How-To: Maintain a correct posture while working on your laptop

Adult or Child Laptop Use at Home, Work or Classroom.



Mobile or Smart Phone Use while Driving, Traveling or on the Move.

Link via Digital Inspiration.

The 10-year rule: you must persevere with learning and practising for 10 years before making breakthrough

From The Lancet:

Hard work is required: “Genius is one per cent inspiration, ninety-nine per cent perspiration” - Thomas Edison

Late in life, Charles Darwin made the same point in a letter to his son: “I have been speculating last night what makes a man a discoverer of undiscovered things, and a most perplexing problem it is.—Many men who are very clever,—much cleverer than the discoverers—never originate anything. As far as I can conjecture, the art consists in habitually searching for causes or meaning of everything which occurs.” Darwin was a relentless student of nature from 1828 until the few weeks in late 1838 when he suddenly perceived the mechanism of evolution by natural selection.

There can be no doubt that geniuses have worked habitually and continually. Darwin produced 160 published papers, in addition to celebrated books and a vast correspondence. Albert Einstein had 240 publications, Sigmund Freud 330, Henri Poincaré 500 papers and 30 books; Edison was the owner of 1093 patents, lodging an average of one patent every 2 weeks of his adult life. In the arts, J S Bach on average composed 20 pages of finished music per day, while Pablo Picasso created more than 20,000 works.

Experience is essential: “Where observation is concerned, chance favours only the prepared mind” - Louis Pasteur

The 10-year rule states that a person must persevere with learning and practising a craft or discipline for about 10 years before he or she can make a breakthrough. The initial scientific evidence for the rule came from studies in the 1960s and 1970s of chess-players, who take 10 years and more to become masters of the game. Then it was found to apply to Olympic swimmers and concert pianists.

Hardly any genius in history—not even Leonardo da Vinci—seems to have short-cut the long and gradual path to creative breakthroughs.

References

Perspiration, inspiration, and the 10-year rule. The Lancet, Volume 376, Issue 9751, Pages 1458 - 1459, 30 October 2010.

Twitter comments:

@equijada: the ability to infer disparate ideas into one is the 1%. The rest is just salty water. 10-yrs, 10,000 hrs -> playing w/ observations

Beware of online "filters" that hide the information you need

Eli Pariser: Beware online "filter bubbles", TEDtalksDirector, May 2, 2011: As web companies strive to tailor their services (including news and search results) to our personal tastes, there's a dangerous unintended consequence: We get trapped in a "filter bubble" and don't get exposed to information that could challenge or broaden our worldview. Eli Pariser argues powerfully that this will ultimately prove to be bad for us and bad for democracy.

Similarly, you don't want Twitter to replace your RSS reader - always get to the original source. When you see a medical news item on Reuters or WebMD, don't stop there - always go to the original journal article. More often that not you will find that the results reported in the original article are a quite a bit more nuanced and less certain than the layman language, SEO-optimized headline that you first encountered. Always go to the source. If you write a blog, always link to the source.


The circle of online information (full version) (click to enlarge).

Related:

For doctors: How to be a Twitter star in two easy steps

Polish Your Online Image, AAMC Advises Medical Students and Residents

How can you make sure future program directors find only the best “you” online? Follow these suggestions when using social media services such as Facebook, Twitter and blogs:

- Consider carefully what you’re posting
- Avoid posting patient stories
- Periodically search yourself
- Check the photos in which you’re “tagged”
- Define funny - Humor can be hard to interpret
- Choose your friends carefully
- Restrict your privacy settings

References:

Careers in Medicine. AAMC, 2010 (PDF).

Image source: OpenClipArt.org, public domain.

'Nodding disease' - Sudan and Uganda's incurable child disease with unknown cause

AlJazeeraEnglish: Hundreds of children in southern Sudan have died from a mysterious illness that they have called the "nodding disease". The mentally and physically disabling disease, which has no cure yet and affects only children, first emerged in Sudan in 1980s.

"We have no clue as what is causing this. It's like a detective novel and a murder mystery, because it's fatal," says a tropical disease specialist from UNICEF.

Bizarrely, the seizures occur when the sufferers start to eat, or when it is particularly cold. When a bowl of sorghum is placed in front of Susannah, the "nodding" begins almost immediately, and stop when she has finished eating.

Some villagers say the disease is a curse, others blame the country's long civil war and suspect that government forces have been dropping chemical weapons.

93% of those surveyed are infected with a parasitic worm which causes Onchocerciasis (also known as river blindness). However, the level of infection among children without "nodding" is 63%. The worm is carried by black flies which breed near fast-flowing rivers.



A team of CDC experts conducts a multifaceted investigation in northern Uganda. An Epidemic Intelligence Service Officer tells the story about Nodding Disease, a neurologic syndrome which is devastating to afflicted children.

References:

'Nodding disease' hits Sudan. BBC, 2003.

African outbreak stumps experts: childhood nodding syndrome. Nature, 2011.
Mysterious nodding disease debilitates children - CNN, 2012.

Top 10 Most Prescribed Medications

According to a report from the IMS Institute for Healthcare Informatics, the top 10 most-prescribed drugs in the U.S. are:

- hydrocodone (combined with acetaminophen)
- simvastatin
- lisinopril
- levothyroxine sodium
- amlodipine besylate
- omeprazole
- azithromycin
- amoxicillin
- metformin
- hydrochlorothiazide

The top 10 best-selling drugs are:

- Lipitor, $7.2 billion
- Nexium, 6.3 billion
- Plavix
- Advair Diskus, $4.7 billion
- Abilify
- Seroquel
- Singulair, $4.1 billion (it will be generic in 2012)
- Crestor
- Actos
- Epogen

References:
The 10 Most Prescribed Drugs. WebMD.

Image source: Wikipedia, public domain.

Cell phones and your brain - CNN video

From CNN:

Do cell phones cause brain cancer? It may be too early to say for sure. The latency period or time between exposure and recognition of a tumor is around 20 years, sometimes longer. And, cell phone use in the U.S. has been popular for only around 15 years. Back in 1996, there were 34 million cell phone users. Today there are 9-10 times as many.

Interphone is a multinational study designed to try to answer this question. The data showed people who used a cell phone 10 years or more doubled the risk of developing a glioma, a type of brain tumor.

References:
Cell phones, brain tumors and a wired earpiece. CNN.
Cell phones and your brain. CNN.

Mobile phones may increase cancer risk - list of DOs and DONT's of mobile phone use (scroll down the page). Daily Mail, 2011.

How much radiation does your phone emit? Comprehensive chart by CNN http://goo.gl/l0l5q

New hepatitis C treatment: 2 new medications may increase success rate to 70%

Mayo Clinic: Four million people in the U.S., 100 million worldwide, are infected with Hepatitis C. It's a virus you can get from blood transfusions given before 1990, shared needles, unclean tattoo needles and sometimes sex.

In many cases it leads to cirrhosis of the liver and eventually liver cancer. Standard treatment with interferon and ribavirin only cures about 45% of all patients. But thanks to two new medications, up to 70% of people with hepatitis C may be be cured. More than 40 medications are in development.

1 in 40 adults older than 40 years has glaucoma

One in 40 adults older than 40 years has glaucoma with loss of visual function.

Adults have one of the two forms of glaucoma:

- open-angle glaucoma

- angle-closure glaucoma

Diagnosis

At least half of glaucoma cases are undiagnosed. Glaucoma is mostly asymptomatic until late in the disease when visual problems arise. Vision loss from glaucoma cannot be recovered.

Treatment

Glaucoma is treated with daily eye-drop drugs, but adherence to treatment is often unsatisfactory.

Similarities to the pathogenesis of common CNS diseases mean that common neuroprotective strategies might exist. Successful gene therapy has been used for some eye diseases and may be possible for the treatment of glaucoma in the future.

References:
Glaucoma. The Lancet, Volume 377, Issue 9774, Pages 1367 - 1377, 16 April 2011.

Image source: Eyelashes, Wikipedia, Steve Jurvetson, Creative Commons Attribution 2.0 Generic license.

How To: Keep Your Family On-Board for Your Blogging Journey

Some tips from ProBlogger:

- Create Healthy Boundaries. For example, I have established a “no computer time” rule for myself where I don’t use the laptop (or my smart phone) between the time I get home from work and when we get the kids to bed. By setting up this boundary, I free my time and my mind to enjoy my children, play outside or help my wife out with dinner each evening.

- Communicate Your Reasons for Blogging. Why are you investing all this time and effort into blogging anyway? Take the time to tell your loved ones why your blog is important to you and how you see it as a benefit for your family.

- Sacrifice Personal Time, Not Family Time

- Seek Their Input

References:

7 Tips to Keep Your Family On-Board for Your Blogging Journey. ProBlogger.
Image source: public domain.

How to Use Social Media for Medical Education

Here are a few suggested approaches for social media use in medical education:

- Peer student groups can utilize a private blog to share clinical experiences

- Course/program directors and staff can use a wiki to manage course/program materials and centralize frequently used documents

- Longitudinal preceptors can use a microblog (e.g., Twitter) to share links to journal articles, medical news, and reminders

- Admissions personnel can use social networks during the application, interview, and acceptance processes to build a community before students ever set foot on campus

- A public affairs office could generate podcasts to share graduate news, campus information, celebrations, and research success stories


The Networked Teacher - Diagram, Flickr http://goo.gl/CVddi

References:

Saarinen C, Arora V, Fergusen B, Chretien K. Incorporating social media into medical education. Academic Internal Medicine Insight. 9(1):12-13, 19. Read the full-text PDF here.

What are the Downsides of Social Media for Doctors? Dr. Wes shares insights from 6 years of blogging

Adaptive eyewear - BMJ video

BMJ medical innovations: Prof. Josh Silver from the Centre for Vision in the Developing World introduces adjustable eyewear that can be made for £1 and fitted by patients themselves.

Night shift workers are fighting ancient rhythms that order them to hunt or forage

From the National Geographic Magazine:

We sleep 1.5 hour less a night than we did just 100 years ago

We sleep on average 1.5 hour less a night than we did just a century ago. Some of our epidemic of insomnia or sleeplessness is probably just our refusal to pay attention to our biology. The natural sleep rhythms of teenagers would call for a late morning wake-up—but there they are, starting high school at 8 a.m.

The night shift worker sleeping in the morning is fighting ancient rhythms in his or her body that order him or her awake to hunt or forage when the sky is flooded with light. Yet he or she has no choice.

We fight these forces at our peril. Harvard's researchers note that going without sleep for 24 hours or getting only 5 hours of sleep a night for a week is the equivalent of a blood alcohol level of 0.1 percent. Yet modern business ethic celebrates such feats. "We would never say, 'This person is a great worker! He's drunk all the time!' "

One in 20 medical residents admits to making a fatigue-related mistake that resulted in the death of a patient

A 2004 study included 2,700 first-year medical residents. These young men and women worked shifts that were as long as 30 hours twice a week. The research revealed the remarkable public health risk that this sleep debt entailed. "We know that one out of five first-year residents admits to making a fatigue-related mistake that resulted in injury to a patient. One in 20 admits to making a fatigue-related mistake that resulted in the death of a patient. One day people will look back on what will be viewed as a barbarous practice."

References:

The Secrets of Sleep. National Geographic Magazine, 2011.

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

Automatic tracker ensures your doctor washed their hands

The University of Illinois Medical Center has installed a system called HyGreen (Hand Hygiene Recording and Reminding System) which acts as a reminder to health care workers before they ever enter a patient's room.

The provider begins by cleaning his hands, then placing them under a sensor that recognizes the cleaning, and transmits a signal to a badge the provider is wearing. When they walk into the patient's room, that badge transmits an "all clean" signal to a sensor above the bed.

If a caregiver walks into a room without washing their hands, the sensor won't get that all clean signal and the badge will start buzzing.



References:
Tech Ensures Your Doc Washed Their Hands. NBC Chicago.

28% of Vermont doctors "to stop practicing medicine" after single payer reform - doctors on Twitter disagree

According to BMJ, Vermont moves closer to becoming first US state to provide “socialised medicine”.

Vermont is set to become the first US state to launch a single payer healthcare plan after a bill passed both houses of the state’s legislature.

The plan is expected to be signed by Governor who originally proposed the idea that would abolish most insurance plans and would instead provide healthcare to all residents through public funding - a “single payer” scheme and is fiercely opposed by many conservative politicians as “socialised medicine.”

Some doctors in Vermont are unhappy about the proposed changes. In an online poll of 600 doctors conducted by a state representative and an ObGyn doctor, 28% said that they will stop practising medicine in the state if the plan is adopted.

Comments from Twitter:

@a_singledrop (Emily Lu): Seriously?

@movinmeat: calling their bluff.

@gruntdoc (GruntDoc): States as exp labs.

@backpackerchick (Hartley): In another era, doctors ****** about Medicare and found themselves richer than ever when it was enacted! What's good for the doctor (profits) is not necessarily good for the patient!

@RN_ing (Mary v. Seattle RN): Change is difficult... to be expected, but continue to want #singlepayor.

@irfandhalla (Irfan Dhalla): Single payer turned out to be well liked by docs in Canada. Will same happen in Vermont?

What do you think? Feel free to comment below, or post on Twitter.

References:

Vermont moves closer to becoming first US state to provide “socialised medicine”. BMJ 2011; 342:d2921.

Image source: OpenClipArt.org, public domain.

17% of U.S. hospitals now provide virtual colonoscopy

Medicare does not currently reimburse routine screening with virtual colonoscopy, but it does cover evaluations with "regular" colonoscopy.

References:

Virtual Colonoscopy Gains in Popularity. Is It Right for You? TIME.
Colonoscopy Developer Dies at 94 - NYTimes http://goo.gl/iBnOp - Dr. Wolff was unconventional and surely made headlines in his day.
When President Obama underwent his first-ever colon cancer screening last year, he chose virtual colonoscopy. USA Today.
Cleveland Clinic Colorectal Cancer Risk Assessment Tool. Get your score in 2 minutes (free).

Comments from Twitter:

@DrSilge (Robert Silge, MD): What are your thoughts? Inability to biopsy, extra radiation... I don't see benefit. W/ fam hist of Colon ca, I won't be signing up.

@DrVes: Correct, "physical" colonoscopy is the procedure of choice rather than the virtual one. In any case, the preparation is the toughest part and is the same for both procedures.

For doctors: How to be a Twitter superstar in 2 easy steps and 30 minutes per day

Warning: The purpose of this article is to inspire you to use Twitter, not to scare you. There are plenty of other blog posts and newspaper articles about doctors posting pictures of body parts on Facebook and getting fired. This is not it. Social media is amazingly useful for doctors and patients if you use the tools responsibly, have common sense, and never share the 18 HIPAA identifiers online or offline with unauthorized parties. The advice below is derived from extensive personal experience. I have used social media for professional purposes, as a physician, for more than 7 years, while working at some of the leading institutions in the U.S. such as the Cleveland Clinic and the University of Chicago. My account @DrVes was ranked #6 on the list of the Most Influential People from Chicago on Twitter (selected by Chicago Tribune and Klout.com). My blog websites have had more than 8 million page views. Just as an example, every time I hit the "publish" button of the sites, the message reaches more than 30,000 people every single day: 17,000 RSS and email subscribers, 9,000 Twitter followers, 3,000 daily visitors, and 1,500 Facebook fans (statistics for the sites ClinicalCases.org and CasesBlog, AllergyCases.org and AllergyNotes, and the Twitter accounts @DrVes and @Allergy).

This is somewhat of a typical example nowadays. There are many other physicians who are much more popular than me on social media and make the stats above look minuscule. You can be one of them. Here is how.

The basics of Twitter use for busy doctors

Most doctors are really busy. Several questions always come up when doctors consider the use of social media for professional purposes: Who has time for Twitter? What am I going to say there? To whom? And why Twitter, to begin with? What about Facebook or YouTube? My office is a mess and I always say "ehhh" when recorded -- I don't want to do video. Do I need a blog too?

Good questions. Here are the answers.

The circle of online information for me is as follows: Google Reader -> Share on Twitter -> Get feedback -> Write a blog post -> Share via RSS and Twitter -> Get feedback, go on. You don't need to use all services.

Here is how to facilitate the Rise of the ePhysican who works hand in hand with the ePatient:



1. Who has time for Twitter?

You do. Twitter should take no more 30 minutes per day and it will be beneficial for you, your colleagues and your patients. You will learn more and will feel better about it. Make it part of your normal routine - just like checking the news. In fact, Twitter is just that - checking the news - and then sharing the ones that you find most interesting with your followers. This takes a single click, and 2 seconds. Ten tweets per day, 2 seconds each. This is 20 seconds. You can do it.

2. Why Twitter?

Start on Twitter because it is quick and relatively easy. Twitter has the lowest barrier to entry among all social media services. "Being on Twitter" requires just 10 short sentences per day, with approximately 7 words each. You can reach thousands of people with a single sentence. Would you like to share the latest guidelines for food allergy? Just click and all your Twitter followers will know about them instantly. You will also get feedback to your tweets via replies and re-tweets.

3. What am I going to say on Twitter?

The answer is simple. You are an expert. There is a flood of medical news that hits the wires every day. I want to know what YOU think is important. Share the 3-10 news items per day that you find interesting. I will subscribe to read them. Many will do the same.

4. Who is going to read my tweets?

As a physician, you are an expert in your field. You provide valuable insight - just be selecting what you think it’s important from the news of the day. Embed this little personal news stream in your practice page. Your patients will appreciate the helpful updates, hand-picked by their doctor. Your colleagues may find it interesting too.

5. What about Facebook or YouTube?

Those are nice but I would start on Twitter first, and then expand if you see the need to do so. It may be a good idea to start a like/fan page on Facebook for your practice and re-post some of the tweets there. This is simple and not time-consuming. It can be done automatically.

6. Do I need a blog too?

Only you can tell if you need a blog. If you feel that you need to expand beyond 7-8 words on Twitter, by all means, start a free blog on Blogger.com by Google or WordPress.com and see how that works for you. Start on Twitter and expand to a blog as a natural extension if you need to write longer or provide some background. Post your blog items in your Twitter feed.

How to be a Twitter "star" in two easy steps

This is easy. It’s a two-step process for beginners and it takes about 30 minutes per day. The best time is just after your kids go to sleep.

1. Review the news of the day from Google Reader. I have ready-made subscription RSS bundles for you below. Alternatively, you can check a service such as Webicina.com for RSS feeds in your specialty.

2. Post the news items that you like best on Twitter. Don’t post all 10 tweets at once. Schedule them evenly throughout the next day. The first tweet goes on at 7:30 am EST and the last one at 8:30 pm EST. You can use Seesmic Web to schedule tweets - it is simple, free, and just works. The alternatives include HootSuite and any number of scheduling services (some of them have a limitation of up to 10 tweets per day).

This summary did no address the other Twitter activities such as listening, engaging, search, chat, HIPAA compliance, etc. They will be discussed in future articles.

RSS bundles of medical news

You can use the following RSS bundles to subscribe to medical news items. The bundles are exported from my personal Google Reader page. They update automatically several times per day. When in Google Reader, just select the ones that you find interesting and share them on Twitter. Feel free to add your own comments to some of the tweets.

Top Twitter Doctors

This is a list of the Top Twitter Doctors arranged by specialty in alphabetical order - feel free to add your own suggestions. The list is open to anybody to edit:

Related reading

What are the Downsides of Social Media for Doctors? Dr. Wes shares insights from 6 years of blogging

Video: Teens See Dangers of Texting While Driving

AssociatedPress — May 16, 2010 — Teenagers are driving through an obstacle course with their cell phones in hand to see why texting while driving is so dangerous.

Related:

Proposal: All cell phones sold in Chicago to allow parents to block their children from texting while driving. Chicago Tribune, 2011.

Postural Orthostatic Tachycardia Syndrome (POTS) - Mayo Clinic video

Phil Fischer, M.D., discusses the latest research on Postural Orthostatic Tachycardia Syndrome (POTS). Two free full text reviews are available via Dr. RW Notes.

Postural Orthostatic Tachycardia Syndrome from a patient's perspective:



After 9 months of struggling and fighting for a diagnosis, she was diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS).

POTS from a mother's perspective:

Comments from Twitter:

@drjohnm (John Mandrola, MD): For EPs, POTS is one tough nut to crack.>>Helpful video.