Risk of heart attack and stroke goes up during holidays - Mayo Clinic video

From the Mayo Clinic YouTube channel: Are you at an increased risk of heart attack and stroke? Studies show the incidents rise during December and January, but particularly on Christmas Day and New Year's Day. Stay safe.

Jon Lord (70), a Hammond organ player, and a founding member of Deep Purple, who is currently recovering from cancer, says it very well: "Party hearty but look after yourselves. I wish you success and happiness, and above all I wish you health."



Jon Lord - Child In Time, 4 March, 2009, Palace of Arts (MÜPA), Budapest, Hungary.

Happy New Year!

References:

Jon wishes you a Happy New Year

iPad app tests athletes for concussion - Cleveland Clinic video

An iPad app tests athletes for concussions (a Cleveland Clinic video). The players perform a series of balance, memory, vision, and reaction time experiments to obtain a baseline reading. If they receive a blow to the head during a game or practice, these tests can be redone to determine when it is safe for the athlete to return to action.

References:

Concussion Center - Cleveland Clinic.
Cleveland Clinic Treats Concussions With iPad App. Fox News.
Chronic traumatic encephalopathy (CTE): Brain bank examines athletes' hard hits - CNN, 2012.

Comments from Twitter:

@DrVes: Why are some doctors and nurses giving back their iPads? http://j.mp/Hq15aD - Easy: iPad works great for pt education, NOT for data entry. Only 10% of doctors currently use an iPad at work http://j.mp/Hq15aD - I use iPad daily to discuss these diagrams: http://j.mp/Hq1k5v

iPad is a great teaching tool @CraigCCRNCEN was able to explain to Vietnamese family AFib and clots by showing them animation from YouTube.

Brian S. McGowan PhD @BrianSMcGowan: so is the best option for docs still a touch screen laptop? teach w/ touch screen, work w/ full keyboard? #hcsm

@DrVes: iPad works well for discussing DDx, Tx options with pts. Much more portable than laptop. Full-keyboard COWs best for typing.

Jeff Bray @jeffkbray: I have been scanning all my medical reference books and store them on my iPad for quick use and no weight - great tool and mobile

Mick Jagger (68) on staying fit: "Don’t look at the clouds of tomorrow through the sunshine of today"

Mick Jagger on staying fit: "You watch what you eat, you exercise, you have a bit of fun. You keep on going forward. Don’t stop. Do what makes you happy. Don’t look at the clouds of tomorrow through the sunshine of today. That’s it."

In other news, you can do anything with a blog (full website and all) - the launch site of Mick Jagger's supergroup SuperHeavy is basically a blog: http://www.superheavy.com

Their new hit "Miracle Worker" plays with medical terminology:

"You have a medical condition.

In an emergency I'm very well prepared
My scalpel, mask and gloves; don't ever get too scared.

No need for anesthetics, I'll go check your charts

You're a Miracle Worker.
You're a surgeon of love."

-- Lyrics from SuperHeavy - Miracle Worker.



Mick Jagger is well-known as an exercise fanatic: "We were busy recording a song and Mick Jagger (68) was doing 120 situps and pushups and singing at the same time time", says Eurythmics founder Dave Stewart.

References:

Mick Jagger's new supergroup with Joss Stone and Dave Stewart. DailyMail.

Redefining age 65 - when your job description is "rockstar"

Paget's disease - NHS Choices video

From the NHS Choices YouTube channel: An expert describes the various areas of the body that can be affected by Paget's disease - a condition in which the normal cycle of bone growth is disrupted.

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 Paget (11 January 1814 – 30 December 1899) is best remembered for Paget's disease and is considered, together with Rudolf Virchow, as one of the founders of scientific medical pathology.

References:

When was the earliest journal club?
James Paget, Wikipedia.

George Michael, still breathless after pneumonia and tracheotomy, plans a show for his doctors (video)

Video: George Michael: This has been the worst month of my life. ShowBiz411.

A thin and visibly weak George Michael (48) told reporters outside his home in London that he wasn't supposed to speak for very long and was still recovering from a tracheotomy: "I got streptococca-something... It's a form of pneumonia and they spent three weeks keeping me alive basically," Michael said of the doctors in the Austrian hospital where the singer has been receiving treatment since he fell ill in November.

He added that he also wanted to hold a special show for the Austrian doctors who treated him. "I've spent the last 10 days since I woke up literally thanking people for saving my life."

References:

Gaunt George Michael says "fortunate to be here". Reuters, 2011.

How to Stay Active With Osteoarthritis: "Motion is Lotion"

Dr. Daniel Montero, a sports-medicine physician within the Department of Orthopedics at Mayo Clinic in Florida discusses what kind of exercises are you should take part in if you suffer from joint pain. Remember, "motion is lotion", says Dr. Montero.

Exercises you may need to avoid if you have moderate or severe osteoarthritis of the knee or hip include:

- Running and jogging. The difference between how much force goes through your joints jogging or running, as opposed to with walking, is sometimes more than 10-fold your whole body weight

- Jumping rope

- High-impact aerobics

- Any activity where, at any time, you have both feet off the ground at once, however briefly (basketball, jumping)

Fortunately, that leaves a lot of activities that are OK for people with knee and hip osteoarthritis and that can help keep you mobile - see the list at WebMD.

References:

Knee and Hip Exercises for Osteoarthritis. WebMD.

40% of police officers have a sleep disorder according to a JAMA study

More than a third of police officers have a sleep disorder, and those who do are more likely to experience heart disease, problems with job performance and rage toward suspects and citizens, says the NYTimes, citing a study in the JAMA. That figure is at least double the estimated 15-20% rate of sleep disorders seen in the general population.

Having a sleep disorder raised the odds of heart disease by 45%, and the odds of depression by 120%. It also raised the odds of being injured on the job by 22% and falling asleep while driving by 51%.


The JAMA report video.

The officers who had sleep disorders reported more instances of “uncontrolled anger” toward suspects and citizens and serious administrative errors. Sleep deprivation may affect the amygdala, a part of the brain where emotion is governed.

Of the 5,000 study participants, 40% screened positive for at least 1 sleep disorder, most of whom had not been diagnosed previously:

- 34% screened positive for obstructive sleep apnea
- 6.5% for moderate to severe insomnia
- 5.4% for shift work disorder

Not surprisingly, the police officer who had smaller body mass indexes were far less likely to have sleep apnea. System-wide practices can have a significant impact. For example, state police officers in Massachusetts are given one hour of paid exercise time four days a week to help them stay fit. They were less liekly to have sleep apnea.

References:

Sleep Problems in Police Officers Take Heavy Toll. NYTimes.
Sleep Disorders, Health, and Safety in Police Officers. JAMA.

Comments from Twitter:

WendySueSwanson MD (@SeattleMamaDoc): Geesh.

@CrumbedOxygen: wonder if EMS similar.

Dr John Weiner @AllergyNet:  Can CPAP Cure Cops?

Martin Wilson @ChInspMWilson: what is CPAP then ...??

@DrVes CPAP (continuous positive airway pressure) is a treatment option for sleep apnea. Here is more info from the Mayo Clinic: http://www.mayoclinic.com/health/cpap/MM00716

Brand Identity

The image source is xkcd, of course.

The "Five Second Rule" doesn't work

In case you had any doubts, the "Five Second Rule" doesn't work, says Dr. Susan Rhem, an infectious disease specialist from the Cleveland Clinic:



A common superstition, the five-second rule states that food dropped on the ground will not be contaminated with bacteria if it is picked up within five seconds of being dropped (Wikipedia).

Comments from Twitter:

@alisha764: The "5 Second Rule" doesn't work: Food + Floor = Bacteria

How to manage your online reputation as a physician in 5 steps

1. Google yourself - repeat on a regular basis, at least once a month, and set up Google alerts to catch new mentions.

2. Correct mistakes and false information about you that is published online. Contact the site authors.

3. Create your own content - start a blog, Twitter account and Facebook page, use Google+ for draft posts. Send selected news to Twitter, try Facebook for updates from you practice. Link you own blog posts from Twitrter and Facebook.

Setup professional profiles on Google+ and LinkedIn.

Push irrelevant or non-reliable content down in the search results. The farther down the better, as 90% of people won't go past the first page of search results and 99% won't go past page 2.

4. Embrace constructive online criticism. Consider it a 360-degree evaluation.

5. Address actionable items such as "hot button issues" among patients - long waits, lack of response or slow responses.



Cycle of Online Information and Physician Education (click here to enlarge the image). An editable copy for your presentation is available at Google Docs.

I developed the concept of Two Interlocking Cycles:

- Cycle of Patient Education
- Cycle of Online Information and Physician Education

The two cycles work together as two interlocking cogwheels (TIC):



References:

5 ways to manage your online reputation. American Medical News, 2011.

Social media in medicine: How to be a Twitter superstar and help your patients and your practice

Patients directed to online tools don't necessarily use them: 25% checked website vs. 42% read same material on paper. Am Medical News, 2012.

Image source: Wikipedia, public domain.

Controversies in COPD treatment

Chronic obstructive pulmonary disease (COPD) is a chronic disorder with high mortality rates (one of the top 5 causes of death).

COPD is expected to rise to the third leading cause of death worldwide by 2030. More than 25% of COPD patients have never been smokers.

Some important controversies in COPD management still exist:

- The classic way to define COPD has been based on spirometric criteria, but more relevant diagnostic methods are needed that can be used to describe COPD severity and comorbidity

- Initiation of interventions earlier in the natural history of the disease to slow disease progression is debatable

- There are controversies about the role of inhaled corticosteroids (ICS) in the management of COPD

- Long-term antibiotics for prevention of exacerbation have had a resurgence in interest

New drugs are urgently needed for management of COPD exacerbation.

COPD is a complex disease and consists of several phenotypes that in future would guide its management.



Asthma Inhalers (click to enlarge the image). Advair and Symbicort are FDA-approved for treatment of COPD in the U.S.

References:

Controversies in treatment of chronic obstructive pulmonary disease. Prof Klaus F Rabe MD a , Jadwiga A Wedzicha MD b. The Lancet, Volume 378, Issue 9795, Pages 1038 - 1047, 10 September 2011.

New insights into the immunology of chronic obstructive pulmonary disease. The Lancet, Volume 378, Issue 9795, Pages 1015 - 1026, 10 September 2011.

COPD—more vigorous research needed. The Lancet, Volume 378, Issue 9795, Page 962, 10 September 2011.

Diagnosis and Management of COPD - Current Guidelines

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

Stress fractures

From a 2011 review in the journal American Family Physician:

Stress fractures are common injuries in athletes and military recruits. These typically affect lower extremities.

Symptoms of stress fractures

Stress fractures should be considered in patients who present with tenderness and/or edema after a recent increase in activity or repeated activity with limited rest.

The Barefoot Professor says barefoot running could minimize injuries although this approach is still experimental:



The differential diagnosis of stress fractures includes:

- tendinopathy
- compartment syndrome
- nerve or artery entrapment syndrome
- medial tibial stress syndrome (shin splints) can be distinguished from tibial stress fractures by diffuse tenderness along the length of the posteromedial tibial shaft and a lack of edema

Diagnosis of stress fractures

When stress fracture is suspected, plain radiography should be obtained initially and, if negative, may be repeated after 2-3 weeks for greater accuracy.

If an urgent diagnosis is needed, triple-phase bone scintigraphy (bone scan) or magnetic resonance imaging (MRI) should be considered. Both modalities have a similar sensitivity, but MRI has greater specificity.

Treatment of stress fractures

Treatment of stress fractures consists of:

- activity modification - nonweight-bearing crutches if needed for pain relief
- analgesics
- pneumatic bracing

After the pain is resolved, patients may gradually increase their level of activity.

Surgical consultation may be appropriate for patients with:

- stress fractures in high-risk locations
- nonunion
- recurrent stress fractures

References:

Stress fractures: diagnosis, treatment, and prevention. Patel DS, Roth M, Kapil N. Am Fam Physician. 2011 Jan 1;83(1):39-46.

The Barefoot Professor says barefoot running could minimize injuries

Related reading:

The Barefoot Running Revolution - INFOGRAPHIC  http://goo.gl/7SUGs

Best Tweets - Selection of Twitter Favorites

Being a SuperHero has its drawbacks RT @Bongi1: Just about to fly to cape town just to turn around and fly back.

— GruntDoc (@gruntdoc) December 13, 2011

This is amusing: Amy Chua's "Battle Hymn of the Tiger Mother" was sold in China as "Being an American Mom." bit.ly/vI0zNo #hardcore

— Heidi N. Moore (@moorehn) December 11, 2011

Chickens' water keeps freezing. I propose adding vodka to it. I have been overruled. Something about killing them.

— Robert Silge, MD (@DoctorMac) December 10, 2011

Walked by a minor car accident earlier & a cop said to passersby: "Nothing to TWEET here, move along now."

— Nick Bilton (@nickbilton) December9, 2011

Study shows people can guess personality via body odor. From inkblot to stinkblot? j.mp/v6DDNX

— Dr John Weiner (@AllergyNet) December5, 2011

I attended a really long talk today.The only thing I learned from it is the flash-drive-around-the-neck is not a good look for lecturers.

— Jonathan,DO,MS,NCC (@DrJonathan) December1, 2011

Dental assistant (before I met dentist): "Ok I'm going to do the routine 14 x-rays." Me: "Uhhh, no that's ok."Her:"But, but-we always do!"

— Jonathan,DO,MS,NCC (@DrJonathan) December1, 2011

The inclusion of a Twitter update (tweet) in Best Tweets - Selection of Twitter Favorites does not represent endorsement or agreement of any kind. If you are included in this post but you would like to have your tweet removed for any reason, please email me and will comply with your request the same day.

Factors that Promote Positive Adaptation to Stress and Adversity

The phenomenon of resilience reflects positive adaptation despite contexts of risk, adversity, or trauma.

Factors that promote positive adaptation to stress and adversity include the following:

- self-esteem
- optimism
- internal control
- coping aimed at acceptance
- coping aimed at seeking emotional support
- social contacts



Tips for managing stress (2-minute BBC video):

- Take a few deep breaths
- Get plenty of exercise
- Socialize - don't stress alone, talk to someone and have a laugh
- Get out - go to the park

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

References:

Psychological and Social Factors that Promote Positive Adaptation to Stress and Adversity in the Adult Life Cycle. M. Guadalupe Jiménez Ambriz, María Izal and Ignacio Montorio. Journal of Happiness Studies, 2011.

Acute pyelonephritis in women (2011 review)

This is a 2011 review from the official journal of the AAFP, American Family Physician:

Acute pyelonephritis is a bacterial infection of the renal pelvis and kidney most often seen in young women.

Symptoms of acute pyelonephritis

Most patients have fever, although it may be absent early in the illness. Flank pain is nearly universal.

Tests for acute pyelonephritis

A positive urinalysis confirms the diagnosis.

Urine culture should be obtained in all patients to guide antibiotic therapy if the patient does not respond to initial empiric antibiotic regimens.

Escherichia coli is the most common pathogen in acute pyelonephritis. In the past decade, there has been an increasing rate of E. coli resistance to extended-spectrum beta-lactam antibiotics.

Imaging, usually with contrast-enhanced CT is not necessary unless there is:

- no improvement in the patient's symptoms
- symptom recurrence after initial improvement

Treatment of acute pyelonephritis

Outpatient treatment is appropriate for most patients.

Oral fluoroquinolone is the initial outpatient therapy if the rate of fluoroquinolone resistance in the community is less than 10%. If the resistance rate exceeds 10%, an initial IV dose of ceftriaxone or gentamicin should be given, followed by an oral fluoroquinolone regimen.

Oral beta-lactam antibiotics and trimethoprim/sulfamethoxazole (TMP-SMX (Bactrim) are inappropriate for therapy because of high resistance rates.

References:

Diagnosis and treatment of acute pyelonephritis in women. Colgan R, Williams M, Johnson JR. Am Fam Physician. 2011 Sep 1;84(5):519-26.
Nephrology Cases

UpToDate is the most read medical reference tool - how did Harrison's, Cecil's, etc. manage to lose that war?

This the summary of my Twitter discussion with an academic nephrologist (by the way, the founding editor of UpToDate is also a nephrologist):

@DrVes: UpToDate is likely the most read medical reference tool, at least in the U.S. - how did Harrison's, Cecil's, etc. manage to lose that war?

@kidney_boy (Joel Topf): Reasons for UpToDate winning: Harrison's had no search, and an editorial style that told you about disease but not how to treat it

@DrVes: Exactly. It's amazing that those publishing companies didn't realize that they shipped "malfunctioning" product for years, and never fixed it.

@kidney_boy (Joel Topf): Harrison's is the great preclinical prof teaching pathophysiology, UpToDate is the smart clinician teaching you how to care for the patient with EBM.

@DrVes: UpToDate now has sections on pathophysiology, some of them quite good, check T-cells types, for example. Unfortunately, a lot of medical students get their basic pathology knowledge from Wikipedia nowadays. Just go to the library section where medical students are and have a look at the monitor screens during study time.

@kidney_boy (Joel Topf): Remember Harrison's is the youngest of the medical texts, it won by having regional approach (headache rather than CNS) to organization.

@DrVes: Classic-style textbooks (e.g. Harrisson's) feel like "half-book" nowadays. The doctors in training often find themselves asking "Where is the second part with treatment, updates, etc.?"

Related reading:

Review of the much anticipated UpToDate iPhone app, arguably the most read medical reference tool. iMedicalApps.com.
Are You Dependent on UpToDate for Your Clinical Practice?
"With UpToDate, students and interns may be as capable of teaching the resident (or attending) as visa versa"
Study: UpToDate More Likely than PubMed to Answer Patient Care Questions

Comments from Google Plus:

Neil Mehta - Ves one of the most useful aspects of Harrison's is/was the approach to symptoms. This is the first 100 or so pages of Harrison's. Understanding this can be a huge help in becoming a good clinician. It is pretty dense reading but internal medicine residents can benefit from spending time on this. Agree UpToDate is a tremendous resource. One thing to remember about U2D is that sections can be written by one author and this does run a risk of bias creeping in (no different than textbooks) but readers should learn to look at other sources/primary literature when necessary.

Ves Dimov - Right. UpToDate is far from perfect but it is very time efficient. It provides quick actionable info within 5-10 minutes of conducting a search. The depth of the content is limited by the person who wrote that particular article, of course.

Robert Silge - Yes, but by and large the people writing that content are qualified to do so. It is to medical textbooks what Wikipedia is to general reference books. Updates faster, to the point, and has info on (almost) everything. Its depth may be lacking, but for clinical practice I doubt the benefits of reading through primary literature is worth the time spent doing it for most endeavors.

And frankly for your first foray into a field, as a med student for example, Wikipedia is a darned useful place to start.

Ves Dimov - And that's why UpToDate is most users' favorite resource. One of the few drawbacks is the price though, $495 per year.

Robert Silge - Wonder how many people pay for it out of pocket vs use an institutional login?

Gary Levin - Up to date is like rounding with your attending or professor with instantaneous gratification. Harrison belongs in the library or for a second year med student to learn the language.

Headache subtypes: 30-year prospective cohort study

This BMJ study included 590 people aged 19-20 from a cohort of 4,500 residents of Zurich, Switzerland, interviewed 7 times across 30 years of follow-up.

The one-year prevalence of subtypes of headache were:

- 1% (female:male ratio of 2.8) for migraine with aura
- 11% (female:male ratio of 2.2) for migraine without aura
- 11% (female:male ratio of 1.2) for tension-type headache

The cumulative 30-year prevalence of headache subtypes were:

- 3% for migraine with aura
- 36% for migraine without aura
- 29% for tension-type headache

Despite the high prevalence of migraine without aura, most cases were transient and only 20% continued to have migraine for more than half of the follow-up period.

There was a substantial crossover among the subtypes and no specific pattern of progression.

The longitudinal overlap among subtypes of headache shows the developmental heterogeneity of headache syndromes.

References:

Magnitude, impact, and stability of primary headache subtypes: 30 year prospective Swiss cohort study. BMJ, 2011.

Image source: Openclipart.org, public domain.

Hirsutism or Excess Hair

From NHS Choices YouTube channel: Hirsutism causes excess hair growth in women, such as on the face and chest. An expert explains the causes or hirsutism, treatments such as hair-removal and cosmetic techniques, and where to go for help if you're worried about excess hair growth.

The Cleveland Clinic Journal of Medicine published an Update on the management of hirsutism in 2010:

Hirsutism is a source of significant anxiety in women. While polycystic ovary syndrome (PCOS) or other endocrine conditions are responsible for excess androgen in many patients, other patients have normal menses and normal androgen levels (“idiopathic” hirsutism).

The finding of polycystic ovaries on ultrasound is not required for the diagnosis of polycystic ovary syndrome (PCOS). Gonadotropin-dependent ovarian hyperandrogenism is believed to cause PCOS. However, mild adrenocorticotropic-dependent adrenal hyperandrogenism also is a feature in many cases.

Even women with mild hirsutism can have elevated androgen levels, and thus, they may benefit from a laboratory evaluation.

Laser treatment does not result in complete, permanent hair reduction, but it is more effective than other methods such as shaving, waxing, and electrolysis. It produces hair reduction for up to 6 months. The effect is enhanced with multiple treatments. Interestingly, a portable laser hair removal device is currently available from Amazon (this post is not a recommendation or endorsement of the product).

References:

Update on the management of hirsutism. Cleveland Clinic Journal of Medicine June 2010 vol. 77 6 388-398.

A home hair removal laser device is available without prescription from Amazon.com (not a recommendation to buy any product, see the link below). A similar device is available from Costco.

Cleveland Clinic calls "Code Lavender" to improve patient satisfaction

From the WSJ:

How patients feel they were treated has always colored their opinions of a hospital. Now, those feelings are being factored into how hospitals get paid.

The Cleveland Clinic CEO, Dr. Cosgrove, says that in his own days as a top cardiac surgeon, he focused so intently on reducing complications from cardiac procedures that he gave little thought to the feelings or experiences of patients.

Times have changed dramatically since then. The Cleveland Clinic has launched a program known as HEART - for hear the concern, empathize, apologize, respond and thank—that empowers employees to handle patient concerns from the moment they arise.

It developed a Healing Services team to offer complimentary light massages, Reiki—a laying on of hands—aromatherapy, spiritual care from a clergy person or lay practitioner and other holistic services, and it will call a "Code Lavender" for patients or family members under stress who need immediate comfort.

Since 2008, the Cleveland Clinic's overall hospital ratings have increased by 89%.

"Code Lavender" has a Twitter account too (@CodeLavender), managed by the former Cleveland Clinic Chief Experience Officer who popularized the term.

From the Cleveland Clinic Twitter account: Efforts to improve patient satisfaction were featured in a NBC Nightly News story (see the video below).



References:

A Financial Incentive for Better Bedside Manner. WSJ.
Image source: Lavender Farm, Wikipedia, public domain.

Disclaimer: I was an Assistant Professor of Medicine at Cleveland Clinic from 2005 to 2008.

Comments from Twitter:

@TanyaPRpro (Tanya R. Walton): Clever and meaningful hospital care

@scottRcrawford: Brand medicine

@gruntdoc: How sad. Condolences. RT @DrVes: Cleveland Clinic calls "Code Lavender" to improve patient satisfaction goo.gl/X4Jtt

@MGastorf (Melissa Gastorf): concerns about satisfaction basis for payment- i.e. if you refuse to write narcotic and patient angry, physician payment suffers.

Acute altitude illnesses

This summary is based on a recent BMJ review:

Acute altitude illnesses include:

- high altitude headache
- acute mountain sickness
- high altitude cerebral edema
- high altitude pulmonary edema

Typical scenarios in which such illness occurs include:

- a family trek to Everest base camp in Nepal (5,360 m)
- a fund raising climb of Mount Kilimanjaro (5,895 m), shown in the map below
- a tourist visit to Machu Picchu (2,430 m)


View Larger Map

High altitude headache and acute mountain sickness often occur a few hours after arrival at altitudes over 3,000 meters.

Occurrence of acute mountain sickness is reduced by slow ascent. Severity can be modified by prophylactic acetazolamide.

Mild to moderate acute mountain sickness usually resolves with:

- rest
- hydration
- halting ascent
- analgesics

Occasionally people with acute mountain sickness develop high altitude cerebral oedema with confusion, ataxia, persistent headache, and vomiting.

Severe acute mountain sickness and high altitude cerebral edema require urgent treatment with:

- oxygen if available
- dexamethasone
- possibly acetazolamide
- rapid descent

High altitude pulmonary edema is a rare but potentially life threatening condition that occurs 1-4 days after arrival at altitudes above 2,500 meters. Treatment includes oxygen if available, nifedipine, and rapid descent to lower altitude.

What do extreme athletes who can summit the peaks of Mt. Everest have in common with people with heart failure? This Mayo Clinic video explains it:



References:

Clinical Review: Acute altitude illnesses. BMJ 2011; 343:d4943 doi: 10.1136/bmj.d4943

Linaclotide for treatment of constipation - minimally absorbed peptide agonist of guanylate cyclase C receptor

Linaclotide is a minimally absorbed peptide agonist of the guanylate cyclase C receptor. It consists of 14 amino acids. The sequence is:

H–Cys1–Cys2–Glu3–Tyr4–Cys5–Cys6–Asn7–Pro8–Ala9–Cys10–Thr11–Gly12–Cys13–Tyr14–OH

Two randomized, 12-week trials included 1,300 patients with chronic constipation (NEJM, 2011). Patients received either placebo or linaclotide once daily for 12 weeks.

The incidence of adverse events was similar among all study groups, with the exception of diarrhea, which led to discontinuation of treatment in 4.2% of patients in linaclotide groups.

Linaclotide reduced bowel and abdominal symptoms in patients with chronic constipation. Additional studies are needed to evaluate the potential long-term risks of linaclotide in chronic constipation.

References:

Two Randomized Trials of Linaclotide for Chronic Constipation. N Engl J Med 2011; 365:527-536August 11, 2011.

Image source: Colon (anatomy), Wikipedia, public domain.

Holiday time can be really stressful for patients with eating disorders - here is what to do

From Mayo Clinic YouTube channel:

For people with eating disorders such as binge eating disorder, bulimia nervosa and anorexia nervosa, the holiday season can be a nightmare.

People with eating disorders usually begin to worry about food consumption at holiday gatherings weeks sometimes even months - before the event, says Leslie Sim, Ph.D., clinical director of the Mayo Clinic Eating Disorders Program. "It's really a stressful time because there are large amounts of food around."

Dr. Sim suggests a few tips to navigate through holiday gatherings:

- Have a plan. People with eating disorders should eat like they would on a normal day and not skip any meals. Make sure to eat breakfast, lunch, and a light snack in addition to the meal. People who starve themselves are more likely to skip out on the meal entirely or engage in binge eating.

- If family or friends know someone is struggling with an eating disorder, it's not a good idea to comment on their weight during a holiday gathering. Even a compliment can be taken the wrong way.

- If you're hosting a holiday gathering with plenty of food, don't take offense if someone doesn't eat.

- People with eating disorders should have a coping strategy if they begin to feel stressed during a gathering. Such tactics include deep breathing, meditation and talking to a close friend of family member.

A blog can help your career - and even if it doesn't, it's still good for you

From CNN:

There is strong evidence that people who use their blog as a career tool do better. In 2005, a Pew survey found that people who blog are generally higher earners. People who use social media end up finding jobs that are a better fit.

Changing your career and skipping entry-level positions can be easier if you have a blog.

Most importantly, a blog is a great platform for networking. Just look at this picture from the annual CME meeting Essentials of EM 2011.

A blog is a good way to meet other people who think like you do and who are in your field. It helps you to make real connections with them based on ideas and passions.

Social media use allows you to focus your connections on other top performers, since blogging about career topics probably self-selects for engaged and motivated people.

Social media in medicine: How to be a Twitter superstar and help your patients and your practice

The key concept is TIC, Two Interlocking Cycles:

- Cycle of Patient Education
- Cycle of Online Information and Physician Education

The two cycles work together as two interlocking cogwheels (TIC).



Cycle of Patient Education (click here to enlarge the image). An editable copy for your presentation is available at Google Docs.



Cycle of Online Information and Physician Education (click here to enlarge the image). An editable copy for your presentation is available at Google Docs. Feel free to use the images in your own presentations with credit to AllergyCases.org.



References:

Blog your way to a better career. CNN.

Social media in medicine: How to be a Twitter superstar and help your patients and your practice

Patients directed to online tools don't necessarily use them: 25% checked website vs. 42% read same material on paper. Am Medical News, 2012.

Comments from Twitter:

Julie Meadows-Keefe @esq140: Challenge is finding time.

Tinnitus is perception of sound where there is none

Just a few days ago, British newspapers reported that a rock fan committed suicide to relieve tinnitus that he had for 3 months after a supergroup's gig. Tinnitus is characterized as perception of sound where there is none. Read more about tinnitus in this blog post. The Cleveland Clinic Journal of Medicine recently published a review on Tinnitus: Patients do not have to ‘just live with it’ and Tinnitus relief: Suggestions for patients.



From NHS Choices YouTube channel: Tinnitus causes people to hear constant sounds in one ear, both ears or in their head. An audiologist explains the possible causes and effects it often has, such as stress and anxiety, plus how to deal with them. Ashleigh, who was diagnosed with tinnitus in 2005, describes how she copes with it.

Lars Ulrich, the drummer for the heavy metal band Metallica, also struggles with tinnitus and warns his fans that "once your hearing is gone, it's gone. I've been playing loud rock music for the better part of 35 years," said Ulrich, 46. "I never used to play with any kind of protection."

Early in his career, without protection for his ears, the loud noise began to follow Ulrich off-stage. "It's this constant ringing in the ears," Ulrich said. "It never sort of goes away. It never just stops." This is a classic description of tinnitus, a perception of sound where there is none (phantom ear sounds).

The military is generating a tremendous number of tinnitus patients, according to a recent CNN report on the problem.

Tinnitus differential diagnosis: Q SALAMI mnemonic

Quinidine

Salicylates (aspirin)
Aminoglycoside antibiotics (ABx)

Labyrinthitis
Acoustic neuroma, CN VIII
Meniere’s disease
Increased blood pressure (BP) (HTN)

References:

Metallica drummer struggles with tinnitus: "Once your hearing is gone, it's gone"
Metallica drummer struggles with ringing in ears. CNN.

Tinnitus: Patients do not have to ‘just live with it’. CCJM, 2011.

Tinnitus relief: Suggestions for patients. CCJM, 2011.
Rock Fan Commits Suicide to Relieve Tinnitus From Supergroup's Gig: Daily Mail and Fox News.
Noise Chart as It Relates to Hearing Damage and Hearing Loss http://goo.gl/tjZh1

"Family practitioners in the US are facing extinction. In their place must come nurse-practitioners" - The Lancet

From the Lancet review of the University of Pennsylvania nursing school:

Family practitioners in the US are facing extinction. In their place must come nurse-practitioners. Nurses are better educated to navigate and refer patients to specialists. They don't have any illusions about managing complex illness. Their lower threshold for referral means less risk of missing diagnoses or delaying expert care.

This is one vision for nursing to be found at the University of Pennsylvania's extraordinary School of Nursing.

I'm not sure if this is the best model for primary care in the U.S. What do you think?

References:

Offline: Nursing, but not as you know it. The Lancet, Volume 378, Issue 9805, Page 1768, 19 November 2011.
Image source: OpenClipArt.org, public domain.

Comments from Twitter:

@scanman: Looks like doctors will be an endangered genus in the US within this century

@MGastorf: so disagree. I know that is being pushed but I can provide far more complete care than nurse practitioner.

@davisliumd: Umm, No -> RT @DrVes Family practitioners in the US are facing extinction. In their place must come nurse-practitioners

@davisliumd: Agree -> RT @drves: @davisliumd that was actually a quote from The Lancet, not my opinion: j.mp/w33Kvq.

Where citations come from

Source: http://xkcd.com/978

A doctor admits: "I love to blog but I still don’t really know why"

From Mike Cadogan, the founder of one the most popular medical blogs Life in The Fast Lane, based in Australia:

I blog to vent, to educate, to converse, to cogitate, to archive thoughts and to stimulate discussion.

I love the concept of a launching a thought, an image, a moment… into the inferno of the blogosphere, and observing the response.

With the average blog-reader attention span being around 90 seconds, I find that most of my ‘good’ posts – thoroughly researched, with well constructed arguments and propositions… are lost on this ‘average‘ reader… Yet, strangely I feel better having taken the time to arrange my thoughts, review the evidence and archive the information.

The advent of Facebook and Twitter has changed the way readers comment and share, and in many cases the promoted discussion continues out-with the confines of the original medium…

I love to blog but I still don’t really know why…

My reply is here:

You blog because you have to, Mike. And we are lucky to have you as a writer.

I have more prosaic and simple reasons to keep several blogs focused on different aspects of clinical practice: internal medicine, allergy and immunology, pediatrics, and IT.

I simply blog as a way to keep track of the new developments in medicine that are relevant to my practice and patients. The blog is a digital notebook and an archive accessible from any place and device with an internet connection.

A lot of people find it useful and that's great but this is an added bonus. If I don't find a blog post interesting and useful, I don't hit the "publish" button. A custom-made Google search engine makes it all searchable in 0.2 seconds. It just works.

Quotes from an interview with Seth Godin and Tom Peters:

"Blogging is free. It doesn’t matter if anyone reads it. What matters is the humility that comes from writing it. What matters is the metacognition of thinking about what you’re going to say.

No single thing in the last 15 years professionally has been more important to my life than blogging. It has changed my life, it has changed my perspective, it has changed my intellectual outlook, it’s changed my emotional outlook.

And it’s free."



Comments from Google Plus:

Neil Mehta - Loved your poetic post. I attempted to reflect on this earlier this year and came up with some reasons http://blogedutech.blogspot.com/2011/05/reflections-on-why-do-i-blog.html but find that it does not come close to your beautiful prose. Thanks for sharing.

References:

Why I Blog?
Why I Blog: Andrew Sullivan from The Atlantic Shares His Thoughts on Blogging
Why Do I Blog?
Why blog? Notes from Dr. RW. A perfectly reasonable list. All doctors should consider blogging. It's do-it-yourself CME.
"One of the best decisions I’ve made in my career was to start a blog and a wiki, leaving a paper trail of ideas" http://bit.ly/GX7Z6C

DRACO drug effective against most viruses (Double-stranded RNA Activated Caspase Oligomerizer)

"New drug could cure nearly any viral infection", proclaimed the media. The drug works by targeting a type of RNA (dsRNA) produced only in cells that have been infected by viruses. “In theory, it should work against all viruses."

Currently there are relatively few antiviral therapeutics, and most which do exist are highly pathogen-specific.

The MIT researchers developed a new broad-spectrum antiviral approach, called Double-stranded RNA (dsRNA) Activated Caspase Oligomerizer (DRACO).

DRACO selectively induces apoptosis in cells containing viral dsRNA, rapidly killing infected cells without harming uninfected cells.

The drugs were nontoxic to mammalian cells and effective against 15 different viruses, including dengue flavivirus, arenaviruses, bunyavirus, and H1N1 influenza. Dengue fever has invaded Florida and there are no effective antiviral agents to treat dengue infection at this time, according to a recent NEJM review (http://goo.gl/0gEXH).

DRACOs have the potential to be effective therapeutics or prophylactics for numerous clinical and priority viruses, due to:

- broad-spectrum sensitivity of the dsRNA detection domain
- potent activity of the apoptosis induction domain



NPR Video: How a Flu Virus Invades Your Body: "It starts very simply. A virus, just one, latches on to one of your cells and fools that cell into making lots more. Lots, lots more, like a million new viruses. This animation shows you how viruses trick healthy cells to join the dark side".

References:

New drug could cure nearly any viral infection. MIT News.

Rider TH, Zook CE, Boettcher TL, Wick ST, Pancoast JS, et al. (2011) Broad-Spectrum Antiviral Therapeutics. PLoS ONE 6(7): e22572. doi:10.1371/journal.pone.0022572

Library of the future - the new UChicago library has a stunning design and functionality

The University of Chicago’s new Mansueto Library is a futuristic bubble of a building that uses an automated retrieval systems that holds the books in steel cases 50 feet below ground.

While many academic libraries are digitizing and moving holdings off site, Manseuto is the largest and latest of about 24 libraries that use the system.



The $81 million Mansueto library (Mr. Mansueto founded Morningstar stock info service) has capacity for 3.5 million volumes.

The Mansueto library is also focused on digitizing its collection and has a lab for both digitization and conservation:

- it mends paper and rebinds the university’s books — some of them papyrus
- it also scans books for its partner, Google Books

It takes 5 minutes for a student to get a book after the request is placed electronically:

- 5 cranes run along parallel tracks; one is activated and locates materials using bar codes

- the crane removes one of the 24,000 containers, each weighing up to 200 pounds and transports it to an elevator, which lifts it to a librarian's desk

Some students apparently like the new library so much that they record poetic videos of "Rain in the Mansueto": "A quick capture of what I think was the first rain storm for the new Mansueto Library at the University of Chicago. My phone's mic really couldn't do justice to the sound, but it was a pretty exciting deep almost-rumble. You also can't capture the immersive fish-bowl-ness of it; it really is all around you. I can't wait for a storm during the day... or a blizzard."



References:

The Bibliotech: Library of the Future, Now. NYTimes.

The Joe and Rika Mansueto Library

Building the Joe and Rika Mansueto Library (video)

The loss of the centuries-old idea of a library building as the place to go to read and to look for information. Johns Hopkins Medical Library Is Closing Its Doors to Patrons and Moving to Digital Model (http://goo.gl/BWjjO and http://goo.gl/KN55o). According to the article, Johns Hopkins will transition the current medical librarians to "informaticians" embedded with the clinical teams.

Disclaimer: I am an Allergist/Immunologist and Assistant Professor of Medicine and Pediatrics at the University of Chicago.

Comments from Twitter:

@aptronym: Very impressive but what happens if there's a power outage, eh?

@BiteTheDust: they provide long ladders?

@DrVes: power outage at University of Chicago's Mansueto Library: http://t.co/fHbuIf2A

@aptronym: Ha! Two weeks after opening and a power outage meant #nobooksforanyone. I always ponder the effects of outages.

Myopia, the most common refractive error, has a prevalence of 10-30% in Western countries, but as high as 80% in Asia

Myopia (nearsightedness), the most common form of refractive error, has a prevalence of about 10-30% in most Western countries, but this figure is as high as 80% in parts of Asia. Furthermore, myopic refractive error is likely to progress during school years, and maintaining appropriate spectacle correction requires regular services for children in these age groups.

A study of self correction of refractive error among young people in rural China showed that although visual acuity was slightly worse with self refraction than automated or subjective refraction, acuity was excellent in nearly all these young people with inadequately corrected refractive error at baseline. Inaccurate power was less common with self refraction than automated refraction.

Self refraction could decrease the requirement for scarce trained personnel, expensive devices, and cycloplegia in children’s vision programs in rural China.

References:

Self correction of refractive error among young people in rural China: results of cross sectional investigation. BMJ 2011; 343 doi: 10.1136/bmj.d4767 (Published 9 August 2011).

Nearsightedness (myopia) becoming more frequent, affects 42% of Americans

Correcting refractive error in low income countries. BMJ 2011; 343 doi: 10.1136/bmj.d4793 (Published 9 August 2011).

20-20-20 rule: For every 20 minutes of reading a screen take a 20-second eye break, look at something beyond 20 feet. NYTimes, 2012.

Image source: OpenClipArt.org.

Any difference between a Mac and a PC?

Permanent link to this comic: http://xkcd.com/934

"Medical systems are made of holes and stacked like slices of Swiss cheese"

From the NYtimes:

"In 2000, the British psychologist James Reason wrote that medical systems are stacked like slices of Swiss cheese; there are holes in each system, but they don’t usually overlap. An exhausted intern writes the wrong dose of a drug, but an alert pharmacist or nurse catches the mistake. Every now and then, however, all the holes align, leading to a patient’s death or injury."

We have to fix the systems.

References:

The Phantom Menace of Sleep Deprived Doctors. NYTimes, 2011.
Image source: OpenClipArt.org, public domain.

Best Practices for Social Media Use in Medical Education

This is a video presentation and summary by one of the best medical bloggers, Mike Cadogan of Life in the Fast Lane:



The Cycle Of Social Media In Medical Education he mentions is based in part on my concept of TIC, Two Interlocking Cycles for Physician and Patient Education.

Dr. Cadogan asked me for feedback on a few questions that he used to prepare the presentations a few weeks ago. The answers are listed below:

1) What are your TOP 3 TIPS for the intrepid doctors starting out on their social media crusade?

1. Post 3 times a week. Schedule posts in advance. In reality, 95% of medical bloggers probably quit within one year.

2. Use your blog to collect interesting ideas and share/comment on health news.

3. Write some original content, if you can, but if you don't have time, that's OK. You have a more important job as a physician in real world.

2) What are your TOP 3 TIPS for WHAT NOT TO DO on this crusade?

1. Don't disclose patient information.

2. Don't offend people.

3. Don't be unprofessional. If you use your real name, it's better to let your employer know about your social media activities. It's OK to start an anonymous blog/Twitter account to test the waters.

3) What are the top 3 benefits YOU see for the role of social media in medicine?

1. Provide expert info on health news and diseases. You, as a doctor, are the one who actually knows what he is talking about - if you stick to your area of expertise.

2. Collaborate with like-minded people.

3. Gather feedback (including critical feedback) for your ideas.

4. Grow your practice by providing high-quality actionable info to patients.

4) What (in your opinion) are the MOST USEFUL 'platforms/apps' in the social media revolution (e.g. Twitter, G+, Slideshare, Facebook, etc.)?

1. Start a blog.

2. Get useful feeds in Google Reader.

3. Share ideas and communicate on Twitter and Facebook.

Speaking from personal experience, I've started more than 30 blogs and still keep around about 7. It's important to find a purpose for your blog and other social media activities. If you don't enjoy it, you will stop eventually. Set limits and respect other priorities. Your family and your patients come first, blogs and social media are a distant second - if you spend most of your time in clinical medicine, of course. Stay away from trolls and online personas looking to start a fight. Ask for help when you need it.

References:

The Social Media Conversation
Social Media In Medical Education

Why blog? Notes from Dr. RW. A perfectly reasonable list. All doctors should consider blogging. It's do-it-yourself CME.
Social media in medical education - Grand Rounds presentation by IUH Med/Peds residency program director http://goo.gl/Zw3lK

Diagnosis and Management of COPD - Current Guidelines

WHO estimates that 210 million people have COPD worldwide. COPD is the 4th leading cause of death in the world, but by 2030 it is expected to be the 3rd, behind CAD and stroke (http://bit.ly/X5nje). COPD mortality is inversely correlated to the forced expiratory volume (FEV1) in 1 second (http://bit.ly/ZYIR7).

Here are the key recommendations from the recently published Guidelines for management of stable chronic obstructive pulmonary disease (COPD):

1. Spirometry should be obtained to diagnose airflow obstruction in patients with respiratory symptoms. Spirometry should not be used to screen for airflow obstruction in individuals without respiratory symptoms.

2. For stable COPD patients with respiratory symptoms and FEV1 between 60% and 80% predicted, treatment with inhaled bronchodilators may be used.

3. For stable COPD patients with respiratory symptoms and FEV1 <60% predicted, inhaled bronchodilators should be used.

4. Clinicians should prescribe monotherapy using either long-acting inhaled anticholinergics (LAMA) or long-acting inhaled β-agonists (LABA) for symptomatic patients with COPD and FEV1 <60% predicted.

5. Clinicians may administer combination inhaled therapies (long-acting inhaled anticholinergics, long-acting inhaled β-agonists, or inhaled corticosteroids, LABA/ICS) for symptomatic patients with stable COPD and FEV1<60% predicted.

6. Clinicians should prescribe pulmonary rehabilitation for symptomatic patients with an FEV1 <50% predicted. Clinicians may consider pulmonary rehabilitation for symptomatic or exercise-limited patients with an FEV1 >50% predicted.

7. Clinicians should prescribe continuous oxygen therapy in patients with COPD who have severe resting hypoxemia (PaO2 ≤55 mm Hg or SpO2 ≤88%).

References:

Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline Update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. ACP, 08/2011. Annals of Int Medicine, 2011.

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

Glaucoma: Aruna's story (video)

From NHS Choices YouTube channel: Glaucoma is a group of eye conditions that affect vision. Aruna talks about her diagnosis and subsequent treatment.

A consultant ophthalmologist explains what glaucoma is, how it can affect your vision and how it can be treated:

Clinical Pearls in Gastroenterology from Mayo Clinic (video)

The social media department of Mayo Clinic combines journal articles and videos by the lead authors. This is a useful approach that should be followed by other journals, in addition to Mayo's own journal, Clinic Proceedings.



Dr. Amy Oxentenko, Assistant Professor of Medicine at Mayo Clinic, discusses "Clinical Pearls in Gastroenterology" (article abstract). Here is the 2009 edition of the same project.

References:

Clinical Pearls in Gastroenterology 2011. Amy S. Oxentenko, MD, John B. Bundrick, MD, and Scott C. Litin, MD

Why you shouldn't close your blog and Twitter account

A few months ago, @Doctor_V and an anonymous doctor on Twitter had an argument, she closed her account and now DrV's blog is the only one left to tell the story: http://goo.gl/mIS3N

I understand and appreciate the arguments of both parties. However, when she deleted her Twitter account, we lost one side of the story forever.

All doctors should consider having online presence because they need to tell their side of the story.

For example, if the majority of pediatricians had blogs, the false autism/immunization link would not have become accepted by celebrities and misled a large part of the general public.

Comments from Google Plus:

Arin Basu: Excellent point by Ves about how false findings spread (read the bit about immunization and autism). I think by the same stretch of logic, I'd strongly vouch for clinician-epidemiologists, and epidemiologists should have their own blogs, and take part in social media more often and raise awareness about findings and interpretation of studies. Well said, Ves.

Related reading:

Why blog? Notes from Dr. RW. A perfectly reasonable list. All doctors should consider blogging. It's do-it-yourself CME.

BMJ, the first medical journal to launch a website in 1996, shows a blog-like redesign

See the video here: Make the most of the new bmj.com. Editor-in-Chief Fiona Godlee and David Payne explain the redesigned bmj.com website, and some of the new features:



And, of course, you can follow BMJ on:

- Twitter
twitter.com/bmj_latest

- Facebook
facebook.com/bmjdotcom

- YouTube
youtube.com/user/BMJmedia

References:

Welcome to the new design. BMJ.

Medical apps are a wonderful thing but those drug ads may sway doctors' choices

From the NYTimes:

Epocrates drug reference app has won over 50% of U.S. doctors. But like so much else on the Web, “free” comes with a price: doctors must wade through marketing messages on Epocrates that try to sway their choices of which drugs to prescribe.

The marketing messages are difficult to ignore. For example, a psychiatrist who recently opened Epocrates on his iPhone said that before he could look up any drugs, he had to click past “DocAlert” messages on hypertension, bipolar disorder and migraines.

Epocrates says drug makers get $3 in increased sales from every dollar spent on DocAlerts.

One in five doctors will not see drug sales representatives at work, and Epocrates sees DocAlerts as a way to get a sales pitch in front of doctors.

Pharmaceutical companies provide at 70% of Epocrates’s revenue, which totaled $104 million last year. According to the former CEO: “It is a unique market. You have a drug industry that spends $14 billion a year to influence people who prescribe drugs. There are only 600,000 people who are allowed to prescribe drugs, so there is $14 billion spent against 600,000 people ($23,333 per U.S. physician). If you have a channel to reach these physicians, it is a gold mine.”

I use the online version of Epocrates. It is free and has a useful integration with a clinical evidence reference database provided by BMJ which works similarly to UpToDate. There are no DocAlerts that you need to click through to access the website.

References:

The Epocrates App Provides Drug Information, and Drug Ads. NYTimes.
"Cocaine for toothache" and other ads that would never be allowed now http://goo.gl/eeYX3 - Cocaine was sold over the counter in the U.S. until 1914.

Comments from Google Plus:

Darin Swonger - Palm or now HP and Epocrates parted ways and is now not supported with my Palm Pre, therefore, I have been using Medscape Reference and have found it to be adequate in most areas and better in others.

Ellen Richter - Gee, I use it every day & I've I never had a problem with the app due to ads getting in the way. I dont even recall seeing any ads! Do you think its because I'm not a doctor? It asks for your profession at registration, so I specified that I am a nurse. For once, could that be a benefit!!? :)

Nancy Onyett, FNP-C - It is the confidence to look past the drug ads, just like immunity to drug reps that hound me on a daily basis. I only practice from EBM and guidelines then I am protected. New drugs to the market are always a worry, they have been trialed and FDA approved, they are more costly to patients and the outcome is still muddy until they have been around awhile. I personally like to use the older drugs that have been around with subsequent studies proving their efficacy.

Road office in a box (video)

An “office in a box briefcase, with a place for everything and everything in its place". Check it out, by ePatient Dave:

Chocolate consumption is inversely associated with coronary heart disease

Cocoa and dark chocolate are rich in flavonoids and may lower blood pressure.

5,000 people aged 25-93 years participated in the National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study.

Compared to subjects who did not report any chocolate intake, odds ratios for coronary heart disease (CHD) were:

- 1.0 for subjects consuming chocolate 1-3 times/month
- 0.74 for subjects consuming chocolate 1-4 times/week
- 0.43 for subjects consuming chocolate 5+ times/week

Consumption of non-chocolate candy was associated with a 49% higher prevalence of CHD comparing 5+/week vs. none per week [OR = 1.49].

Consumption of chocolate is inversely related with prevalent CHD in a general United States population.

References:

Chocolate consumption is inversely associated with prevalent coronary heart disease: the National Heart, Lung, and Blood Institute Family Heart Study. Djoussé L, Hopkins PN, North KE, Pankow JS, Arnett DK, Ellison RC. Clin Nutr. 2011 Apr;30(2):182-7. Epub 2010 Sep 19.
Image source: Wikipedia, public domain.

From Writer's Almanac:

Ode to Chocolate by Barbara Crooker (excerpt)

I hate milk chocolate, don't want clouds
of cream diluting the dark night sky,
don't want pralines or raisins, rubble
in this smooth plateau. I like my coffee
black, my beer from Germany, wine
from Burgundy, the darker, the better.

Don’t just swallow, check the evidence first - it applies to diet, medications, and more

The wrong approach

According to the food conglomerate Danon: “Evidence is increasing that even mild dehydration plays a role in the development of various diseases.” It’s a campaign, sponsored by the producers of Volvic, Evian, and Badoit bottled waters, to get us all to drink more water.

But what and where is this evidence? A doctor replies: “This is not only nonsense, but is thoroughly debunked nonsense.”

The right approach

Worried by the fact that European guidelines classified almost all older people as being at high risk of cardiovascular disease, Norway has developed its own guidelines that use differential risk thresholds according to age.

Compared with the European guidelines, the total sum of life gained is about the same, but the number of patients treated is considerably lower.

How does clinical evidence work?



Ben Goldacre's Moment of Genius on BBC4 radio:

"Clinical trials in medicine are designed to be free from bias. They test, as objectively as possible, the effectiveness of a particular intervention.

When you bring the results of all these individual trials together, however, how do you weigh up what evidence is relevant and what is not? In 1993, a method of "systematic review" was introduced that enables us to get the clearest possible view of the evidence."

References:

Don’t just swallow, check the evidence first. Godlee 343. BMJ, 2011.

Image source: Plastic bottles before processing. Wikipedia, dierk schaefer, Creative Commons Attribution 2.0 License.

Interesting Correlation: Fast Food Founders and Longevity

Jay Parkinson noted an interesting correlation between Fast Food Founders and Longevity:

- Ray Kroc (McDonald’s) died at age 82

- Jimmy Dean died at age 81

- Taco Bell founder Glen Bell died at 86

- Sonic founder Troy Smith died at 87

- Hardee’s founder Wilber Hardee died at 89

- Baskin-Robbins founder Irvine Robbins died at 90

- Carl’s Jr. founder Carl Karcher died at 90

- Frozen french fry mogul J.R. Simplot died at 99

- Murray Handwerker, credited with making Nathan’s Famous Hot Dogs into a well-known national chain, died at 89




"Fake foods are more affordable. It's enticing people to eat more because they think they're saving money when they're really just buying heart disease." 10 Questions for Jillian Michaels. TIME, 2010.

Comments from Google Plus (Jul 27, 2011):

Maf Lewis - I'm going to guess that most of them were American, rich and therefor some of the few that could get good healthcare in the USA.

Neil Mehta - Good point +Maf Lewis
In addition they probably did not eat the fare their restaurants dished out?

Ves Dimov - I would assume they didn't eat the items on their restaurants' menu regularly.

One McDonald's CEO was famous for eating at least one product of its company daily. Unfortunately, he died at 44, from metastatic colon cancer. This does not prove causation, of course.

http://en.wikipedia.org/wiki/Charlie_Bell

Mr Bell oversaw McDonald's "I'm lovin' it" advertising campaign and introduced successes such as McCafe.

http://news.bbc.co.uk/2/hi/business/4180627.stm

Robert Silge - +Maf Lewis They clearly were both rich and American, and we could add male and white, but stating that they are among the "few" that could get good healthcare is grossly overstating it.

Maf Lewis - +Robert Silge As there are around 25%-30% uninsured Americans and another 20%-30% who have significant restrictions on their health insurance, I would say that Americans that get good healthcare (as compared to other countries of similar wealth per capita) would be in the minority - hence the few. Even if my figure are way off, the difference between health care of the top few % in the USA and the rest is enormous.

Robert Silge - +Maf Lewis Define "significant restrictions". Every system of organized healthcare has significant restrictions on how you can get healthcare. A complete lack of restrictions would be unfettered capitalism, where you can get whatever you want if you can pay for it.

Look at the literature. There is an association between socioeconomic status and longevity in any society. It is admittedly more pronounced in the US than in some countries. Some western countries are worse still.

Ves Dimov - Lifespan and social status: Why your boss will probably live longer than you
http://goo.gl/DQJRR

Maf Lewis - +Robert Silge - I agree it's hard to define and be accurate with some of these points, but for me significant restrictions would mean that you have a limit by the amount insurance will pay out for a specific illness, or pre-existing conditions, or other small print such as your activities are deemed dangerous sports (climbing on a roof to fix and ariel), or even having insurance investigators look into your case to see if there is a loophole that will enable them to not fund treatment- something I and my family came across first hand in my 6 years living in the USA.

I would confidently say that general healthcare in the USA is substandard to that of France, UK, Germany, Australia New Zealand etc, but for the top few % it is possibly the best in the world... actually it's best for the top few % in any country who can go anywhere in the world and get anything done...

The USA has the highest standard of living but one of the lowest life expectancies of the top 10 richest (per capita) countries.. why? Healthcare.

Maf Lewis - I absolutely agree about social status/health in all countries. I think it's just a bigger gap in the USA, as with educations, income, everything.

Robert Silge - Yes, it is bigger in the USA than in other countries. This article is horribly out of date (as in, it looks at WEST Germany), so take it for what it's worth, but the relationship between income and lifespan was least pronounced in Sweden and Norway, worst in the US and UK (and W. Germany, but let's ignore that all together). http://www.bmj.com/content/304/6820/165.full.pdf

Are there more uninsured and under-insured than I would like? Absolutely. But I think you're looking at this upside down. Our ability to take care of the bottom of our society is undeniably poor. But the middle elements of society get good care. And I'm not even saying that this is the way things ought to be. But it's the way things are, and to say a minority of patients get good healthcare is inaccurate to me. I would fundamentally disagree that FEW people in the US get "good healthcare".

Maf Lewis - Ok, all good points Robert. Maybe if I said that the average person in the USA doesn't get as good health care as the top 10 richest countries (per capita)?

Maybe I'm bias because of my direct experience with health care in the USA (6 years), Australia (1 year), UK (30 years), France (on and off 20 years). Always the USA was more limited and slower.

Robert Silge - Well you certainly have more direct experience than I, and no one can argue with that. I think it would be accurate to say that the highs are higher and the lows are lower in the US. That probably applies to a whole host of aspects of life here. For better or worse it's what we do.

Maf Lewis - True, but my direct experience could a series of both good and bag luck;) I'm sure there are horror and hero stories in all counties.

Yes I think the extreme highs and lows do apply to most things, and in a weird way it's both the worst and also the best of the USA.

Maf Lewis - Just to make it clear (if I hadn't already) it's not the health care professionals in the USA that are the problem here, but the insurance industry, and healthcare for profit in general.