Anesthesia 2.0: Web 2.0 in anesthesia education

Educators in all specialties of medicine are increasingly studying Web 2.0 technologies to maximize postgraduate medical education.

Web 2.0 technologies include:

- microblogging
- blogs
- really simple syndication (RSS) feeds
- podcasts
- wikis
- social bookmarking and networking

Although direct practice and observation in the operating room are essential, Web 2.0 technologies hold promise to innovate anesthesia education and clinical practice such that the resident learner need not be in a classroom for a didactic talk, or even in the operating room to see how an arterial line is properly placed.

Web 2.0 and advanced informatics resources will be part of physician lifelong learning and clinical practice.

References:
Anesthesia 2.0: Internet-based information resources and Web 2.0 applications in anesthesia education. Chu LF, Young C, Zamora A, Kurup V, Macario A. Curr Opin Anaesthesiol. 2010 Jan 19. [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/20090518

Image source: Wikipedia.

GE Has Clinical IMAGES iPhone App for Radiologists

Clinical IMAGES from GE Healthcare showcases clinical images obtained from GE Healthcare imaging systems. You can choose a product and browse by anatomy or by applications specific to the selected system. The application contains both static images and video of various image acquisitions.



References:
GE Healthcare Releases Clinical IMAGES iPhone App for Radiologists
Clinical IMAGES for iPhone, iPod touch, and iPad

Fish Oil Comes from “The Most Important Fish in the Sea”: Menhaden

From the NYTimes:

A considerable portion of fish oil comes from a creature upon which the entire Atlantic coastal ecosystem relies, a big-headed, smelly, foot-long member of the herring family called menhaden, which a recent book identifies in its title as “The Most Important Fish in the Sea.”

Menhaden filter-feed nearly exclusively on algae, the most abundant forage in the world, and are prolifically good at converting that algae into omega-3 fatty acids and other important proteins and oils. They also form the basis of the Atlantic Coast’s marine food chain.

Nearly every fish a fish eater likes to eat eats menhaden. Bluefin tuna, striped bass, redfish and bluefish are just a few of the diners at the menhaden buffet. All of these fish are high in omega-3 fatty acids but are unable themselves to synthesize them. The omega-3s they have come from menhaden.

Menhaden is also called bunker, pogies, mossbacks, bugmouths, alewifes, and fat-backs. The maximum size for the Atlantic menhaden is usually 15 inches in length. The average size of menhaden is smaller in the southern portion of their range, and largest at the northern portion. They are bright silver in color, and have a number of black spots extending horizontally from the gill plate to the tail.

References:

A Fish Oil Story. NYTimes.

Menhaden, Wikipedia.

Fishing For Answers: How To Choose Fish and Seafood | Summer Tomato http://goo.gl/0OBf

Image source: Menhaden B. tyrannus from the Chesapeake Bay. Wikipedia, Brian.gratwicke, Creative Commons Attribution 2.5 License.

Square For Mobile Payments At Political Fundraisers, Any Future Use at Doctor Offices?

Square is an innovative way to let people quickly and easily accept physical credit card payments from their mobile phone. The service was started by the Twitter co-founder Jack Dorsey.

Here is how Square works: A small device attaches to the phone via the headset/microphone jack. The device gets the power it needs to send data to the phone from the swipe of the card, and sends the information over the microphone connection. The device is compatible with both the iPhone and Android. It’s similar in some ways to PayPal, but anyone can now accept physical credit card payments, too. With no contracts or monthly fees. People are sent receipts by text and email. If you haven’t seen Square in action, check out this video:



References:
Square Now Being Used For Mobile Payments At Political Fundraisers
Video: Jack Dorsey Talks Square And I Buy Him Coffee With It
Square Turns Your iPad Into A Cash Register

Updated: 04/03/2010

Old drug, new warnings: Acetaminophen (paracetamol, Tylenol)

Acetaminophen is the leading cause of acute liver failure in the United States. Nearly half of acetaminophen-associated cases are due to unintentional overdose.

Especially vulnerable patients are:

- taking enzyme-inducing drugs
- chronic users of alcohol
- malnourished

Although no consensus has been reached on what is a safe dose in patients with liver disease, 4 g/day is too much: a total daily dose of no more than 2 g is recommended to decrease the risk of toxicity in these patients.

The US Food and Drug Administration (FDA) is considering banning acetaminophen-narcotic combination products.

References:
Acetaminophen: Old drug, new warnings. Cleveland Clinic Journal of Medicine January 2010 vol. 77 1 19-27.
Image source: Amazon, used for illustrative purposes only - NOT a suggestion to purchase any medications.

FDA: Rotarix rotavirus vaccine contains DNA from a "harmless" pig virus and should not be used

GlaxoSmithKline confirmed that the pig virus, porcine circovirus type 1 or PCV-1, has been in the vaccine since it was developed.

75% of U.S. doctors prescribe the three-dose RotaTeq vaccine, made by Merck, which was approved in 2006.

Electron micrograph of Rotaviruses. Image source: Wikipedia, Environmental Protection Agency, public domain.

Rotavirus-related diarrhea used to cause 70,000 hospitalizations per year in the U.S. before the introduction of the vaccines. The first vaccine against the virus called RotaShield was withdrawn from the market due to reports of an intestinal blockage (intussusception) associated with its use.

References:
Pig Virus DNA Found in Rotavirus Vaccine. WebMD.

Image source: GSKsource.com.

Now There’s Pig Virus DNA in Merck’s Rotavirus Vaccine, Too. WSJ, 2010.

Updated: 05/06/2010

Oral fingolimod more effective than intramuscular interferon in relapsing–remitting multiple sclerosis

Oral fingolimod is a sphingosine-1-phosphate–receptor modulator that prevents the egress of lymphocytes from lymph nodes.

In patients with relapsing–remitting multiple sclerosis, oral fingolimod was more effective than intramuscular interferon beta-1a in reducing relapse rates.

Adverse events in the fingolimod group included:

- herpesvirus infections (two fatal infections)
- atrioventricular block
- macular edema
- skin cancer
- liver-enzyme elevation

This trial showed the superior efficacy of oral fingolimod with respect to relapse rates and MRI outcomes in patients with multiple sclerosis, as compared with intramuscular interferon beta-1a.

References:
Oral Fingolimod or Intramuscular Interferon for Relapsing Multiple Sclerosis. NEJM, 2010.
http://content.nejm.org/cgi/content/short/362/5/402
A Placebo-Controlled Trial of Oral Fingolimod in Relapsing Multiple Sclerosis. NEJM, 2010.
http://content.nejm.org/cgi/content/short/362/5/387
A Placebo-Controlled Trial of Oral Cladribine for Relapsing Multiple Sclerosis. NEJM, 2010.
http://content.nejm.org/cgi/content/short/362/5/416

Image source: Fingolimod, Wikipedia, public domain.

Worst disaster in the history of Mount Everest climbs and the only doctor on the mountain

TED Med: Ken Kamler: Medical miracle on Everest.

When the worst disaster in the history of Mount Everest climbs occurred, Ken Kamler was the only doctor on the mountain. At TEDMED, he shares the incredible story of the climbers' battle against extreme conditions and uses brain imaging technology to map the medical miracle of one man who survived roughly 36 hours buried in the snow.

Water as an essential nutrient

Water has numerous roles in the human body:

- building material
- solvent
- reaction medium and reactant
- carrier for nutrients and waste products
- thermoregulation
- lubricant and shock absorber

The regulation of water balance is very precise, as a loss of 1% of body water is usually compensated within 24 hours.

Healthy adults regulate water balance with precision, but young infants and elderly people are at greater risk of dehydration.

Dehydration can affect consciousness and can induce speech incoherence, extremity weakness, hypotonia of ocular globes, orthostatic hypotension and tachycardia.

Human water requirements are not based on a minimal intake because it might lead to a water deficit due to numerous factors that modify water needs (climate, physical activity, diet and so on). On an average, a sedentary adult should drink 1.5 l of water per day, as water is the only liquid nutrient that is really essential for body hydration.



From Wikipedia:

"Water" is a song which opened the Eurovision Song Contest in 2007. The singers explained the title: "Our folklore is like water. We've chosen this title "Water", because in Bulgarian folklore there are very slow beautiful songs, which are like a lake. But we also have songs, with very fast rhythm which are like a waterfall. And my wish is this song to be like "Water", a gasp of fresh air, for the human spirit and soul. When we recorded the promo video of this song, they poured lots of rain on us, and I felt purified. I want everyone, who hears this song to feel the same way- liberated. This is a very positive song! I'm sure that people will feel it!"

References:
Water as an essential nutrient: the physiological basis of hydration. E Jéquier1 and F Constant2. European Journal of Clinical Nutrition (2010) 64, 115–123; doi:10.1038/ejcn.2009.111; published online 2 September 2009.

Collective patient data has power to comfort, explain and predict - TED video

"When Jamie Heywood's brother was diagnosed with ALS, he devoted his life to fighting the disease as well. The Heywood brothers built an ingenious website where people share and track data on their illnesses -- and they discovered that the collective data had enormous power to comfort, explain and predict." TED Talks.

The journey of a medical blogger: from Twitter to the New York Times

From @Berci: "I have many reasons to use Twitter. One of them is that it’s quite easy to get feedback from doctors who also use Twitter for communication. Now one of my stories was featured in the New York Times:

"Some people are even using Twitter for more urgent questions. Bertalan Meskó, a medical student at the University of Debrecen in Hungary, wrote a post about a patient with mysterious symptoms: “Strange case today in internal medicine rotation. 16 years old boy with acute pancreatitis (for the 6th! time). Any ideas?”

Within hours, specialists worldwide had responded, suggesting gallstones, lupus or growths on the pancreas. One of the suggestions helped the doctors with a diagnosis.

“It would have been impossible to find that specialist through e-mail, because we had no idea who to contact,” Mr. Meskó said."

Congratulations to Berci for being featured in the “newspaper of record” as mentioned by Susannah Fox!

We can use Google Buzz, Skype and Facebook to talk about interesting cases (not a good idea at present but in the future, with better privacy controls and HIPAA protection, may be) but does that improve patient care? The NYTimes does not mention the correct diagnosis, if one was reached....

References:
Getting the Most Out of Twitter, No Posting Necessary - NYTimes.com
From Twitter to the New York Times. ScienceRoll.

TED Talks: The giant hospital on the hill is "mainframe healthcare" - a relic from the last century

At TEDMED, Eric Dishman makes a bold argument: The US health care system is like computing circa 1959, tethered to big, unwieldy central systems: hospitals, doctors, nursing homes. As our aging population booms, it's imperative, he says, to create personal, networked, home-based health care for all.

Two fish dishes per week can help your heart

From CNN:

Most Americans eat very little fish compared to chicken and beef (just under 7 pounds a year vs. more than 100 pounds.

Some farmed fish like tilapia and catfish have significantly lower levels of omega 3s than their wild counterparts. Experts say you should choose wild-caught species whenever possible.

Although most fish naturally contain omega 3 fatty acids, oily fish (such as salmon, herring, and trout) are the richest sources. Healthy people should consume two 3.5-ounce servings of fish per week, which provides approximately 500mg of omega 3s per day.

When cooking fish, keep calories in check by broiling, grilling, baking, or steaming it instead of frying. Fresh herbs, spices, and/or citrus contribute great flavor without an excess of sodium.

Try experimenting with different tastes -- add an Asian flair with a gingery teriyaki glaze or go Mediterranean with a creamy cucumber-dill sauce made with low-fat Greek yogurt.

References:
An easy fish recipe to help your heart. CNN.

"Fishy treatment": Women (older than 49 yo) who eat more than 3 servings of fish/week are 16% less likely to experience a stroke. "Fish consumption in many countries, including the U.S., is far too low, and increased fish consumption would likely result in substantial benefits in the population". Reuters, 2010. http://goo.gl/VMec9
Five Fab Fish Dishes. Health.com.

Recipes for Health - Getting More Fish in Your Diet - NYTimes.com.

Fishing For Answers: How To Choose Fish and Seafood | Summer Tomato http://goo.gl/0OBf

Image source: Gadus morhua, Atlantic cod. Wikipedia, public domain.

Treatment options for migraine patients

From the NYTimes:

"Migraines are notoriously tricky to treat. Those who suffer from these disabling headaches often try a dozen or so medications before they find something that works.

“What might be a miracle drug for one person could be a dud for another.” Be prepared for a multi-tiered approach.

Doctors typically prescribe a triptan drug or an ergot-related drug to help people control infrequent migraine attacks. There are 7 types of triptans. The best-seller Imitrex (sumatriptan) is available in an affordable generic version (the chemical formula is shown above). Triptans are far more popular, but many people who do not respond well to triptans do well with the ergots, such as D.H.E. (dihydroergotamine), Dr. Saper said.

If you have migraines at least weekly your doctor may prescribe a preventative medicine. “Prescription preventatives are grossly underutilized. They can be extremely effective for some people.”

Preventive medicines, taken every day, include antiseizure drugs, beta blockers and tricyclic antidepressants."

References:
Migraines Force Sufferers to Do Their Homework
http://www.nytimes.com/2010/01/30/health/30patient.html
NYTimes, Patient Voices: Migraine
http://www.nytimes.com/interactive/2009/12/15/health/healthguide/TE_migraine.html

Triptans for Migraine: How should triptans be used? NEJM blog, 2010.

Image source: Sumatriptan, Wikipedia, public domain.

Related:

Migraine with aura is an independent risk factor for cardiovascular and all cause mortality in men and women http://goo.gl/kAxc

Migraine with aura might, in addition to ischaemic events, also be a risk factor for haemorrhagic stroke http://goo.gl/GQvf

Review: Which drugs are effective for preventing migraine headache? http://goo.gl/WXfEl

Migraine headaches are more common in patients with allergic rhinitis - immunotherapy decreases headache frequency http://goo.gl/XEIBq

Pharmacological prevention of migraine - BMJ review http://goo.gl/Q5K2m

Risks and Benefits for Physicians Who Use Social Media/Web 2.0

From the newsletter of the AMA, AmMed News: "Social media behavior could threaten your physician reputation and job prospects. Less is more." How do you expect doctors to use social media more when they are "bombarded" with headlines like this. There is little on the positive aspects of social media in this particular article although the AmMed News has published some better, more nuanced and balanced, reports on social media use in the past.

Practical benefits of social media for a physician practice

In addition to the obvious benefits for a physician practice to be open and social, there are some practical advantages of using social media. KevinMD shares the example of a patient who searches for "primary care doctor Nashua" (where he works) and Kevin is in the top search results due to his heavy use of social media - blog, Twitter, RSS, email subscriptions and Facebook. He also employs some "white hat" search engine optimization to ensure that his relevant pages are well-ranked by the search engines.

Benefits of social media in day-to-day clinical work

I use my own blogs as an useful archive of hand-picked and reviewed articles that is classified with appropriate labels (e.g. asthma, food allergy, etc.) and is fully searchable from any Internet-connected device: desktop PC, laptop, netbook, iPhone and even Kindle. All doctors may benefit if they use a similar resource created by them.

Let me give you a few real-life examples of social media use in clinical work:

- A patient needed instructions on dust mite control - I pulled my own mind map on the screen and discuss it with them http://bit.ly/cSxpQW

- A patient wanted to know about the new angioedema therapies - I pulled a different mind map and we discussed the different options http://bit.ly/caWmS7

- A colleague was unsure about "wine allergy" and its connection to wasp and bee venom - I searched my own blog on the cell phone: http://bit.ly/cykR2g and found a relevant article that I had read months ago which answered his clinical question http://bit.ly/bCdoeg

When working on the blog, I am often more like a "curator" of medical content (collecting the best articles and links) rather than a "producer" (creator of de novo content). Sometimes a doctor with a smartphone is more helpful than "a crowd" ("wisdom of crowds" or not) trying to recall an obscure fact, disease or complication from distant memory.

Benefits of social media for academic collaboration

The benefit of social media in academia is well-proven at this point if one is inclined to use such tools. For example, I have co-written more than 100 abstracts and 25 articles with the help of the online office suite Google Docs.

However, I don't think that a physician not using social media is at risk of becoming irrelevant (something mentioned recently). This is a limiting view.

I look forward to your feedback Please let me know what your think in the comment form embedded below this post.

Image source: OpenClipArt.org, public domain.

Rock star Ozzy Osbourne to CNN: "Between drugs and STDs, I'm lucky to be alive today"

"Ozzy Osbourne, the former front man of rock group Black Sabbath, says that after decades of living a life of drugs and sex, he's lucky to be alive today.

Osbourne described how he often played a dangerous game when it came to using drugs and having promiscuous sex. "With the drugs, it nearly killed me on a daily basis -- I did a lot of heavy drug taking for a long time and I survived it by the grace of God.

Answering a viewer's question on whether he realized his power to change people's lives, Osbourne replied with shock. "When you're on the inside looking, you don't see it that way," Osbourne said. "But I suppose you're right. I do -- I do have the power to change people's lives."

References:
Ozzy Osbourne: I'm living on borrowed time. CNN.

"Researchers studying Ozzy Osbourne's DNA found that the singer is descendant of Neanderthals" http://goo.gl/7Fa8

Related:

Did I Win?

A bicyclist falls into the finish and asked if he did win.

Whether it was staged or not, I am glad that he looks OK after the crash in the video.

How to move like a monkey: astounding feats of agility

From the National Geographic YouTube channel:



Fight Science / How to Move Like a Monkey. Danny uses his monkey technique to accomplish astounding feats of agility.



Fight Science / Crane Style Kung Fu. Crane style Kung Fu fighters are known for keeping perfect balance, even while evading lethal attacks.

See all videos here.

Related full-length videos:
Fight Science Season 1 Episode 1
Fight Science Season 1 Episode 2
Fight Science / Mixed Martial Arts

More related videos: 'Monkey' man scales high walls.

FDA: Plavix does not work in 2-14% of patients

The FDA has put a new "black box" warning on the anti-clotting drug Plavix, the second best-selling drug in the world.

The new label warns that normal doses of Plavix have a potentially deadly lack of effect in 2% to 14% of patients.

Such patients are so-called "poor metabolizers" who carry a variant CYP2C19 gene affecting the enzyme that converts Plavix into its active form. The frequency is about 2% of Caucasians, 4% of blacks, and 14% of Chinese.

However, a 2010 study published in the NEJM contradicted the statement above:

It has been suggested that clopidogrel may be less effective in reducing the rate of cardiovascular events among persons who are carriers of loss-of-function CYP2C19 alleles that are associated with reduced conversion of clopidogrel to its active metabolite.

Among patients with acute coronary syndromes or atrial fibrillation, the effect of clopidogrel as compared with placebo is consistent, irrespective of CYP2C19 loss-of-function carrier status.

References:
New Plavix Warning: Lack of Effect in Many People. WebMD.
Effects of CYP2C19 Genotype on Outcomes of Clopidogrel Treatment. NEJM, 2010.

Image source: A box of Plavix. Wikipedia, Trounce, Creative Commons Attribution-Share Alike 2.5 Generic license.

Updated: 10/27/2010

Atrial Septal Defect - Mayo Clinic Video

Harold Burkhart, M.D., a cardiovascular surgeon at Mayo Clinic, describes the congenital heart condition atrial septal defect (ASD) and discusses treatment options for children and adults.

Nurses seeking more health care authority, patients "don't see a big difference"

From USA Today:

Each year, Wendy Fletcher says, she and two partners see more than 5,000 patients at their practice in Morehead, Ky. They are not doctors, but rather registered nurse practitioners who say they are able to increase access to health care and make it more affordable.

"None of us are trying to play doctor," she said.

Nurse practitioners are "gaining traction because people are seeing how cost-effective they are," Patton said. "The primary care physician shortage is going to drive it."

Judi James, 56, who lives in Morehead, Ky., said she gets her basic medical care from a nurse practitioner and has no qualms about going to see a nurse rather than a doctor.

"I really just don't see a big difference," James said. "The nurses are the ones who take care of you anyway, not always the doctor. If I need a specialist, she'll send me there."

Is this the beginning of the end of the primary care doctors in the U.S.?

Comments from Google Buzz:

Vamsi Balakrishnan - Then...what's the difference of a nurse from a PA?

Aidan Finley - There's no real difference between a NP and a PCP for routine patient care.

From Twitter: @CarmenBPhillips: at ped's office, my kids most often seen by NP.

References:

Nursing covering more health care

Image source: OpenClipArt.org, public domain.

The risky side and the cautious side of me

David Spiegelhalter's proper title is Professor of the Public Understanding of Risk. He is in two minds (literally) about playing it safe or chucking caution to the wind. Decisions, decisions!? Are bacon sandwiches really that dangerous and is it wise to drive when you love cycling? David shows us how to use statistics to face up to life's major risks.

Link via Flowing Data.

Times have changed

@ConanOBrien:

http://twitpic.com/17lx53 - I no longer have health care. Could someone show this to a dermatologist and get back to me?

@pyknosis:

I'm a hematologist, not a dermatologist, but looking at that, I give you 7 months. Don't worry. That's a really long time.

That's just good humor, as Happy Hospitalist likes to say.

The Colonoscopy Song - March is National Colorectal Cancer Awareness Month

Peter Yarrow of the musical group Peter, Paul and Mary appeared on the CBS Early Show to sing a song he composed about his own colonoscopy:



In the video below, Dr. Paul Limburg, a Mayo Clinic Gastroenterologist, provides background on colorectal cancer and the screening methods:

Related reading:

Cleveland Clinic Colorectal Cancer Risk Assessment Tool. Get your score in 2 minutes (free).
Colon cancer and colonoscopy - Cleveland Clinic YouTube playlist 
Dr. Oz Has Colon Cancer Scare During Taping of His Colonoscopy for the TV Show http://goo.gl/F4CX

Fear was the No. 1 reason people gave to explain why they hadn’t gone in for a colonoscopy to screen for colon cancer. NYTimes.

Get your colonoscopy in the morning - each hour brings a 4% reduction in the number of polyps the doctors spotted http://goo.gl/2FGQt

Dr. Oz: What I Learned from My Colon Cancer Scare http://goo.gl/q7rjD
Colonoscopy Developer Dies at 94 - NYTimes http://goo.gl/iBnOp - Dr. Wolff was unconventional and surely made headlines in his day.

"Values-In-Action" Character Strengths Predict Well-Being

Character strengths can be conceptualized in the Values-In-Action (VIA) strengths classification system.

135 undergraduate university students completed measures of strengths use, subjective well-being (SWB), self-esteem, self-efficacy, and health-related quality of life (HRQOL), and endorsed 5 top VIA strengths.

Results revealed that strengths use is a unique predictor of subjective well-being, but not HRQOL.

The VIA strengths of hope and zest were significant positive predictors of life satisfaction.

The most commonly-endorsed VIA strengths were:

- love
- humor
- kindness
- social intelligence
- open-mindedness.

The least-endorsed VIA strengths were:

- leadership
- perseverance
- wisdom
- spirituality
- self-control

The results suggest a link between VIA strengths and subjective well-being.

References:
Predictor of Well-Being and Health-Related Quality of Life. Journal Journal of Happiness Studies, 2010.

Image source: OpenClipArt.org.

Geo-medicine: Your health may depends on where you live

Where you live: It impacts your health as much as diet and genes do, but it's not part of your medical records. At TEDMED, Bill Davenhall shows how overlooked government geo-data (from local heart-attack rates to toxic dumpsite info) can mesh with mobile GPS apps to keep doctors in the loop. Call it "geo-medicine."

Will Twitter soon be an essential tool for medical practices? asks CWRU

59% answered "yes", according to the Case Western Reserve University (CWRU) poll.

Doctors are using Twitter to connect both with patients and other medical professionals.

Other doctors use Twitter to communicate with patients - generally not to give medical advice - but to guide the public to reputable sources of information, or share breaking medical news. The CDC, for instance, uses Twitter to provide constant updates on H1N1 influenza.

Finally, Twitter offers an opportunity for doctors to ask questions of other medical providers. Given the real-time nature of Twitter, opinions and answers to clinical issues can be obtained immediately.

Some doctors simply do not have enough time to Twitter, or utilize other social media applications like Facebook. And time spent with patients in the social media sphere is not compensated by health insurance.

But Twitter is a valuable way to reach thousands of people at once.

My opinion: I was a Clinical Assistant Professor of Medicine at CWRU until 2008 and I think it is great that the university community shows an active interest in social media services such as Twitter. Using Twitter frequently @DrVes, I follow 77 accounts and have around 3,500 followers. That said, I am yet to ask medical questions on Twitter and generally do not answer clinical queries from patients there.

References:

CWRUmedicine SHARE Twitter Poll

Assistant professor uses Twitter to teach students dental anatomy at Ohio State University - 113 of 200 students signed up, 56% http://goo.gl/jvyq7

David Beckham suffered 'total rupture' of Achilles tendon

From CNN:

The Finnish orthopedic surgeon who operated on Beckham for 50 minutes on March 15 said the injury was a total rupture of Beckham's left Achilles tendon. Beckham "probably knew there was no chance he could play [in the World Cup] when he arrived."

His injury occurred late on during Sunday's game against Serie A league opponents Chievo, as the apparent tendon rupture caused the midfielder to pull up while attempting to kick the ball, pain visible on his face.

Achilles rupture -- a tearing of the tissue connecting the heel to lower leg muscles -- can take months to heal, with physiotherapists advising weeks of rest before resuming even light exercise.

Doctors at his Italian club, AC Milan, have told him that, under their care, he should recover and be able to continue playing until he is 40.

They believe he's an 'extraordinary' athlete worth nurturing and that he will make a full recovery over the summer.

Beckam, age 34, said that he hopes to make a swift and full recovery. I wish him the same.

References:

CNN.

Daily Mail.

49-yo man with childhood asthma who was told he would never be able to do exercise runs a marathon every day for a year http://goo.gl/6fwOY

Monoclonal antibodies against C. difficile toxins reduce recurrence of the infection

New therapies are needed to manage the increasing incidence, severity, and high rate of recurrence of Clostridium difficile infection.

A randomized, double-blind, placebo-controlled study included 2 neutralizing, fully human monoclonal antibodies against C. difficile toxins A (CDA1) and B (CDB1). The antibodies were administered together as a single infusion, each at a dose of 10 mg per kilogram of body weight, in patients with symptomatic C. difficile infection who were receiving either metronidazole or vancomycin.

Among the 200 patients who were enrolled (101 in the antibody group and 99 in the placebo group), the rate of recurrence of C. difficile infection was lower among patients treated with monoclonal antibodies (7% vs. 25%).

However, the mean duration of the initial hospitalization for inpatients did not differ significantly between the antibody and placebo groups (9.5 and 9.4 days, respectively).

The addition of monoclonal antibodies against C. difficile toxins to antibiotic agents significantly reduced the recurrence of C. difficile infection.

My opinion: It is always encouraging to add new tools to the treatment armamentarium aimed at defeating dangerous infections such as C. diff. colitis. However, monoclonal antibodies are generally very expensive and require intravenous administration.

References:

Treatment with Monoclonal Antibodies against Clostridium difficile Toxins. Israel Lowy. NEJM Volume 362:197-205 January 21, 2010 Number 3.

No antibitoc is superior for initial cure of C. difficile infection. Recurrence is less frequent with fidaxomicin http://goo.gl/dBRDj

Image source: Micrograph of a colonic pseudomembrane in Clostridium difficile colitis, a type of pseudomembranous colitis. H&E stain. Wikipedia, Nephron, Creative Commons Attribution-Share Alike 3.0 Unported license.

Emphysema and Airflow Obstruction Associated with Impaired Left Ventricular Filling

Very severe chronic obstructive pulmonary disease (COPD) causes cor pulmonale - elevated pulmonary vascular resistance and secondary reductions in left ventricular filling, stroke volume, and cardiac output.

The authors of this NEJM study hypothesized that emphysema, as detected on computed tomography (CT), and airflow obstruction are inversely related to left ventricular end-diastolic volume, stroke volume, and cardiac output among persons without very severe lung disease.

Of the study participants, 13% were current smokers, 38% were former smokers, and 49% had never smoked.

A 10% increase in emphysema on CT was related to decrease in left ventricular end-diastolic volume, stroke volume, and cardiac output.

Percent emphysema and airflow obstruction were not associated with the left ventricular ejection fraction (LVEF).

Mind map of Chronic Obstructive Pulmonary Disease (COPD) (click to enlarge the image).

References:
Percent Emphysema, Airflow Obstruction, and Impaired Left Ventricular Filling. R. Graham Barr et al. NEJM Volume 362:217-227 January 21, 2010 Number 3.

Image source: Enlarged view of lung tissue showing the difference between healthy lung and COPD, Wikipedia, public domain.

5.7% of teenagers have participated in "choking game"

From the NYTimes:

During "choking game" adolescents try to achieve a high by briefly depriving the brain of oxygen through strangulation. The "game" is extremely dangerous and could lead to brain damage, long-term neurological disability and death.

According to the recent survey of more than 10,642 eighth graders in Oregon, 36.2 percent reported having heard of the choking game, 30.4 said they had heard of someone participating in it and 5.7 percent said they had participated themselves.

Many adults are unaware of the many names the game goes by — including “Knock Out,” “Space Monkey,” “Flatlining” or “The Fainting Game” — and the warning signs:

- bloodshot eyes
- marks on the neck that may look like hickies
- frequent severe headaches
- disorientation after spending time alone
- ropes, scarves and belts discarded on the floor or tied to bedroom furniture and doorknobs



References:
Choking Game No Mystery to Children, Oregon Study Finds. NYTimes, 2010.

Small Town Story: Nebraska Boy Dies Playing 'The Choking Game' http://goo.gl/gy5V

Choking game claims lives of two Chicago girls - chicagotribune.com http://goo.gl/AOgU
Image source: The vulnerable carotid artery, (large, red tube), and the vagus nerve running parallel on its left. Wikipedia, public domain.

Updated: 08/12/2010

"Cutting Salt as Good as Quitting Smoking"

Cutting U.S. salt intake by just half a teaspoon (3 grams) a day would prevent up to 92,000 deaths, 99,000 heart attacks, and 66,000 strokes -- a benefit as big as smoking cessation. A 3-gm per day reduction in salt (1,200 mg of sodium) will result in 6% fewer new cases of heart disease and 3% fewer deaths.

The average U.S. man gets about 10.4 grams a day and the average U.S. woman gets about 7.3 grams a day.

77% of the salt in the American diet comes from processed food. Only 6% is shaken out at the table, and only 5% is sprinkled during cooking.

Once people cut back on salt -- whether or not they know they are doing it -- they begin to prefer less salt in their food. This happens in a matter of weeks.

Alarmed by high death rates from strokes, Portugal plans to decrease salt in bread, blamed for high blood pressure. Portugal has one of the highest mortality rates from strokes in Europe - double that in Spain and 3 times that in France. Strokes account for 20% of deaths in Portugal, reduction of salt intake by 1 gram per day would save 2,650 lives per year. http://is.gd/ndNv

The daily salt intake in Portugal is a staggering 12.3 grams (ranging from 5.2 to 24.8 gm) http://is.gd/ndQq

References:

Cutting Salt as Good as Quitting Smoking. WebMD, 2010.
Sweat Bees prefer sweaty people because the human diet is so salty that their perspiration is saturated with that essential nutrient. WSJ, 2012.

Image source: Single-serving salt packets. Wikipedia, GNU Free Documentation License.

Single and unhappily married men are at 64% higher risk of dying from stroke

Men who were single in the 1960s were 64% more likely to suffer a fatal stroke over the next three decades than their married counterparts.

The risk of fatal stroke was also 64% higher in men who reported dissatisfaction with their marriages than in men who rated their marriages as successful.

That figure is comparable to the risk of fatal stroke faced by men with diabetes.

References:
Single Men Have Higher Risk of Stroke. WebMD.

Image source: CT scan slice of the brain showing a right-hemispheric ischemic stroke (left side of image). Wikipedia, GNU Free Documentation License.

Let kids be kids: unstructured play time may be more important than homework

From Half Full: Science for Raising Happy Kids:

Let Kids Just Play: unstructured play time is actually more important than homework.

Children have lost 8 hours per week of free, unstructured, and spontaneous play over the last 2 decades due to homework.

Decrease in unstructured play time is in part responsible for slowing kids’ cognitive and emotional development. Today’s 5-year-olds had the self-regulation capability of a 3-year-old in the 1940s; the critical factor seems to have been not discipline, but play.

Pretend play is particularly beneficial, so make sure kids have ample time for it.

Related:

The Case for Saturday School - WSJ.com http://goo.gl/6IBT - We tend to choose the "more" approach when often the smarter one works better.

Social relations as a primary factor underlying children’s happiness

Image source: Child playing with bubbles. Wikipedia, Steve Ford Elliott, Creative Commons Attribution 2.0 License.

How to Exercise WHILE Blogging or Doing Other Computer Work

The exercises below have been adapted from a ProBlogger post. Most of the names have been modeled after popular social media services such as Twitter, RSS, Blogger, etc.

1. Cyber Squats. Set your chair aside for a few minutes and instead move to a semi-squat position with thighs parallel to the floor. Hold for 1 minute.

2. RSS Raises. As you’re sitting at your desk, straighten your knees and lift your legs out in front of you.

3. Ten Minute "Move it!" Break. Alternate jogging in place with jumping jacks – do a minute of each and repeat 5 times.

4. Twitter Tummy Tone. Tighten your abdominal muscles for 30 seconds and then release.

5. Social Squeezes. Tighten your gluteal muscles for 30 seconds and then release.

6. Ten Minute "Move it!" Break. Grab a step stool and climb up and down.

7. Inbox Incline. While you’re sitting with your feet on the floor, raise your heels so you are on the balls of your feet and lower them.

8. Ten Minute "Move it!" Break. Do walking lunges around the house. You can add some weights and do bicep curls at the same time.

9. Blogger Breather. Close your eyes and focus on your breath. Count to 10 as you slowly inhale through your nose, thinking positive thoughts. Exhale through your mouth, again counting to 10. Release all the tension and stress out of your body.

10. Sign Off Stretches. Shoulder shrugs – with your head at your chest, shrug your shoulders up and down. Neck Rolls – relax your shoulders and let your head roll forward. Slowly rotate your head in a circle. Repeat five times.

How to stay healthy while traveling: This is a mnemonic for exercises that can be done with just body weight: PLSS

P ushups
S itups
L unges
S quats


Exercises that can be done with just body weight: PLSS.

Exercise slows telomere shortening (and aging). Telomeres are the chromosome tips which shorten each time a cell divides, making them a possible marker of aging. A study of 2400 twins showed that physically active people had longer telomeres than sedentary people. According to the authors, this provides a powerful message that could be used by clinicians to promote the potentially antiaging effect of regular exercise.


Human chromosomes (grey) capped by telomeres (white). Image source: Wikipedia, public

domain.

If you need any more convincing, please see this "health promotion" video that clearly shows the benefits of exercise:

"Health Promotion" video: Benefits of exercise.

References:

10 Ways to get Fit WHILE Blogging. ProBlogger, 2009.
How to stay healthy while traveling

What's the best exercise for heart health? A combination of weight training and aerobic exercise http://goo.gl/h1YKD and bit.ly/on9sNn

Related reading:

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

CNN video: Life with Hepatitis C

18-year-old London teenager talks about life with the "silent killer" Hepatitis C and shares the dramatic story of how she came to be infected.

References:
Life with Hepatitis C for London's teenage 'It Girl'. CNN.

Distracted Walking: Using a Cell Phone and Walking Is Risky

From the NYTimes:

"Distracted driving has gained much attention lately because of the inflated crash risk posed by drivers using cellphones to talk and text.

But phones aren't just distracting drivers; they make pedestrians inattentive too.

Distracted walking combines a pedestrian, an electronic device and an unseen crack in the sidewalk, the pole of a stop sign, a toy left on the living room floor or a parked (or sometimes moving) car.

Examples include a 16-year-old boy who walked into a telephone pole while texting and suffered a concussion; a 28-year-old man who tripped and fractured a finger on the hand gripping his cellphone; and a 68-year-old man who fell off the porch while talking on a cellphone, spraining a thumb and an ankle and causing dizziness."





References:
Forget Gum. Walking and Using Phone Is Risky. NYTimes.
Video: Stop texting while driving. Terrifying. All drivers should watch this.

Image source: OpenClipArt.org, public domain.

AT&T Don't Text While Driving Documentary (video).

How to overcome the fear of blogging or writing in public

You will get some ideas from the following conversation on Twitter:

@dreamingspires: I realised that a previous problem in my blog was that I was writing for people more qualified than me - instead of health professionals just starting out.

@DrVes: One of the best approaches to educational blogging is to write for yourself as you learn or write for beginners - which is basically the same thing.

@dreamingspires: good advice - as an(ex)publisher suddenly having to write myself as opposed to hiding behind someone else doing it is... a learning process.

@DrVes: Did Twitter help?

@dreamingspires: Twitter helped in the sense of connecting me into a community, I didn't 'micro-blog' though.

@DrVes: Twitter makes you more comfortable to write in public - you don't have to "micro-blog"... :)

@dreamingspires: This IS true and my experience - it reduced my stage fright!

@DrVes: Also, you may have micro-blogged on Twitter or somewhere else without even knowing it... I set up my blog posts to publish automatically in the future -- it may help with your "stage fright".

@dreamingspires: To be honest I am unsure what micro-blogging is -- specific tweets on a topic like you do, or a mini conversation? Yes, I also now autopublish via Twitter feed, and now using Stumble too. OK - microblog is an 'opinion'/link/statement.

@DrVes: Anything you post on Twitter is micro-blog as long it's not only replies... A comment on a comment is not a blog. I think you qualify as a fully-fledged blogger and microblogger now... :)

@dreamingspires: You mean I've MADE IT?! Newbie happiness.

@DrVes: It's official: You've made it. You're a blogger now. Expect you share of nasty comments and spam... :)

$295,000 In Medical School Debt... Why do medical schools charge students so much money?

Rob Centor:

"Why do medical schools charge students so much money? It was not this way when I went to medical school. I paid an average of $1000 per year in the early 1970s.

Using an inflation calculator, that would become around $5000 per year in current dollars. Yet that same school and most state schools charge 3 times that much."

References:
http://www.huffingtonpost.com/2010/02/23/295000-in-medical-school_n_473601.html
http://www.medrants.com/archives/5327

Image source: OpenClipArt.org, public domain.

Video: "Help Your Heart With the Mediterranean Diet"

Help Your Heart With the Mediterranean Diet from ChefMD.

The 2010 Annual Perioperative Medicine Summit Starts Today

The annual Perioperative Medicine Summit 2010 starts on March 4 in Miami:

http://periopmedicine.org and @PeriopSummit

I maintain their website for the University of Miami and Cleveland Clinic, and help with the Twitter account, hosting of PDF handouts, videos, etc.

Dr. Jaffer, Chief of Division of Hospital Medicine and Summit Director will text his own tweets at http://twitter.com/PeriopSummit

Expect multiple free handouts posted on the front page of the summit website during March 4-6, 2010 and clinical pearls and discussions on Twitter: http://periopmedicine.org and @PeriopSummit

Program and Abstracts of the 5th Annual Perioperative Medicine Summit 2010

Summit Brochure



Summary

Dr. Amir K. Jaffer and Dr. Franklin Michota, the founding Summit Directors, in collaboration with Dr. David Hepner, will direct the 5th Annual Perioperative Medicine Summit in Miami, Florida.

The course is co-sponsored by the University of Miami Miller School of Medicine and the Cleveland Clinic in collaboration with the Society for Perioperative Assessment and Quality Improvement (SPAQI).

The goal of the Summit is to enable clinicians who are actively engaged in perioperative medical care to incorporate the latest findings from clinical research into their practices so that they can improve the quality and safety of their medical care.

Map of the Meeting Location


View Larger Map
Map of Eden Roc Resort

Green tea may be a cancer fighter - Cleveland Clinic video

A new study finds the tea shows promise as a possible oral cancer fighter.

Green Tea Doesn’t Prevent Breast Cancer, Study Finds http://goo.gl/j5xZ

Related:

Coffee vs. Tea - Infographic of Health Benefits and Risks http://goo.gl/StIsr
Green Tea Decreases Total and LDL Cholesterol by 5 mg/dL http://goo.gl/AwVDr and http://goo.gl/Ku55O

Cigarette smokers have lower IQs than non-smokers, and the more a person smokes, the lower their IQ

From Reuters:

Young men who smoked a pack of cigarettes a day or more had IQ scores 7.5 points lower than non-smokers in a study of over 20,000 Israeli military recruits.

"Adolescents with poorer IQ scores might be targeted for programs designed to prevent smoking," concluded the researchers in the journal Addiction.

The average IQ for non-smokers was 101, while it was 94 for men who had started smoking before entering the military. IQ steadily dropped as the number of cigarettes smoked increased, from 98 for people who smoked one to five cigarettes daily to 90 for those who smoked more than a pack a day. IQ scores from 84 to 116 are considered to indicate average intelligence.

The study may suggest that lower IQ individuals are more likely to choose to smoke, rather than that smoking makes people less intelligent.

References:
http://www.reuters.com/article/idUSTRE61M3UQ20100223

Comments from Google Buzz:

Dr Mike Cadogan - By definition non-smokers smarter than smokers...

Ben Ferguson - That's a weird conclusion to come to, in my opinion. They associated essentially pack-years with intelligence, which would seem to indicate a dosage effect, but then the suggestions were that they had lower IQs to begin with? It's a bit of a non sequitur. That there's a dosage effect would suggest that most of them had equal IQs before starting smoking; to conclude that they started smoking as a result of having lower intelligence to begin with has nothing to do with their aims and even undermines their findings.

Lakshman Swamy - Smoking is an addiction, and the smoking population is marginalized as it is. Obviously smoking is terrible for you... but let us not forget that smokers need healthcare and health advice more than most. I worry that this will further a "judging" attitude on the part of physicians.

Arin Basu - There is a problem in reducing entities like intelligence to single numbers like IQ scores (this is an offhand comment, I have not read /this/ particular article), but talking of programme targetting on the basis of studies that go to suggest "if you have low IQ then you smoke", in other words, implicitly accepting low IQ as /cause/ of smoking is dangerous. Well spotted though.

Image source: Wikipedia, Tomasz Sienicki, Creative Commons Attribution ShareAlike 2.0 License.

Using Wikipedia and Google for medical information

Some interesting abstracts from PubMed:

"Google is an efficient web resource for identifying specific medical information." Google was more efficient than all other resources for identifying medical information (P less than 0.0001) http://bit.ly/6FXATW

Google Scholar versus PubMed in locating primary literature to answer drug-related questions: no major differences http://bit.ly/8OygYt

Wikipedia is not authoritative and should only be a "supplemental source" of drug information http://bit.ly/7qzZ7k

Does Wikipedia provide evidence-based health care information? http://bit.ly/4WVLHt - No. Who is surprised?

Personality characteristics of Wikipedia members: Introverted women more likely to be members than extroverted women http://bit.ly/8YfrXb

Mobile Websites from Pubmed: Search Abstracts and Find Disease Associations http://bit.ly/7ucyn5 - Works on Kindle too. The mobile MedlinePlus (for consumers) is at m.medlineplus.gov http://bit.ly/6jjkt3

Wikipedia: A Key Tool for Global Public Health Promotion (review article)

Image source: Doctors Using Google by Philipp Lenssen, used with permission.

Health News of the Day

A school based compulsory physical activity improved fitness and reduced adiposity in children. BMJ, Feb 2010.

Dr. Wes: Cardiology is easy until it isn't

No doubt Mr. Cheney has had impecable cardiovacular care. But despite that care, after three bypasses, a history of atrial fibrillation, deep venous thrombosis, a cardiomyopathy that requires a defibrillator or two, and scores of medications to stabilize the angina - you've suddenly got a tough case: http://drwes.blogspot.com/2010/02/dick-vs-bill.html

PeRSSonalized Geriatrics from Webicina.com

http://www.webicina.com/perssonalized/?page=1&cat=37

PeRSSonalized Medicine is a free, easy-to-use aggregator of quality medical information that lets you select your favourite resources and read the latest news and articles about a medical specialty or a medical condition in one personalized place.

Image source: OpenClipArt.org, public domain.

Health News of the Day

Hypertension is a "neglected disease"

"Although hypertension is relatively easy to prevent, simple to diagnose, and relatively inexpensive to treat, it remains the second leading cause of death among Americans," said David Fleming, who led the study committee that wrote the report for the US Institute of Medicine. Hypertension is the most common primary diagnosis in the United States, affecting about 73 million adults (one in three).

http://www.bmj.com/cgi/content/short/340/feb22_2/c1074

Can't Remember Faces? Blame Your Genes

The ability to remember a face is inherited, according to a paper in the Proceedings of the National Academy of Sciences. Researchers also found that people who are good at remembering faces are not necessarily good at other memory tasks. Face recognition ability comes from a dedicated circuit, or set of circuits, in the brain.

http://www.npr.org/templates/story/story.php?storyId=123975339&ft=1&f=1007

Erythropoiesis stimulating drugs caused tumours to grow faster and led to earlier deaths in some cancer patients, prompting the FDA to restrict their use.

http://www.bmj.com/cgi/content/short/340/feb22_2/c1050

Medical implications of the Taser: Serious harm is rare, but incident reporting needs to be improved

Amnesty International has identified more than 300 deaths associated with Taser use in the United States. However, association is not causation, and other factors complicate the interpretation of fatal outcomes. The dominant conducted energy device used in police forces worldwide is the Taser X26. This device generates five second trains of electrical pulses that are delivered to the body either by two propelled barbs (which embed in clothing or skin and remain connected to the handset by conductive wire) or by direct contact of the handset’s electrodes (drive-stun mode).

http://www.bmj.com/cgi/content/short/340/feb22_1/c853

Rational Or Emotional? After you've lost weight, you have an increase in the emotional response to food

One of the hormones that play a role in controlling appetite in the body is called leptin. After significant weight loss, leptin levels drop. This seems to signal to the brain a need to seek more food.

http://www.npr.org/templates/story/story.php?storyId=123894109&ft=1&f=1007

Image source: OpenClipArt.org, public domain.

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