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For people with congestive heart failure, a hot dog can trigger a trip to the hospital due to excessive salt

The average daily salt intake in America is one and 1/2 teaspoon a day. This is 3,400 milligrams of sodium a day, or 1,100 milligrams more then the recommended maximum.

For people with congestive heart failure, a salty hot dog can trigger a trip to the hospital.

The experts say the new target for sodium intake should be set at 1,500 milligrams daily.

In a previous study, reducing dietary salt by 3 gm per day (1200 mg of sodium per day) was projected to reduce the annual number of new cases of coronary heart disease by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. Such an intervention would be more cost-effective than using medications to lower blood pressure in all persons with hypertension.

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.

For example, 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. 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:
Americans Need Help Shaking The Salt Habit - Shots - NPR Health News Blog.

"Cutting Salt as Good as Quitting Smoking"

3-gram reduction in daily salt intake would decrease coronary heart disease, stroke, and death

Image source: Wikipedia, GNU Free Documentation License.

Doctors blends cardiology and country music

Listen to the Doctor: Cleve Francis, cardiologist and country singer.

Dr. Francis, who recently turned 65, is a genteel singer of country and pop songs. He favors vintage ballads.

A man inching up the line in a walker can't believe it. "You want his autograph? I get it on a prescription every three weeks," he says.



References:

Listen to the Doctor: Cleve Francis, cardiologist and country singer. Washington Post.
Dr. Wes: Working the Backup Plan

When was the earliest journal club?

The earliest references to journal clubs are in the memoirs and letters of Sir James Paget, a British surgeon, who described a group at St. Bartholomew’s Hospital in London in the mid-1800s as “a kind of club … a small room over a baker’s shop near the Hospital-gate where we could sit and read the journals.”

Sir William Osler established the first formal medical journal club at McGill University in Montreal in 1875. The original purpose of Osler’s journal club was “for the purchase and distribution of periodicals to which he could ill afford to subscribe” (see the excerpts from Google Books below).

References:
Journal clubs as a trigger for ’socializing’. The Search Principle blog.



Comments from Google Buzz:

Laika Spoetnik - Besides the point, but I have good memories of St Bartolomews. Here I learned direct sequencing and did part of my experiments. Very old building btw.

Aidan Finley - the father of Stephen Paget of "seed and soil" hypothesis.

Related reading:

Virtual Journal Club for Hospital Medicine by the Washington University in St. Louis

Gene test decreases warfarin-related hospitalizations by 28%

Patients who received a test of two genes connected to warfarin sensitivity were 28 percent less likely to be hospitalized for a bleeding episode or blood clot than those whose safe and effective warfarin dosing was determined by traditional trial and error method.

The genetic tests, which are easily done with a cheek swab or blood sample, need only be performed once ever for each patient and cost somewhere between $200 and $400 - far less than even a brief hospital stay.


Warfarin Sensitivity Genotype Test - Mayo Clinic Video.

References:
Gene test can cut warfarin hospitalizations | Reuters.

Women in US academic medicine earn $13,000 less than male peers

A survey of 3,000 faculty members at the top 50 US medical schools has shown that women members earned $13,000 less than their male counterparts with the equivalent career position and professional activity.

There were no obvious reasons for the difference.

According to the study authors, "despite increased national attention to gender inequalities in salary, women in the life sciences at all academic ranks, both PhDs and MDs, continued in 2007 to receive lower annual salaries than did their male counterparts."

References:

Women in US academic medicine earn less than male peers. BMJ, 2010.

Image source: OpenClipArt.org, public domain.

The Lancet: Nephrology is not for normal doctors - it is for exceptionally skilled specialist physicians

From The Lancet:

Many doctors may view nephrology as a remarkable kind of intensive care. A patient presents in an acute crisis, close to death. Immediate transfer to the renal team follows, then the magical effects of dialysis, and finally recovery. Nephrology is not for normal doctors. The kidney is for exceptionally skilled specialist physicians.

Unlike fish, mammals do not seem to have renal regenerative capacity.

The silence of the kidney leads medicine to overlook its importance. This lack of awareness means that immense opportunities to prevent not only renal, but also cardiovascular, diseases are being lost.

References:
Protect the kidney, protect the heart. The Lancet.

Image source: Wikipedia, public domain.

Ed Goljan, M.D., professor of pathology and top notch arm wrestler

Goljan, professor and chairman of pathology, says that as the smallest kid in his class “I got picked on and so I started exercising.” It worked. By age 11, he was able to pin his dad in arm wrestling. Now 61, he’s still a contender.

Goljan likes to say that his arm wrestling is “just a ‘Y’ chromosome thing.” It’s a sport where size doesn’t mean much, he says. “When I weighed 175 pounds, I defeated a 275-pound super heavy weight.” In high school, college and medical school he arm wrestled (with either arm, it didn’t matter) and won.

References:

CenterNet | Rounds. Oklahoma State University Center for Health Sciences.

Related:

Clinical Pearls in Men's Health - Mayo Clinic Proceedings Video

Dr. Thomas Beckman discusses his July 2010 Mayo Clinic Proceedings concise review on 3 cases involving men's health.

Reduced workload and increased participation of attendings associated with higher satisfaction of doctors in training

An experimental inpatient-medicine service was designed with reduced resident workload comprising two teams, with each team consisting of two attending physicians, two residents, and three interns.

Attending physicians, selected for their "teaching prowess", supervised the teams throughout the workday and during bedside team-teaching rounds.

This experimental model was compared with a control model comprising two teams, with each consisting of one resident and two interns, plus multiple supervising attending physicians who volunteered to participate.

Over a 12-month period, 1892 patients were assigned to the experimental teams and 2096 to the control teams; the average census per intern was 3.5 and 6.6 patients, respectively.

Overall satisfaction was significantly higher among trainees on the experimental teams than among those on the control teams (78% and 55%, respectively; P=0.002).

Interns on the experimental teams spent more time in learning and teaching activities than did interns on the control teams (learning: 20% of total time vs. 10%, P=0.01; teaching: 8% of total time vs. 2%, P=0.006).

A model with two attending physicians and limited patient-staff census resulted in greater satisfaction on the part of trainees and attending physicians than the standard approach.

Reduced trainee workload and increased participation of attending physicians was associated with higher trainee satisfaction and increased time for educational activities.

References:
Evaluation of a Redesign Initiative in an Internal-Medicine Residency Program. NEJM.

Image source: OpenClipArt.org, public domain.

"Sleep eaters" binge on sugary, high-calorie snacks, sometimes 5 times a night

Consequences of nighttime eating can include injuries like black eyes from walking into a wall or hand cuts from a prep knife, or dental problems from gnawing on frozen food.

Upwards of 10 percent of adults suffer from some sort of parasomnia, or sleep disorder, like sleepwalking or night terrors. Some have driven cars or performed inappropriate sexual acts — all while in a sleep-induced fog. About 1 percent, mostly women, raid the refrigerator.

References:
Raiding the Refrigerator, but Still Asleep - NYTimes.com.

Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.

How to keep your brain in top performance shape - BBC video

Look After Your Brain - Brainsmart - BBC video.

Get these right and your brain will be in top shape:

- Diet - slow and steady release of glucose
- Water
- Exercise
- Sleep

Read more: http://www.bbc.co.uk/scotland/brainsmart

DNA Is a Doctor's Best Friend

The Director of the National Institutes of Health (NIH):

"It did affect me to find out that I was at risk for diabetes, which I had no family history of. But my family has all been extremely lean and I was not so lean, as I discovered when I got this information," Collins says.

The "wake-up call" led Collins to switch up his diet and start an exercise program.

His efforts helped him drop 25 pounds.

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

References:

Francis Collins: DNA May Be A Doctor's Best Friend - Shots - NPR Health News.

2 in 3 people with known risk factors for COPD don't know they have the disease

One in five heavy smokers over age 40 have findings of COPD, but only one-third have been previously diagnosed with the common lung disease.

10% of people worldwide over the age of 40 are affected by COPD.

Researchers screened 1,003 people aged 40 and over who were current or former heavy smokers. Heavy smoking was defined as a smoking history of 20 pack-years or more.

The results showed that 20.7% of the people screened met the criteria for a diagnosis of COPD but only 32.7% had previously been diagnosed with the disease or were aware of their COPD diagnosis.

References:
Many Unaware They Have COPD. WebMD.

Image source: Lungs, Wikipedia, public domain.

Non-surgical Baldness Treatments Rated Ineffective by Most Patients

Only 27% of men who used Propecia (finasteride) said it was “very” effective. Finasteride is a 5-alpha reductase inhibitor used to treat prostate enlargement symptoms and baldness. Finasteride has 2 trade names: Propecia for baldness and Proscar for BPH.

Over-the-counter minoxidil (Rogaine) is applied directly to the scalp and is the only hair regrowth drug approved for use by women. Just 4% of respondents said it was very effective, with 43% of users saying it was not effective at all.

Only 2% of men surveyed underwent hair transplants; but of these, 49% were either very or completely satisfied with the results of their surgery, the poll shows.


Minoxodil - Costco.

References:
Survey: Most Baldness Treatments Don't Work. WebMD.
Widely used baldness drug finasteride (Propecia) boosts hair growth in men, but 1 in 80 may develop ED http://goo.gl/6lmd

Experts Answers on Alopecia and Hair Loss - NYTimes.com http://goo.gl/Oplfw

Drugs that "shrink prostate" and treat baldness (5-alpha-reductase inhibitors) may have sexual side effects that persist after stopping them, WebMD, 2011.

Image source: Finasteride, Wikipedia, public domain.

Comments from Facebook:

"Ah... so you are supposed to rub it on the scalp... I've been drinking it all these years, no wonder it has had no effect"

Kylie Minogue on cancer - BBC video

Kylie Minogue on cancer - Friday Night with Jonathan Ross - BBC One.

Science 2.0: More publishing but less (legitimate) publishers?

Science 2.0 will come: More publishing but less (legitimate) publishers? http://bit.ly/dmx37u and http://bit.ly/bJyxkw

Publish or post? Paradigm shift for scientists http://ff.im/-oYYKH

References:

Science 2.0 (change will happen….). Burgelman, Jean-Claude, Osimo, David, AND Bogdanowicz, Marc. UIC.edu, Volume 15 Number 7 (5 July 2010).

Tai Chi and Cardiac Rehabilitation - Mayo Clinic Video

For hundreds of years people have practiced the Chinese martial art of Tai Chi for its many health benefits. Researchers who study Tai Chi say it can help reduce blood pressure, decrease anxiety, improve flexibility and much more. For these reasons, some doctors at Mayo Clinic have embraced Tai Chi and are teaching it to their patients.

Related reading:

Tai chi helps balance in people with Parkinson's: "It can't cure the disease. But it can slow down the progression" (http://goo.gl/r6Gx5).

"With UpToDate, students and interns may be as capable of teaching the resident (or attending) as visa versa"

From Wachter's World:

"In 1984, one resident even wrote a letter to the New England Journal of Medicine called “Ripping and Filing Journal Articles,” taking the Journal to task for its habit of beginning an article on the back of the last page of the previous one (which meant the page needed to be photocopied if you wanted to tear both articles out of your personal copy of the journal). Fair point, but talk about a resident who needed to get a life.

Today, as in so many other parts of our lives, the computer, with its magical access to the universe of on-line resources, has democratized the learning of clinical medicine. At UCSF, by the time morning rolls around, the students and interns have often already read the on-line UpToDate synopsis of the topic at hand, and may be as capable of teaching the resident (or attending) about it as visa versa."

Note: UpToDate is a peer reviewed medical information resource (paid, not free access) published by a medical company called UpToDate, Inc. It is available both via the Internet and offline. An update is published every four months. The material is written by over 3600 clinicians and has over 7300 topics. The website was launched in 1992 by Dr. Burton D. Rose along with Dr. Joseph Rush. A new online subscription for 1 year costs $495, $195 for trainees (source: Wikipedia).

References:

Substituting Coffee Cake for Journal Articles: Another Unforeseen Consequence of IT. Wachter's World.

Are You Dependent on UpToDate for Your Clinical Practice?
Small association between use of UpToDate and reduced patient length of stay, lower mortality (study sponsored by UTD) http://goo.gl/zSG8R

95% of junior doctors consider electronic textbooks the most effective source of knowledge. 70% of junior doctors read the medical literature in response to a specific patient encounter. BMJ, 2011. http://goo.gl/QZyJE

Image source: UpToDate.

Updates in Pediatrics

You can find this information on PubMed but this is a nice summary from UpToDate (only brief highlights are posted below, check the source link for full text):

Sexually transmitted infections

25% of urban adolescent females (14-17 years of age) were diagnosed with a sexually transmitted infection (STI) within one year of first intercourse.

Attention deficit hyperactivity disorder (ADHD)

ECG screening should not be required before initiating stimulant therapy for patients with ADHD.

Autism prevalence

The prevalence of autism spectrum disorders (ASD) among eight-year-old children in the United States increased from 1 in 150 children in 2000 to 2002 to approximately 1 in 111 in 2006. No clear reason for increase has been found.

The choking game

5.7% of eighth-graders had participated in the self-strangulation activity known as "the choking game". Recognize signs of these activities: bruising or red marks on the neck; wearing high-necked shirts, even in warm weather; bloodshot eyes or pinpoint bruising around the eyes; petechiae on the face, especially the eyelids or conjunctiva.

HPV vaccine

The US Food and Drug Administration (FDA) approved the use of quadrivalent human papillomavirus vaccine in males aged 9 through 26 years to reduce their likelihood of acquiring genital warts.

13-valent PCV

The FDA approved a 13-valentpneumococcal conjugate vaccine (PCV13). PCV13 adds serotypes 1, 3, 5, 6A, 7F, and 19A to those contained in the PCV7, the 7-valent vaccine (4, 6B, 9V, 14, 18C, 19F, and 23F). The six additional serotypes accounted for 63% of invasive pneumococcal disease among children younger than five years of age.

References:
What's new in pediatrics. UpToDate.
Pediatrics and Medicine

Image source: OpenClipArt.org, public domain.

Video Lecture: Anne Wojcicki from 23andMe Personal Genomics

Direct link here.

23andMe is a personal genomics company based in Mountain View, California that is analyzes saliva samples for genetic information (the average cost for the service is decreasing and is currently $399-$499).

The company name is a play on the 23 pairs of chromosomes that carry every individual’s DNA. 23andMe was co-founded by Anne Wojcicki, wife of Google co-founder Sergey Brin.

"Genes load the gun. Lifestyle pulls the trigger" - Dr. Elliot Joslin.

Whole genome sequencing fails to predict risk of most common diseases, according to BMJ.

Related reading:

Genetic testing is available for approximately 2000 clinical conditions - Preparing for Precision Medicine - NEJM, 2012.

How to talk to patients about genetic testing  http://goo.gl/kkW4m

Glycated hemoglobin as a diagnostic test for diabetes predicts mortality more accurately than fasting glucose

Fasting glucose is the standard measure used to diagnose diabetes in the United States. Recently, glycated hemoglobin was also recommended for this purpose.

The glycated hemoglobin value at baseline was associated with newly diagnosed diabetes and cardiovascular outcomes.

For glycated hemoglobin, values of less than 5.0%, 5.0-5.5%, 5.5-6.0%, 6.0-6.5%, and 6.5% or greater, the hazard ratios for diagnosed diabetes were 0.52, 1.00, 1.86, 4.48, and 16.47, respectively.

For coronary heart disease, the hazard ratios were 0.96, 1.00, 1.23, 1.78, and 1.95, respectively. The hazard ratios for stroke were similar.

In contrast, glycated hemoglobin and death from any cause were found to have a J-shaped association curve.

The association between the fasting glucose levels and the risk of cardiovascular disease or death from any cause was not significant.

In this community-based population of nondiabetic adults, glycated hemoglobin was associated with a risk of diabetes and more strongly associated with risks of cardiovascular disease and death from any cause as compared with fasting glucose. These data add to the evidence supporting the use of glycated hemoglobin as a diagnostic test for diabetes.

References:

Glycated Hemoglobin, Diabetes, and Cardiovascular Risk in Nondiabetic Adults. NEJM, 2010.

Image source: OpenClipArt.org, public domain.

People behaved more selfishly and dishonestly when working in a dimly lit room or when wearing sunglasses

Researchers found that people working in a dimly lit room were more likely to cheat about their own performance on a task in order to earn more money than people working in a well-lit room.

Darkness may create a sense of illusory anonymity that disinhibits self-interested and unethical behaviors. It appears to induce a false sense of concealment, leading people to feel that their identities are hidden.

References:
Dim Lighting and Sunglasses Encourage Unethical Behavior in Study. WebMD.
Image source: Ray Ban Original Wayfarer, Wikipedia, Creative Commons Attribution-Share Alike 3.0 Unported license.

Comments from Twitter and Facebook:

@scanman: RT @DrVes: when working in a dimly lit room http://goo.gl/fb/erLEf

@doctorwhitecoat: Clubbing/bars? RT @DrVes People behaved more selfishly/dishonestly when in a dimly lit room or when wearin sunglasses http://goo.gl/fb/erLEf

Mike Cadogan: "Recently started working in the office with the light on...feeling better and more energetic already, though not sure about the selfish/dishonest part..."

98% of People Cannot Drive Safely Using Cell Phones According to a Study

Driving while talking on a cell phone is extremely hazardous for most people.

Only a tiny fraction of “supertaskers” can do both simultaneously without ill effect - 2.5% of people studied could successfully drive and use a cell phone at the same time.

It took most people 20% longer to hit the brakes and increased following distances 30%, meaning they failed to keep pace in the simulator with virtual traffic. Also, their memory performance dropped 11% and their ability to do the math fell 3%.


Video: Stop texting while driving (http://bit.ly/S6osm). Terrifying. All drivers should watch this. Warning: This video may not be suitable for minors.

References:
97.5% Can't Drive Safely Using Cell Phones. WebMD.
Video: Stop texting while driving. Terrifying. All drivers should watch this.
Texting while driving increases crash risk 23 times
AT&T Don't Text While Driving Documentary (video).

From Twitter:

@BiteTheDust: RT @DrVes: 98% of People Cannot Drive Safely Using Cell Phones http://bit.ly/cWMcLH 100% of drivers think they are in the 2%!

Sport Injuries: MRIs of hips of hockey players show abnormalities in 70% - are they clinically significant?

A study included M.R.I.’s of the hips of 21 professional hockey players and 21 college players. They showed abnormalities in 70 percent of the athletes, even though these hockey players had no pain or only minimal discomfort that did not affect their playing. More than half had labral tears, rips in the cartilage that stabilizes the hip.

“M.R.I.’s are so sensitive,” Dr. Musahl said. “They frequently show little tears or fraying everywhere. And it is very, very common to have a small labral tear in your hip — it doesn’t mean you have to have the particular symptoms.”

References:
Personal Best - Sports Injuries - Go to a Doctor or Tough It Out? NYTimes.com.

A Young Man with Hip Pain due to Piriformis Syndrome

Image source: X-rays (not MRIs), Edheads.org.

Kidney Transplant Overview - Mayo Clinic Video

Mayo Clinic emphasizes living donor kidney transplants as the best option for patients. Martin Mai, M.D., nephrologist at Mayo Clinic offers information about living donation, statistics, including the fact that living donor kidneys last longer. Half of living donor kidneys transplanted today will still be functioning 25 years from now, whereas half of cadaveric kidneys will fail in the first 10 years.



Candy and Ellen's Story.

Using the Internet for health purposes was associated with increased depression

The rapid expansion of the Internet has increased the ease with which the public can obtain medical information. Most research on the utility of the Internet for health purposes has evaluated the quality of the information or examined its impact on clinical populations. Little is known about the consequences of its use by the general population.

Health-related Internet use was associated with small but reliable increases in depression (i.e., increasing use of the Internet for health purposes from 3 to 5 days per week to once a day was associated with 0.11 standard deviations more symptoms of depression, P = 0.002).

Using the Internet for health purposes was associated with increased depression. The increase may be due to increased rumination, unnecessary alarm, or over-attention to health problems.

In contrast, using the Internet to communicate with friends and family was associated with declines in depression.

References:

Effects of Internet Use on Health and Depression: A Longitudinal Study. J Med Internet Res 2010;12(1):e6.

Negative consequences from the use of internet for health information - CDC (PDF) http://goo.gl/Fgcq via http://goo.gl/947F

Image source: Wikipedia, public domain.

Updated: 08/12/2010

People who "drink heavily every so often" are 45% more likely to develop coronary heart disease

Occasional heavy drinking was defined as having 5 or more standard drinks in a day at least 12 times per year. "Regular" heavy drinkers - those who averaged at least 5 drinks per day, were excluded from the analysis.

In general, moderate drinking - a drink or two per day - is considered a potentially heart-healthy habit. A number of studies have found that moderate drinkers have lower risks of heart disease than teetotalers do.

Research suggests that alcohol can increase "good" HDL cholesterol, has anti-inflammatory effects in the blood vessels and may make the blood less prone to clotting.

On the other hand, regular heavy drinking may increase blood pressure, promote blood clotting and contribute to development of arrhythmias.

References:

Occasional binges may undo alcohol's heart benefits. Reuters, 2010.

Monounsaturated fats found in vegetable oils, nuts and avocados increase "good" HDL cholesterol levels by 12% http://goo.gl/GBQa5
Alcohol literally kills: Gary Moore had 380mg/dL in his blood, Winehouse 416mg/dL when she died surrounded by 3 empty vodka bottles. Telegraph UK, 2012. 

Image source: OpenClipArt.org, public domain.

Blast from Europe's medieval medical past: leeches

From TIME:

Another blast from Europe's medieval medical past are medicinal leeches. Similar to bloodletting, leeches were utilized to draw out the "bad blood" that medieval physicians believed caused many of their patients' ailments.

In modern medicine, however, leeches are used in reconstructive surgery to provide a vacuum effect that helps stimulate blood circulation. This process is crucial to help kick start blood flow into, for example, a reattached finger.



Covered by sucking leeches! BBC video.Miichael Palin experiments with a traditional Russian health therapy in Estonian capital Tallinn by allowing a doctor to cover him in sucking leeches. Fascinating video that is definitely not for the faint hearted! Taken from BBC travel documentary, Palin's New Europe.

References:
Leeches are making a comeback as medical helpers. Chicago Tribune, 2011.

Top 10 Unusual Medical Treatments. TIME.

PubMed: "Does garlic protect against vampires? An experimental study. Owing to the lack of vampires, we used leeches" http://bit.ly/IKOrY

Top 10 Bloodsuckers: Leech. AnimalPlanetTV.