday, February 3, 2010

Treatment Options for Osteoporosis

I selected a few excerpts from a patient information review in the New York Times:

What is osteoporosis

Osteoporosis is defined as having a bone mineral density T score of minus 2.5 or lower. Lesser degrees of bone loss, known as osteopenia, may not benefit from drug therapy.

Bisphosphonates

The first drug licensed to counter osteoporosis, Fosamax, is now available generically as alendronate, which can be taken once a day or, at a higher dose, once a week. A reluctance on the part of many patients to adhere to a daily or weekly regimen led to the development of Boniva (ibandronate), administered by an intravenous injection every three months. To further simplify the frequency of administration, Reclast (zoledronic acid) was developed as a once-a-year intravenous treatment.

Actonel, alendronate and Boniva have been shown in three-year studies of postmenopausal women to reduce vertebral fractures by 41-50%, and less for other kinds of fractures.

A three-year study of Reclast found it to be somewhat more effective, with a 70 percent reduction in vertebral fractures, 41 percent in hip fractures and 25 percent in other fractures in postmenopausal women with osteoporosis.

Side Effects of Bisphosphonates

In a large study of Reclast, there was also a worrisome increase in atrial fibrillation — an irregular heart rhythm — not known to occur with other bisphosphonates.

Low-trauma fracture with a delay in healing or complete failure may occur after many years on bisphosphonates.

These side effects have prompted a warning that after five years on bisphosphonates, people should take a break from the drugs for at least a year.

Evista (raloxifene)

Evista (raloxifene) has an added advantage of reducing the risk of breast cancer, but the disadvantage of increasing the risk of deep vein blood clots.

Calcitonin

Somewhat less effective at reducing vertebral fractures is calcitonin, a naturally occurring hormone sold as Fortical and Miacalcin.

Forteo (teriparatide)

Finally, there is the bone-building drug Forteo (teriparatide), which must be self-injected once a day. This human parathyroid hormone can reduce vertebral fractures by 65 percent and other fractures by 53 percent within 18 months in patients with osteoporosis.

Denosumab

Under study is an entirely new bone drug, denosumab, a human monoclonal antibody. The drug inhibits a receptor that activates cells called osteoclasts that break down bone. In a large three-year study, denosumab, given by injection every six months to postmenopausal women with osteoporosis, reduced vertebral fractures by 68 percent and hip fractures by 40 percent.

References:
Options for Bone Loss, but No Magic Pill. NYT, January 4, 2010.
Denosumab is a monoclonal antibody that reduces fractures in osteoporosis
Image source: Flickr, Creative Commons license.