Acute low back pain: What to do? What works and what doesn't?

Here is an excerpt from a recent review article in the official AFP journal American Family Physician:

Acute low back pain is one of the most common reasons for adults to see a physician. Most patients recover quickly with minimal treatment.

"Red flags"

Serious "red flags" include:

- significant trauma related to age (i.e., injury related to a fall from a height or motor vehicle crash in a young patient, or from a minor fall or heavy lifting in a patient with osteoporosis or possible osteoporosis)
- major or progressive motor or sensory deficit
- new-onset bowel or bladder incontinence or urinary retention
- loss of anal sphincter tone
- saddle anesthesia
- history of cancer metastatic to bone
- suspected spinal infection

Diagnosis

Without signs of serious pathology, imaging and laboratory testing often are not required.

Treatment

Patient education, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and muscle relaxants are beneficial.

Bed rest should be avoided, if possible.

Exercises directed by a physical therapist, such as the McKenzie method and spine stabilization exercises, may decrease recurrent pain.

Spinal manipulation and chiropractic techniques are no more effective than established medical treatments.

No substantial benefit has been shown with:

- oral steroids
- acupuncture
- massage
- traction
- lumbar supports
- regular exercise programs

References:

Diagnosis and treatment of acute low back pain. Casazza BA. Am Fam Physician. 2012 Feb 15;85(4):343-50.

Image source: Different regions (curvatures) of the vertebral column, Wikipedia, public domain.

Top articles in medicine in June 2012

Here are my suggestions for some of the top articles in medicine in June 2012:

Risky Music-Listening Behavior Associated with Health-Risk Behavior: alcohol, drugs and unsafe sex (study) http://goo.gl/eoUfL

Study: Couples get health benefits simply from sleeping in the same bed - WSJ http://goo.gl/PBlPJ

Love's initial romantic phase lasts anywhere from 18 months to 3 years, experts say, then it ends - WSJ http://goo.gl/2x1mS

5 Minute Medicine Video Series by Internal Medicine at McMaster University http://bit.ly/KidaPU

Aspiring to Make MDR-TB Nevermore: Delamanid for Multi-drug Resistant Pulmonary Tuberculosis - NEJM http://goo.gl/b7rQ8

The risks and benefits of social media for cardiologists - theheart dot org interview with @doctorwes http://goo.gl/TUfxj

Radiation from 2-3 head CTs in children triple the risk for brain tumors (5-10 CTs triple risk for leukemia) http://goo.gl/xs2ZH - Source: Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study - The Lancet http://goo.gl/teqnX

Inhibiting Hedgehog Pathway in Basal-Cell Cancer: Vismodegib is effective but 50% stop treatment due to adverse events http://goo.gl/966X5

Small-molecule inhibitor of the hedgehog pathway Vismodegib showed 58% response rate in advanced basal-cell cancer http://goo.gl/sJfm1

Another therapeutic option for Multidrug-Resistant TB: Delamanid nitro-dihydro-imidazooxazole inhibits mycolic acid http://goo.gl/zUhYY

Hospital mortality is complex and should be used cautiously in evaluating quality of care. Last 10 years marked by diminishing returns, with growth in costs far outpacing reductions in inpatient mortality http://goo.gl/T16W3

Churchill had a doctor's approval for "medicating with a minimum 250 cc alcohol at meal times" - “This is to certify,” the doctor writes — this in the midst of Prohibition — “that the postaccident convalescence of the Hon. Winston S. Churchill necessitates the use of alcoholic spirits especially at meal times.” The quantity, the doctor continues, is “naturally indefinite,” but the “minimum requirements would be 250 cubic centimeters,” or just over 8 ounces. Archives in NYT http://goo.gl/Yc9cr

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

Healthcare social media #HCSM - top articles

Here are my suggestions for some of the top articles related to healthcare social media (#HCSM) in the past 2 weeks:

Survey of 1,700 U.S. physicians reports that 12.9% are writing a blog http://goo.gl/zDUUO - Not realistic.

Infographic: The Anatomy of Linkbuilding http://goo.gl/gSnyK

Another healthcare social media #HCSM expert moves "completely away from from healthcare" http://goo.gl/Nwfup

Transforming academic conferences through Twitter http://goo.gl/bF55K

A Little 'Like' Can Mean Big Trouble - Facebook Can Mean Trouble at the Office (of course) - WSJ http://goo.gl/KsXOF

The new JAMA website looks just like a blog and that's on purpose http://goo.gl/nTGFV

Top Reasons for unfollowing people on Twitter - Infographic http://goo.gl/7Prfh

The risks and benefits of social media for cardiologists - theheart dot org interview with @doctorwes http://goo.gl/TUfxj

7 Tools To Make Your Twitter Account Stand Out http://goo.gl/ltX1d

Twitter Knows When You Sleep, and More - NYTimes http://goo.gl/n6m3L

The DSM-Tw: Handbook of Twitter Personality Types http://goo.gl/f7w6U

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive an acknowledgement in the next edition of this publication.

Beyond a hearing aid - Cochlear implants - Mayo Clinic video

From Mayo Clinic YouTube channel: Imagine what life would be like if you lost your hearing. No music, no sounds of nature, no listening to the voices of your loved ones. But some people with profound hearing loss do have options. Cochlear implants, in the right patients, offer the chance to hear again.

Best of Medical Blogs - weekly review and blog carnival

The “Best of Medical Blogs - weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.

New mnemonic for CXR Interpretation: DRS ABCDE (Doctors ABCDE)

Life in the Fast Lane: Many people would be familiar with the ABC method to interpreting CXRs: Airways, Breathing & Bones, Circulation.The mnemonic DRSABCDE can used as a simple, yet comprehensive, approach to CXR interpretation http://goo.gl/fGDmS:

D – Details
R – RIPE (Assessing The Image Quality): Rotation, Inspiration, Picture, Exposure (Penetration)
S – Soft Tissues And Bones
A – Airway & Mediastinum
B – Breathing
C – Circulation
D – Diaphragm
E – Extras: ETT, CVP line, NG tube, ECG electrodes, PICC line, chest tube

Why not grab a copy of the “Basic CXR Interpretation” flow chart and put it up in your clinic: http://lifeinthefastlane.com/wp-content/uploads/2012/06/CXR-DRSACBCDE.png

Routine physical exam and screening tests rarely yield valuable information

From Dr. Centor’s blog: Doing a routine exam rarely yields valuable information in the absence of symptoms. Doing routine screening tests rarely yields value information. http://goo.gl/xobBm

Tips for wearing flip-flops from Cleveland Clinic

From the Health Hub blog from Cleveland Clinic, Dr. Brian Donley talks about avoiding flip-flop related injuries this summer http://goo.gl/gJltj:

- Don’t wear flip-flops if you’re going on a long walk.
- Don’t buy flip-flops with soles that freely bend or twist.



With expectations set high, "it’s hard, perhaps impossibly hard, to be a good doctor", says the former BMJ Editor-in-Chief Richard Smith http://goo.gl/CTJc6

Skeptical Scalpel: The report of "10 Shocking Medical Mistakes" by CNN has a few mistakes of its own: http://goo.gl/oglRX

How to harvest the medical research with "snowballing" and "pearl growing" search strategies http://goo.gl/gEsdQ

A Brief Social Media Guide for Authors of Medical Resources http://goo.gl/6n17e

Dr. Wes: Third Party Central http://buff.ly/LaRjyE

Blood substitutes: Working to Fulfill a Dream - FDA Voice blog http://buff.ly/LaRE4q

How to make your own infographics with templates by Google

Here are 3 infographic templates for Google Drive by Google:

Infographics Toolbox By Google - Illustrate your data with your own custom graphs, charts, maps and more. Draw your own pie charts and bar charts with this template. Edit the colors of the map of the United States. Create an infographic of male and female symbols to use for counting data (including one-half male and female symbols). http://goo.gl/R0Cjh



United States Data Map By Google - This map of the United States is shaded based on state-by-state data. Just click on each state and set a custom color based on the information that you want to display. Then adjust the key at the bottom of the drawing to describe your custom data. The default data displayed is the population density from the year 2000 census. Notes: - States with multiple unconnected parts have been created as grouped shapes (eg. Hawaii, Michigan). - Washington DC starts as a grouped shape with Maryland. - Map can be changed to be displayed at any size. Using the same border for all states (eg. 1px white) is recommended. http://goo.gl/KjM3H

Map of the United States (Multi-colored) By Google - This map of the United States is colored with 5 standard colors to distinguish each state outline. Each set of same-colored states is a grouped shape, just click a state and change the color to choose custom map colors for all those states. A gray shadow of the states outlines adds a lightweight 3D effect. http://goo.gl/p58VS

Related reading:

How to Get Started With Infographics | PCWorld Business Center http://goo.gl/ViWk2

How To Create Your Own Infographics: Step By Step Guide and Tips - TechTheBest.com  http://goo.gl/pT2mH

New treatment for dry eyes: "LipiFlow" uses heat and pressure to open blocked eyelid oil glands

The Meibomian glands (or tarsal glands) are sebaceous glands at the rim of the eyelids, responsible for the supply of meibum, an oily substance that prevents evaporation of the eye's tear film. They prevent tear spillage onto the cheek, trapping tears between the oiled edge and eyeball, and make the closed lids airtight. There are approximately 50 glands on the upper eyelids and 25 glands on the lower eyelids. The glands are named after Heinrich Meibom (1638–1700), a German physician (source: Wikipedia).

The LipiFlow Thermal Pulsation System uses heat and pressure to open blockages of the eyelid (Meibomian) glands. The treatment was approved by the FDA in 2011. Here is more information: http://lipiflow.com

Here is a Mayo Clinic video about the procedure:

Top articles in medicine in June 2012

Here are my suggestions for some of the top articles in medicine in June 2012:

Cancer rates worldwide are expected to increase by 75% by 2030 http://goo.gl/Wu8i9

Zinc could be useful adjunct treatment in infants with probable serious bacterial infection - The Lancet http://goo.gl/Hgqs7

To screen or not to screen for prostate cancer? Fewer than 2% of Johns Hopkins doctors plan to follow the recommendations and stop ordering PSA screening - Lancet http://goo.gl/5Nkha

Dark chocolate could work as prevention therapy of cardiovascular disease - BMJ's exercise in wishful thinking: http://goo.gl/Om6kq

UV protection and sunscreens: What to tell patients - CCJM http://goo.gl/yhRH4 -- Related reading: How to avoid damaging ultraviolet light - CCJM launches "Patient Page" similar to JAMA http://bit.ly/MkL6Ae

NYTimes asks experts what they want from the future: "permanent sunblock that embeds in skin ~ Lasik eye surgery" ?! http://goo.gl/TnHZa -- Related: 32 Innovations Will Change Your Tomorrow - underwear with sensors tells how hard you’re working your quadriceps muscles http://goo.gl/EWRuX

Psoriasis: Evolving treatment for a complex disease - CCJM 2012 review, free full text http://goo.gl/Sc9Uy

Acute community-acquired bacterial meningitis in adults: CCJM 2012 review, free full text http://goo.gl/XKYQR

"Walmart clinics go live in the cloud": retail giant pushes healthcare providers to make diagnoses over the internet http://goo.gl/P51NW

A Single Inhalation of Laninamivir Works in Children With Influenza (study) http://goo.gl/BxgRs

Inhaled Hypertonic Saline (3%) mixed with albuterol reduces length of stay and admission rate for wheezing children http://goo.gl/g9cFH

College freshman at age 9, medical degree at 21 - Dr. Yano is the youngest student to get an M.D. from UChicago http://goo.gl/qkqNh -- Disclaimer: I am an assistant professor of medicine and pediatrics at UChicago and have met Dr. Yano in our clinic.

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

88-year-old George H.W. Bush: "Maybe they’ll come out with a new drug that makes memory come roaring back"

The former president George H.W. Bush wrote a poem for his grandkids:

"So I can add to the report on getting older. 

Who knows, maybe they’ll come out with a new drug that makes legs bend easier,
Joints hurt less, drives go further, memory come roaring back,
And all fears about falling off fishing rocks go away. 

Remember the old song: I’ll be there ready when you are.
Well I’ll be there ready when you are
There’s so much excitement ahead, so many grandkids to watch grow.
If you need me I’m here."

By the way, the 88-year-old former president said he was not done skydiving. His goal: to jump again when he is 90.

Visit msnbc.com for breaking news, world news, and news about the economy

References:

'If you need me I'll be there': George HW Bush moved to tears during interview with granddaughter Jenna about his family and growing old | Daily Mail Online http://goo.gl/noCt0

Best of Medical Blogs - weekly review and blog carnival

The “Best of Medical Blogs - weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.

The DSM-Tw: Handbook of Twitter Personality Types

Dr. Wes: In an effort to assist the American Psychiatric Association with the publication of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) expected in May, 2013 it seemed only appropriate that a DSM-Tw (Twitter) supplement be provided to help classify newly emerging personality types on Twitter.

Example: 292.891 Caffeine-induced disorder: Newscycling Disorder - chronic obsession with Tweeting main stream media news stories. For instance, all topics that have an association with medicine are cited: even acne studies. Diagnostic finding: first to tweet the story so that others will "retweet" their tweet, as if it was their own. Gaining followers is the name of the game, so they occasionally venture off on tangents, like American Idol, or Justin Bieber. http://goo.gl/f7w6U

Who paid for that study?

From Dr. Jay Parkinson's blog: "When I read that something is good or bad for you, the first question I ask myself is “Who would pay for that study?” Here are a few examples: Is coffee good or bad for you? Is kale a better food for you than sprouts? Does Acai really prevent cancer? Read more here: http://goo.gl/gqS3T

Do you avoid using your iPhone’s medical apps in the hospital for social reasons?

An overcautious doctor: “Even though I have an iPhone, I don’t like to pull it out in the Hospital because I’m worried my patients or staff will think I’m playing games or using it for social reasons. When I have a book or manual in my hand, at least people can see what I’m doing”. http://goo.gl/O05pG

100% Patient Satisfaction Scores

Fauquier ENT Blog: Whether good or bad, patient satisfaction scores can be VERY misleading if not completely wrong... http://goo.gl/sOjvm

How significant is the lack of a reversal agents with the new blood thinners?

From the blog of the electrophysiologist Dr. John M: Dabigatran and rivaroxaban have no reversal agents; but their effects dissipate quickly. More than 50,000 AF patients have been enrolled in trials comparing novel blood thinners to warfarin, and in all three studies, a trend towards lower mortality was seen with the new blood thinners. This fact strongly suggests the lack of reversal agents may not be clinically significant. http://goo.gl/Q2Rui

"Hello Doctor. I Wouldn't Hesitate To Sue You"

From Freelance MD Blog: If you Google “how to sue a doctor,” an abundance of information follows. There’s an “ehow” on the subject, and even CNN offers an opinion. Any doctor has a 75% chance, give or take, that he or she will be named in at least one claim during their career. http://goo.gl/W64JZ

Medical School Life in Cambridge and Debrecen - @Berci compares the promotional videos http://goo.gl/BZm2w:

Medicine at Cambridge:



University of Debrecen Medical and Health Science Center:



Comments from Twitter:

Dr. Ellis @DrAnneEllis: Cute read, I'm sure we could come up with even more: The DSM-Tw: Handbook of Twitter Personality Types buff.ly/MC1338 via @DrVes

Healthcare social media #HCSM - top articles

Here are my suggestions for some of the top articles related to healthcare social media (#HCSM) in the past 2 weeks:

Ed Bennett shares three things he's learned about Healthcare Social Media: Our patients are ahead of us, Real change start at the top, Social media is more than the sum of its parts http://goo.gl/fD2Sj

Three things I've learned about Healthcare Social Media

View more PowerPoint from Ed Bennett

Social media do's and don'ts for doctors - common sense advice from "Fierce Practice Management" http://goo.gl/ISzYO

ENT blog reaches 5 million web visits - their YouTube channel received 230 million views http://goo.gl/0nlFg

Many people still think Mayo Clinic is (only) a hospital http://goo.gl/kqfr9

Medical Schools and Teaching Hospitals realize they need to start blogging ASAP - AAMC http://goo.gl/Sa5qO

Should doctors stop patients from taking smartphone pictures? Yes, suggests amednews http://goo.gl/Mf1if - Not likely to work.

70% of heavy users of mobile devices experience “phantom vibration syndrome” - NYTimes http://goo.gl/Drvy5

How to Become a Healthcare Social Media Superstar #HCSM http://goo.gl/5J3PO and http://goo.gl/LtvQN

Research Bloggers show a preference for papers from high-impact journals - just like everyone else on earth http://goo.gl/Ny7EA

Traffic to Hospital Web Sites - Cleveland Clinic surges, overtaking Mayo and Johns Hopkins http://goo.gl/O5Msp

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

Top articles in medicine in June 2012

Here are my suggestions for some of the top articles in medicine in June 2012:

Fatty acids in formula don't make babies smarter http://goo.gl/FYyVX - Long-Chain Polyunsaturated Fatty Acids http://goo.gl/1WVjY

Electronic health records linked to worse diabetes care compared to old-fashioned paper records (study) http://goo.gl/vm2mR

Being sleepy behind the wheel is almost as bad as drinking and driving (study) http://goo.gl/Ub9hu

Study: Older People Have Special Smell, but It's Not Unpleasant as Stereotype Implies http://goo.gl/7bHfv

If we're going to think of exercise as a therapeutic intervention, like all interventions there will be adverse effects http://goo.gl/unjJS

DrotAA in Septic Shock - graph clearly shows lack of benefit from rh activated protein C, drotrecogin alfa http://goo.gl/bCktn

The Emerging Threat of Untreatable Gonococcal Infection - what to do if allergic to PCN and cephalosporins? NEJM http://goo.gl/fwFq3

Gallup tracks the U.S. Mood daily, only 41% were happy on June 7, 2012 http://goo.gl/Pn0lz

Drowning - free NEJM review of the current concepts, 2012 http://goo.gl/xSqLu

Intensive Enough? Intensive care units (ICUs) began in the 1950s, staffing models continue to be controversial http://goo.gl/2rZNk

Men vs. Women: Whose Offices Are Germier? Study confirms suspicion: Men Are "Greater" Source of Bacteria Than Women http://goo.gl/JkzF5

Residents' Response to Duty-Hour Regulations: 41% reported worsened education - NEJM http://goo.gl/leaC4

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

Surgeon Folds and Throws Paper Airplane Using da Vinci Robot (video)

From Swedish hospital YouTube channel: Dr. James Porter, medical director of robotic surgery at Swedish folds a small paper airplane with the da Vinci robot to demonstrate how this device gives surgeons greater surgical precision and dexterity over existing approaches.



With over 600,000 views, this video undoubtedly brings good publicity to the hospital.

However, the robot costs on average $1.3 million, in addition to several hundred thousand dollars of annual maintenance fees. Surgical procedures performed with the robot take longer than traditional ones. Critics say that hospitals have a hard time recovering the cost and that most clinical data does not support the claim of improved patient outcomes.

The manufacturer Intuitive Surgical has sold more than 1,000 units worldwide.

References:

Prepping Robots to Perform Surgery, The New York Times, 4 May 2008.
Wikipedia

Comments from Twitter:

Meenakshi Budhraja @gastromom: Cool !!

Westby Fisher, MD @doctorwes:  Surgeon Folds and Throws Paper Airplane Using da Vinci Robot (video) bit.ly/KG2EG6 - Manual faster, no?

PDara MD, FACP @JediPD:  da Vinci good for that

Skeptical Scalpel @Skepticscalpel:  Finally a use. Maybe the airplanes could have the hospital's logo on them. Folding a paper airplane. Amazing feat by a surgical robot? I think not. My blog. is.gd/6tBcZp -- Folding a paper airplane. Amazing feat by the surgical robot?  http://goo.gl/cz7lC

Ravi Pamnani @ravrav0: Surgical robots: Folding tiny paper airplanes - CHECK. Actually improving clinical outcomes - TBD. bit.ly/LEp3jg  #medtech

Jenaro Fdez-Valencia @JenaroFV_MD: after all ... it doesn't fly! If he did a boat instead, it would work. Can he try?

Best of Medical Blogs - weekly review and blog carnival

The “Best of Medical Blogs - weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.

Maybe the young doctors are onto something

From the blog of the electrophysiologist, Dr. John M.: As is often the case when doctors of my generation talk about younger doctors, the issue of attitudes on work and life came to the fore. We are perplexed that young doctors focus so strongly on finding balance in life. Maybe they are onto something? Maybe they have figured out that even doctors get only one crack at life? http://goo.gl/FzEDU

Sunglasses for Kids: What Parents Need to Know

The effect of the sun’s damage is cumulative; it adds up over time. Eye damage beginning during childhood can lead to the development of cataracts, skin cancer around the eyes, photokeratitis (“eye sunburn”), and damage to the retina itself. They’ve gotta wear shades! Here are some tips from Dr. Natasha Burgert http://goo.gl/SStt9:



Doctors specializing in Emergency Medicine are the most active bloggers - by far

Here is Dr. Mike Cadogan @sandnsurf, the co-founder of the blog Life in the Fast Lane (LiTFL): Updated the EM bloggers list... WOW - they certainly like to write! bit.ly/aPWZXe

If this is too much for you, try Mike’s list of Top 10 clinical medicine blogs: http://www.blogs.com/topten/top-10-best-clinical-medicine-blogs

New allergy medications and drug affordability advice. The allergist Dr. Neil Kao does not blog every day but when he does his posts are very well-researched: http://goo.gl/ogZmT

How can I treat toenail fungus? Ask Doctor K from Harvard Medical School http://goo.gl/9pdj9

Dr Nick Tullo's ECG Academy - LiTFL calls it "asynchronous learning at its best" http://goo.gl/dokV6

Comments from Twitter:

John Mandrola, MD @drjohnm: Thank you!

Mike Cadogan @sandnsurf: Reading: Best of Medical Blogs - weekly review and blog carnival - another rollercoaster from @DrVes

What you need to check on the sunscreen label

Here are some simple tips for sunscreen selection and use from CNN:

- Use a sunscreen with a minimum of SPF 15 and a maximum of SPF 50. SPF 15 can block 93% of incoming UVB rays. SPF 30 blocks 97%. SPF 50 blocks 98%.

- Make sure labels list both UVA and UVB protection

You get exposed to both UVA and UVB light:

UVB light is the light that Burns (causes sunburn)
UVA light as the light that Ages the skin (wrinkles, etc.)


- Avoid products containing oxybenzone and retinyl palminate. They may get absorbed through the skin and may increase cancer risk

- Choose lotions versus spray sunscreens for a more evenly distribution

- Remember to apply at least 2 ounces of lotion (about a shot glass full). Reapply every 2 hours. Reapply after swimming or heavy sweating.

How to apply sunscreen - NHS video:



References:

Avoid sunscreens with potentially harmful ingredients, group warns. CNN, 2012.

How to avoid damaging ultraviolet light - CCJM launches "Patient Page" similar to JAMA

Image source: OpenClipArt.org, public domain.

Healthcare social media #HCSM - top articles

Here are my suggestions for some of the top articles related to healthcare social media (#HCSM) in the past 2 weeks:

The pros/cons of using social media in biomedicine http://goo.gl/neenB

14 Ways Social Media May Soon Change Your Doctor's Visit http://goo.gl/muWK1

Can Twitter predict disease outbreaks? | BMJ http://goo.gl/EU0uO

Social Media ROI Reform - Measuring the effectiveness of your hospital SoMe efforts http://goo.gl/3YPQH

As Facebook grows, millions say, 'no, thanks' - AP story http://goo.gl/QdfkB

Create free infographics online with Drag and Drop pre-designed themes: easel.ly http://goo.gl/uXXmi

How Amazon Killed The Book Reviewer Star - aggregate rating of Amazon reviewers as good as professional book critics http://goo.gl/ISc15

Research Sidebar in Google Docs - find more information about words in a document, add web content http://goo.gl/IqdQb

How blogging has helped me academically: Because I write most days, my writing has improved dramatically http://goo.gl/GLNsL

Social Media and Relationship Stress: There can be consequences when "Like" turns to love online http://goo.gl/V5itM

Medical School Life in Cambridge and Debrecen - @Berci compares the promotional videos http://goo.gl/BZm2w

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

Comments from Twitter:

Neelesh Bhandari MD @edrneelesh: @DrVes That's an excellent selection of #hcsm posts

Social media FTW: Mayo Clinic offers preferred early access to journalists and bloggers to health news

The newly launched "Mayo Clinic News Network" is billed as the journalists' multimedia source for health, science and research information: http://newsnetwork.mayoclinic.org

The no cost, password-protected site for journalists offers the latest breaking medical news, videos, graphics, links for background, animation, experts and patient interviews. Journalists from TV, radio, newspaper, blogs, and mobile platforms are invited to visit our site http://newsnetwork.mayoclinic.org and register. Pending approval, you will have access to this rich source of multimedia content.



I feature high-quality videos from Mayo Clinic on CasesBlog 2-3 times per month, and after some brief consideration I registered and applied for access. I will let you know if a medical blog with 7 million page views qualifies for access to the Mayo Clinic News Network or not (update: the application was approved).

The flagship journal of ACP, Annals of Internal Medicine, already includes medical bloggers in their embargoed news release before each new issue.

The ACP Internist website took a step further and includes guest posts from hand-picked medical bloggers (disclaimer: I am one of the selected authors). Many of the posts are quite interesting and cover a wide variety of topics. You can see for yourself here: http://blog.acpinternist.org

Kudos to the ACP editor Ryan DuBosar who is leading the medical blog initiative there: http://blog.acpinternist.org/2012/05/qd-news-every-day-nearly-1-in-8-doctors.html

Top articles in medicine in May 2012

Here are my suggestions for some of the top articles in medicine in May 2012:

The primary care doctor is a rapidly evolving species - and in the future could become an endangered one - NEJM http://goo.gl/BPcVB

Japanese rail workers have to pass a daily smile scan. Even a faux smile may increase happiness - Lancet http://goo.gl/DKwD9

Mental Illness: "Checklist diagnoses" cost less in time and money but fail compared to comprehensive evaluation - NEJM http://goo.gl/uOmcd

Only 50% of people with major depression in the general population receive any treatment for depression http://goo.gl/IfCCq

Natalizumab-Associated Progressive Multifocal Leukoencephalopathy (PML) - NEJM lists the risk factors http://goo.gl/J71JA

Azithromycin and the Risk of Cardiovascular Death - NEJM: 7 additional cardiovascular deaths per 1 million courses; patients in the highest decile of risk for cardiovascular disease had an estimated 245 additional cardiovascular deaths per 1 million courses. http://goo.gl/QITcP

Coffee consumption was inversely associated with total and cause-specific mortality. Whether this was a causal or associational finding cannot be determined - NEJM http://goo.gl/0EMJF

The Right Way to Try to Buy Happiness: By using money to create memories with your family, build things with your hands or even sleep more, you stand a pretty good chance of being happier. http://goo.gl/FO2I5

Up to 21% of adults will develop tinnitus - 2% of population have severely impaired quality of life because of it http://goo.gl/q1Yuc

Aspirin Prevents the Recurrence of Venous Thromboembolism, with no increase in risk of major bleeding - NEJM http://goo.gl/3sqDu

Women who worked the night shift were 40% more likely to develop breast cancer http://goo.gl/VQPQt

Hyperglycemia on admission predicts death in patients with community acquired pneumonia without pre-existing diabetes http://goo.gl/edAwQ

How can I treat toenail fungus? Ask Doctor K from Harvard Medical School http://goo.gl/9pdj9

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

The evolution of a physician's blog

Dr. Smith presents his research poster, which charts the tremendous growth of his eponymous blog, Dr Smith’s ECG blog. The blog is practically free to maintain, hosted by Google's service, Blogger.com, and will break 1,000,000 page views this year. The site itself represents a living and breathing, dynamic textbook: http://hqmeded-ecg.blogspot.com



Dr. Stephen W. Smith is a faculty physician in the Emergency Medicine Residency at Hennepin County Medical Center (HCMC) in Minneapolis, MN, and Associate Professor of Emergency Medicine at the University of Minnesota.

Best of Medical Blogs - weekly review and blog carnival

The “Best of Medical Blogs - weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.

Healthcare CIO: On Turning 50 

From John D. Halamka, MD: The difference between an expert and novice is not the detail they notice, but what they choose to ignore. For example, when I do a toxicology consult, I focus less on the exact subspecies of mushroom the patient has ingested, and more on ensuring it is not one of the few that kill humans. http://goo.gl/UXJe4

No one remembers the details of last year's urgencies. What really matters is happiness at home. Jobs may change but family is forever.

The End of House, MD.

Dr. Wes predicts bleak future: Yes, the image of Gregory House MD must end, because like Marcus Welby, MD, he no longer exists. That’s because instead of “House,” our medicine is now morphing into the “Office.” http://goo.gl/JxffI

A weekend with grandmaster

From ShadowFax ER blogger: He chose to dedicate his life to the study and preservation of the traditional Okinawan martial arts as a young man. He is, it seems, as old as the hills and as enduring. He is pushing 80, but still as tough as nails. Standing a diminutive 5'0", he can toss young men about like rag dolls, despite the fact that they have 12 inches of height, 60 lbs, and 50 less years of age on them. And his bones are so dense that blocking his punches feels like smashing your forearms into a cement wall. http://goo.gl/JixZ0

A Personal Rapid Learning System

From Social QI blog, here is how to assemble your Personal Rapid Learning System http://goo.gl/hPXuc:

1. Cast an information net. The tools include: saved Pubmed searches and Google alerts (and now RSS feeds and other channels).

2. Build a network of people in the know through LinkedIn and Twitter.

3. Narrate your learning and experiences. Share what you know and what you need to learn.

The pros/cons of using social media in biomedicine 

This is a presentation by one of the best thinkers about Web 2.0 use in medicine, Dean Giustini http://goo.gl/neenB:

Social media in health & medicine 2012 workshop

View more PowerPoint from Dean Giustini

Dean is UBC Biomedical Branch librarian at Vancouver hospital. He teaches at the School of Library, Archival and Information Studies, and the School of Population and Public Health.

ENT blog reaches 5 million web visits - their YouTube channel received 230 million views http://goo.gl/0nlFg

Is Acetaminophen Safe For Children With Asthma? Interpreting the Medical Literature Is Complex, says pediatric pulmonologist Dr. Canapari. The jury is still out on this topic. Hopefully large-scale trials will help answer the question conclusively. http://goo.gl/mxNpv

Comments from Twitter:

Mike Cadogan @sandnsurf: Reading: Best of Medical Blogs - weekly review and blog carnival. More fantastic links form @DrVes

Top articles in medicine in May 2012

Here are my suggestions for some of the top articles in medicine in May 2012:

Large numbers of very rare genetic mutations may underlie common human diseases like schizophrenia and cancer http://goo.gl/GttAQ

14 Ways Social Media May Soon Change Your Doctor's Visit http://goo.gl/muWK1

Drunk driving across the globe: many countries have “no tolerance” laws with 0.0% blood alcohol limit http://goo.gl/aIsRn

Top 10 Cloud-Based EHRs - CureMD and Practice Fusion (the only free EMR) scored best http://goo.gl/jWMuu

Pets at birth either decreased or had no effect on allergic disease up to age 12. No evidence that exposure to cats or dogs at birth increases the risk of allergic disease in high risk children http://goo.gl/MS4iW

Cleveland Clinic starts a blog called "Health Hub" http://goo.gl/66FF0 - competing with the aging consumer portal of MayoClinic.com

CT colonography is accurate in detecting adenomas 10 mm or larger but less so for smaller lesions http://goo.gl/gMTiX -- Laxative-free colonoscopy on the way? Virtual colonoscope digitally removes stool from the colon http://goo.gl/sJG6H

Do we need vacations? Vacations improve employee wellbeing but the positive effect is short-lived (study) http://goo.gl/jd3CH

NRMP to Implement “All-in” Policy for 2013 Match http://goo.gl/tn5Cs

New labeling will help you pick the best sunscreen - Consumer Reports http://goo.gl/Wtm3M

U.S. politicians invoke the “R word” - rationing for healthcare - NEJM http://goo.gl/Urhua

Pepsi and Competitors Scramble as Soda Sales Drop in the U.S. Average American drank less than 2 sodas/day in 2011, a drop in per capita consumption of 16% since the peak in 1998. Sugary soft drinks are the No. 1 source of calories in U.S. diets - NYTimes http://goo.gl/9tjdD

"Z-Pak Heart Attack" - sudden death may be a new (rare) risk linked to commonly prescribed antibiotic azithromycin http://goo.gl/3DeIh

Coffee Drinkers May Live Longer - there are 1,000 or more compounds in coffee - NYT and NEJM http://goo.gl/VSfbN

Using Internet Search Engines to Obtain Medical Information: users preferred Bing over Google in this study http://goo.gl/mJgpm

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

Comments from Twitter:

Mike Cadogan @sandnsurf: Reading: Top articles in medicine in May 2012 bit.ly/KUxEhs via @DrVes ...more great articles from the world of medicine

Karim Jessa @karimjessa: great stuff! thanks dr @DrVes

Healthcare social media #HCSM - top articles

Here are my suggestions for some of the top articles related to healthcare social media in the past 2 weeks:

Understanding Research Impact http://goo.gl/2ZHCK and 20 Strategies To Enhance The Impact Of Your Research http://goo.gl/49MLb

BMJ Learning gets social - British Medical Journal platform learns new tricks in this brave new social media world http://goo.gl/4vncy

Doctors' Use of iPads Becoming Mainstream (not my impression). Also, physician-only social networks remain stagnant http://goo.gl/9QfDf

Heart Rhythm Society 2012 Scientific Session in the Age of Twitter http://goo.gl/FGH10

"Healthcare Going To The Dogs" - a video for training hospital administrators http://goo.gl/hv40a and http://goo.gl/xsW4J

Cleveland Clinic starts a blog called "Health Hub" http://goo.gl/66FF0 - competing with the aging consumer portal of MayoClinic.com

JAMA will link 10 AMA journals like a group blog - all names will start with “JAMA”, for example, Archives of Surgery will become “JAMA Surgery” http://goo.gl/FJLL2

Cultivate followers on social media if you want to communicate science

From the blogs Soapbox Science http://goo.gl/cPQq1 and Medical Museion http://goo.gl/QmEU7 :

"Social media platforms can be very limiting. For example, can you define genotype and phenotype in 140 characters or less? If you want to use social media to communicate effectively, you need to drive readers somewhere.

Writing a blog gives substance to your social media presence. You have the opportunity to talk about science in a meaningful way, which ultimately helps people better understand the world around them. Answering those questions is probably why you got into science in the first place. Don’t be afraid to share what you’ve discovered."

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to allergycases@gmail.com and you will receive acknowledgement in the next edition of this publication.

Dr Topol to med students: "When I was in medical school, the term "digital" was reserved for the rectal examination"

Here are some excerpts from the Baylor College of Medicine commencement address by Dr. Eric Topol, director of the Scripps Translational Science Institute, delivered yesterday, May 22, 2012. This should be a required reading for everyone involved in healthcare, which is basically everybody because each and every one of us will be a patient one day.

Eric Topol to medical students: "When I was in medical school, the term "digital" was reserved for the rectal examination."

"You sleep with your cell phone and prize it right up there with food and water. We have evolved to a new species of man. We are Homo distractus!"

The benefits of digital medicine are clear to Dr. Topol who shares the story of a patient he saw last week: "I asked him to put his fingers on the 2 sensors on the back of my iPhone case so I could do his electrocardiogram—ECG—that was normal. And free, by the way. Then instead of using a stethoscope to listen to his heart, I used a portable pocket-sized high-resolution ultrasound device and within a minute I could see every heart structure—the heart muscle thickness and function, the valves, the size of the 4 chambers. Why would I ever listen for lub-dub when I can see everything? I haven't used a stethoscope for over 2 years to listen to a patient's heart."

From Baylor College of Medicine (BCM) YouTube channel: 2012 Commencement Speaker, Dr. Eric Topol, spoke on May 21, 2012:



Here is Eric Topol's presentation at Health at Google:



References:

Baylor College of Medicine commencement address by Dr. Eric Topol, director of the Scripps Translational Science Institute

Comments from Twitter

Quoc-Dien Trinh, MD @qdtrinh: Makes it sound cool. “@DrVes: Dr Topol to med studs: When I was in med school, the term "digital" was reserved for the rectal examination"

Hemophilia educational videos by CDC

Hemophilia belongs to a family of inherited lifelong bleeding conditions that prevent blood from clotting properly. Patients with these disorders bleed for longer than normal, either as a result of injury or spontaneously without an external cause.

The severity of bleeding depends on the amount of clotting factor that is missing or not functioning properly, which in hemophilia A and B - the most common types of hemophilia - is the coagulation factors VIII and IX, respectively.

In addition to external bleeding, patients more commonly have internal bleeding around the joints and muscles, which can be extremely painful and cause permanent disability. Bleeding into major organs such as the brain is especially difficult to manage and can be fatal.

Here are 2 hemophilia educational videos by CDC:  Playing it Safe With Hemophilia: Friends with hemophilia talk about playing sports growing up and the importance of making smart decisions.



Starting the Conversation: Hemophilia. How to talk to your friends about hemophilia. A group of friends ask their friend Billy questions about his hemophilia:



Hemophilia care has undergone substantial improvements during the past 40 - 50 years. Early clotting factor concentrates were not sufficiently refined to enable self-administered treatment at home until the 1970s.

Long-term substitution therapy (prophylaxis) of the missing clotting factor is the recommended treatment in severe hemophilia. The major side-effect of treatment, development of inhibitors to the infused concentrate, is the main threat to the health of patients.

Mnemonic: Differential Diagnosis of Bleeding Disorders: F-CAP

Fibrinolysis - tPA
Coagulopathy - hemophilia, vWD
Angiopathy - conditions affecting blood vessels, e.g. Osler-Weber-Rendu syndrome
Platelets - thrombocytopenia or thrombocytopathia

Initial diagnostic tests = 3P:

Platelets
PT - INR
PTT

References:

http://www.cdc.gov/NCBDDD/video/Hemophilia_sports/index.html

http://www.cdc.gov/NCBDDD/video/Hemophilia_Friends/index.html

Making haemophilia a global priority - The Lancet, 2012.

Modern haemophilia care - The Lancet, 2012.

Best of Medical Blogs - weekly review and blog carnival

The “Best of Medical Blogs - weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.

Cultivate followers on social media if you want to communicate science

From the blogs Soapbox Science http://goo.gl/cPQq1 and Medical Museion http://goo.gl/QmEU7:

Social media platforms can be very limiting. For example, can you define genotype and phenotype in 140 characters or less? If you want to use social media to communicate effectively, you need to drive readers somewhere.

Writing a blog gives substance to your social media presence. You have the opportunity to talk about science in a meaningful way, which ultimately helps people better understand the world around them. Answering those questions is probably why you got into science in the first place. Don’t be afraid to share what you’ve discovered.

Are doctors afraid to be wrong?

From the surgeon blogging at Skeptical Scalpel: "I once did some expert witness work for a malpractice insurance company. There is rarely a case that does not have many opportunities for second-guessing. When you know the outcome, you can always find something in the medical record that could have been done differently.

The current medicolegal and patient safety climate creates a feeling among physicians that any error is going to be extensively scrutinized. This results in a situation analogous to an athlete trying not to lose a game instead of trying to win. For those of you not familiar with sports, that strategy usually fails. Fear of being wrong can lead to excessive testing too." http://goo.gl/FWTbC

When did we stop teaching the basics to medical students and residents?

Dr. Centor of the blog db's Medical Rants likes the ACGME 6 core competencies just fine, but also suggests a simpler list http://goo.gl/2sqip:

1. Take a complete, relevant, accurate history
2. Do an appropriate physical examination
3. Order the correct laboratory tests and interpret them fully and accurately
4. Order the correct images and interventions and interpret them

Happy 5th Blogiversary!

Former plastic surgeon and blogger extraordinaire Dr. Ramona Bates reflects on her 5 years of blogging and the medical blogging community. http://goo.gl/0EVJW

How blogging has helped me academically. According to Dr. Centor: Because I write most days, my writing has improved dramatically http://goo.gl/GLNsL

Social media and medicine - Stanford University Grand Rounds

Graham Walker was one of the first medical bloggers. He went on a hiatus during his emergency medicine (EM) residency, and has now found new reasons to blog as an EM attending at Stanford University medical center. This is his talk on social media and medicine at Stanford University Grand Rounds: http://youtu.be/qtkggenLmlE



Dr. Walker: "My talk on the dissemination of medical information over time, how the internet and social networking are changing medicine, and how to use digital tools to be a better clinician at the bedside."

Here is Graham's list of Digital Tools to Improve the Specialty.

Paper-based Charts: How Soon We Forget http://goo.gl/Vspmp - Dr. Wes: Suddenly, I don't miss paper charts anymore.

Dr. Wes: How Bad Is Azithromycin's Cardiovascular Risk? http://goo.gl/yVgfo - Are "Big Data" linked to "Big Error"?

Comments from Twitter:

Seth Trueger @MDaware: some great stuff in there

Skeptical Scalpel @Skepticscalpel: Thanks for including me.

Mayo Clinic now offers Patient App: access to personal medical record, appointment schedule and more

The Mayo Clinic Patient app allows access to the latest news, publications, and health information from Mayo Clinic. Mayo Clinic patients also have access to their personal medical record, appointment schedule and other services using their Patient Online Services account.

The Mayo Clinic Patient app provides local community information, including directions to local restaurants, entertainment, and more. http://youtu.be/UAymmf5ZUNo

Top articles in medicine in May 2012

Here are my suggestions for some of the top articles in medicine in May 2012:

For every hour of "social jet lag", the risk of being overweight or obese rises 33% http://goo.gl/fTlge

Lorcaserin (Lorqess) will be the first new prescription weight loss drug in more than a decade http://goo.gl/MexzC

Healthcare crushed by acronyms http://goo.gl/FqPX6

Pulmonary embolism and deep vein thrombosis - 2012 Lancet review http://goo.gl/SpbKg

Spanish health cuts could create “humanitarian problem” - The Lancet http://goo.gl/YA0OA

Doctors in China were once revered, but now face increasing threats to their personal safety at work - Lancet http://goo.gl/gf62Q

Cosmetic laser treatment for removal of hair and tattoos can cause burns, blistering, scarring, permanent blindness http://goo.gl/71gdx

Statins: Is It Really Time to Reassess Benefits and Risks? http://goo.gl/vnn9x -- NEJM: studies are needed assess statin-induced diabetes.

How To Do Medical Education Research? A step-by-step guide: http://goo.gl/bTnIh

Understanding Research Impact http://goo.gl/2ZHCK and 20 Strategies To Enhance The Impact Of Your Research http://goo.gl/49MLb

Knee osteoarthritis in former elite soccer players: 40-80% have osteoarthritis http://goo.gl/qLu4f

Former world record holder in the 100-meter sprint, ran it in 22.04 seconds -- when he was 95 years old http://goo.gl/9bu01

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

Healthcare social media #HCSM - top articles

Here are my suggestions for some of the top articles related to healthcare social media in the past 2 weeks:

Social media “likes” healthcare: From marketing to social business. Social media and health care: opportunities and obstacles - PWC 2012 report, free download http://goo.gl/GtSgE

8 Chrome Extensions that Make Blogging Easier http://goo.gl/fFKye

"News Squares" for Chrome is a new visual RSS reader http://goo.gl/ZgO7Z

CDC Social Media Guidelines and Best Practices http://goo.gl/Sw0n - Twitter guide updated in Feb 2012.

"20 Days to High-Quality, Engaged Twitter Following (in just 20 minutes a day)" http://goo.gl/8T0xL - Mixed bag of advice, some good tips

There is an allergy/immunology wiki: "AI notes" http://goo.gl/Qt1iE - Not sure who's behind it, looks useful.

Medicine, Social Media and Clinical Excellence. Let’s do it. http://goo.gl/WgRDw -- Here is one of my related blog posts: Doctors are natural communicators - social media is extension of what they do every day http://goo.gl/2FzQb

Study: There is a kernel of truth to the popular term "Facebook stalking". Introducing new terms (to me) such as: cyber obsessional pursuit (COP) and obsessive relational pursuit (ORI), which are categories of cyberstalking and stalking, resulting in three factors: Covert Provocation, Public Harassment, and Venting. http://goo.gl/sgVys

How to find RSS feeds for Twitter accounts, Facebook pages, YouTube, other SoMe sites http://goo.gl/Q6tNg

Fake tweet stops Nashville doctor's lecture, plans for cruise http://goo.gl/Lj0mO

How to Create Your Own Website using Blogger - Step-by-Step Guide for Physicians http://goo.gl/tCd37

Science blogging and self-promotion? http://goo.gl/yGUqS

How To Deal With Information Overload http://goo.gl/h4CmL and http://goo.gl/wDv5

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to allergycases@gmail.com and you will receive acknowledgement in the next edition of this publication.

Social media and medicine - Stanford University Grand Rounds

Graham Walker is one of the first medical bloggers. He went on a hiatus during his emergency medicine (EM) residency, and has now found new inspiration to blog as an EM attending at Stanford University medical center. This is his talk on social media and medicine at Stanford University Grand Rounds: http://youtu.be/qtkggenLmlE



Dr. Walker: This is my talk on the dissemination of medical information over time, how the internet and social networking are changing medicine, and how to use digital tools to be a better clinician at the bedside.

Here is Graham's list of Digital Tools to Improve the Specialty:
http://gmergency.tumblr.com/post/22727728700/stanford-grand-rounds-may-9-2012

Comments from Twitter:

Alice Ackerman, MD, @CloseToHomeMD: [You need to watch the video-Gr8 talk]

Top articles in medicine in May 2012

Here are my suggestions for some of the top articles in medicine in May 2012 so far:

Point-of-care genetic testing for personalisation of antiplatelet treatment is effective http://goo.gl/ZWLvz

Patient empowerment - who empowers whom? Virtually all people are patients at some point in their lives http://goo.gl/4YKjq

Doctors' love-hate relationship with EHRs http://goo.gl/wd74F

Why U.S. spends more on healthcare than other developed countries: Higher prices, readily accessible technology, obesity http://goo.gl/cid6S

Austerely law transforms Spain’s health system from universal access to one based on employment | BMJ http://goo.gl/36u4C

Bevacizumab (Avastin) is as effective as ranibizumab (Lucentis) for wet AMD and could save NHS millions - NHS http://goo.gl/JJ8uV

Having 'Type D' Personality - a distressed and pessimistic outlook on life - May Affect Your Health http://goo.gl/kFbpA

New Cautions About Bisphosphonate Use - NYTimes http://goo.gl/PYiKy

How to Create Your Own Website using Blogger - Step-by-Step Guide for Physicians http://goo.gl/tCd37

Truvada (Emtriva + Viread), first drug to prevent HIV infection in healthy people at high risk (MSM, partners of HIV+) http://goo.gl/e1MJM

Can mobile phones give you brain cancer? The verdict's still on hold http://goo.gl/gI6Ta

Drink Water to Improve Test Scores http://goo.gl/MNB6k and http://goo.gl/EO12p

The articles were selected from my Twitter and Google Reader streams.

What it's like to study medicine at Cambridge (video)

What is "the favorite" for medical students in the UK at the moment? Going into General Practice (at minute 2:45 of the video). They are also "very keen into going into a specialty such as pediatrics". This is a night and day difference compared to their counterparts in the U.S.



From Cambridge University YouTube channel: "At Cambridge, we offer two medicine courses - the Standard Course and the Graduate Course. With both, our aim is to educate students to become compassionate, thoughtful, skilled members - and leaders - of the medical profession.

Success in medicine requires application and hard work, both while studying and when in practice. However, it brings great rewards in terms of job satisfaction, involving as it does a combination of science and human interactions, and numerous career opportunities."

To find out more about Medicine at Cambridge, see http://study.cam.ac.uk/undergraduate/courses/medicine

Comments from Twitter:

Nick Bennett @peds_id_doc: Best medical school in the world. Seriously.

Medical School Life in Cambridge and Debrecen - @Berci compares the promotional videos http://goo.gl/BZm2w

Best of Medical Blogs - weekly review and blog carnival

The “Best of Medical Blogs - BMB weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.

A Medical Educator Joins Social Media: One Year Later

Dr. Djuricich, Program Director in Medicine-Pediatrics at the Indiana University, shares what he has learned in one short year: If physicians and other health care professionals are not becoming involved in social media, they are missing out on a “place” where many of the patients already are. There is a lot of misinformation floating around on the internet. It is a duty of physicians to combat this and provide correct information. Do not let social media take over your life. The important things (family, friends, etc.) are still the important things, so don’t lose the priorities. http://goo.gl/zNfpe

What explains blogging longevity? It's easy: blog for yourself, and share with others

Dr. Centor explains his blogging longevity after 10-years of blogging. I've been blogging for 8 years, and I agreee with him: Why you should write a blog for yourself rather than for a shifting audience http://goo.gl/P8xtz

Here's Dr. Centor again: Explaining longevity is subjective. Mostly, I like blogging. Basically I blog with myself in mind, and am gratified that others find my comments interesting. Blogging is never a chore. One cannot last 10 years doing a chore. http://goo.gl/Jyl2o

Cardiologist Dr. Wes nominates the hardest to read Abstract of the Year at 2012 Heart Rhythm Society

What is the abstract that contributes the smallest amount to our field while demonstrating the worst grammar, the most bureaucratic lingo and, of course, verbosity. The sentence that clinched it? "Conclusions: The harmonization of endpoint definitions, terminology, and clinical trial design paradigms provides consistency across clinical trial studies that can facility (sic) clinician acceptance of results and the evaluation of safety and effectiveness of devices and medicines for atrial fibrillation." http://goo.gl/ZstA0

Harvard Medical School Q&A blog doctor reflects on his readers’ feedback

Dr. Komaroff from the blog Ask Doctor K.: “Since I began this column last September, I’ve received a lot of mail — both emails and “snail mail.” Mostly it’s been health questions. I can’t answer them all, but I try to answer as many as I can. However, I’ve also received complaints. Sometimes they represent an honest difference of perspective. On occasion, they reflect the fact that I’m a man.” http://goo.gl/XK3O1

A complete list of all academic medical journals available for the iPad

The omnipresent blog iMedicalApps makes a good use of Google Docs spreadsheet to list the apps of many academic medical journals available for the iPad. I still have personal preference for the open web rather than apps but that’s just me. http://goo.gl/13Gjz

What is postinfectious cough and how to treat it?

From Dr. Matthew Mintz' blog: While the cause of the postinfectious cough is not known, it has been thought to be due to the extensive damage of cells lining the lung and widespread airway inflammation of the upper and/or lower airways. The good news is that this usually goes away by itself, the bad news is that it can take weeks or even months, and can be quite disruptive to patients lives. Since symptoms are caused primarily by inflammation and hyperresponsiveness/bronchoconstriction in the lungs (which is what we see in asthma), then treatment is likely best with something that treats both inflammation and bronchoconstriction in the lungs, such as an inhaled corticosteroid/long-acting beta agonist like Advair (which is commonly used in asthma). Use of Advair for postinfectious cough may be the single most common off-label use of any prescription product. Since inflammation can persist for weeks, it is important that Advair be used for at least 4 weeks. If symptoms return, the patient should be brought back for pulmonary function testing as this may be a new presentation of asthma. http://goo.gl/RgxLb

Reality Social Media: Live Tweeting Brain Surgery. What is the downside of this marketing push? Dr. Wes explains: http://goo.gl/XbKwv

"Healthcare Going To The Dogs" - a video for training hospital administrators http://goo.gl/hv40a and http://goo.gl/xsW4J

Science blogging and self-promotion? http://goo.gl/yGUqS

Depression affects up to 9% of U.S. population - how to do effective screening?

From American Family Physician:

Depression affects up to 9% of U.S. population.

The U.S. Preventive Services Task Force recommends screening in adolescents and adults but it does not recommend screening for depression in children 7-11 years of age, or screening for suicide risk in the general population.

The Patient Health Questionnaire (PHQ)-2 and PHQ-9 are commonly used and validated screening tools.

The PHQ-2 has a 97% sensitivity and 67% specificity in adults. The PHQ-2 inquires about the frequency of depressed mood and anhedonia over the past 2 weeks, scoring each as 0 ("not at all") to 3 ("nearly every day").

PHQ-9 has a 61% sensitivity and 94% specificity in adults. The PHQ-9 depression module scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day).

If the PHQ-2 is positive for depression, the PHQ-9 should be administered.

In older adults, the 15-item Geriatric Depression Scale is an appropriate follow-up test.

If these screening tests are positive for depression, further evaluation is needed to confirm that the patient's symptoms meet the Diagnostic and Statistical Manual of Mental Disorders' (DSM) criteria for diagnosis.

References:

Screening for depression. Maurer DM. Am Fam Physician. 2012 Jan 15;85(2):139-44.

Image source: Vincent van Gogh's 1890 painting At Eternity's Gate. Wikipedia, public domain.

Top articles in medicine in May 2012

Here are my suggestions for some of the top articles in medicine in May 2012 so far:

Is Geriatric Medicine Terminally Ill? asks Annals of Internal Medicine http://goo.gl/J4jMU

Low vitamin D (below 50 nmol/L (20 ng/mL) increases risk for clinical disease among older adults http://goo.gl/tBXS4

Senior physicians keep working, putting off the R-word - 20% of U.S. physicians are older than 65 http://goo.gl/Dxgip

Many young doctors worried about future of medicine - amednews http://goo.gl/r61lW

"One of the greatest risks of social media is ignoring social media" says chief integrity officer of Cleveland Clinic. Patients want to use social media tools to manage health care http://goo.gl/9SAry

Doctors can risk lawsuits when writing about patients - amednews points to books about patients as examples http://goo.gl/QhqFS

Coffee is the most complex food known to man. It has 1200 flavor components. The nearest comparison is red wine with 450 chemical compounds in the flavor make-up. In most commercial blends there are 10 to 12 different coffees, from different farms. http://goo.gl/m2LwD

Guidelines for social media use by Federation of State Medical Boards (FSMB) describe in detail what NOT to do: http://goo.gl/Raq2e

Prevention of acute knee injuries in adolescent female football (soccer) players: warm-up could help http://goo.gl/dBgSS

Is It Possible To Walk And Work At The Same Time? Kaiser Permanente tries walking meetings http://goo.gl/cRu8l

Corneal transplantation - 2012 state of the art review in The Lancet http://goo.gl/JBAag

Towards an optimum strategy in rheumatoid arthritis: For RA patients who fail initial methotrexate treatment, add-on disease-modifying antirheumatic drugs are appropriate http://goo.gl/ONq6u

Time Spent Behind the Wheel May Increase Heart Health Risks, linked to less time spent exercising http://goo.gl/NUYX7

Recipe For Safer Drinking Water (from bacteria)? Add Sun, Salt And Lime http://goo.gl/kU2ZK

The articles were selected from my Twitter and Google Reader streams.

Healthcare social media - top articles

Here are my suggestions for some of the top articles related to healthcare social media in the past 2 weeks:

Healthcare social media is a moral obligation

Healthcare social media is a 'moral obligation', says Farris Timimi, M.D., medical director for the Mayo Clinic Center for Social Media. Social media needs to be grown and nurtured for patients. "Our patients are there. Our moral obligation is to meet them where they're at and give them the information they need so they can seek recovery," Timimi said. "You've got to be ready for it. You build it for the patients; not for yourself. "This is not marketing," he added. "This is the right thing to do." http://goo.gl/BHzKf

The New World Of Medical Tweeting

300 million users generate 300 million messages every day, and doctor are part of it. 38% of tweets are conversational - transferring information and spreading content. Twitter can be a strong educational tool.

The American Medical Association has released a public statement about professionalism in social media:

“Participating in social networking and other similar internet opportunities can support physicians’ personal expression, enable individual physicians to have a professional presence online, foster collegiality and camaraderie within the profession, provide opportunity to widely disseminate public health messages and other health communication." http://goo.gl/K2QtK

Guidelines for social media use by Federation of State Medical Boards (FSMB) describe in detail what NOT to do: http://goo.gl/Raq2e

Digital Strategies for Healthcare Organisations http://goo.gl/PZtWl

Use of Social Media by Western European Hospitals: Longitudinal Study shows that SoMe awareness is growing http://goo.gl/l41tz

Doctors can risk lawsuits when writing about patients - amednews points to books about patients as examples http://goo.gl/QhqFS

GruntDoc: It’s my 10th Blogging Anniversary http://goo.gl/TkBc7 - Congratulations! A great reflection on a long journey.

The articles were selected from my Twitter and Google Reader streams.

Dermatology Art Contest by Mayo Clinic shows that art can be seen in every aspect of life

A Mayo Clinic dermatology art contest shows beauty really is skin deep. From Mayo Clinic News blog:

A hair follicle or skin specimen that doesn’t look like much of anything to the naked eye can become a complex, colorful work of art under a microscope. The winner of the Mayo dermatologists’ first art contest in 2011 was “Hair Follicle Triplet”. Alexander Meves, M.D., used fluorescent dyes to highlight proteins. The inaugural winners of the art contest appeared in the May issue of the Journal of Cutaneous Pathology.

“Every single day, dermatopathologists get to see beautiful images under the microscope, and most people never have the opportunity to see that. So I thought it would be a nice way to show not only the science of dermatopathology, but also the art,” says the contest’s creator, Dr. Lehman, a Mayo Clinic dermatopathologist.



Dr. Lehman hopes medical societies will run with the idea and hold similar competitions to highlight aesthetics in their specialties. People in other lines of work can also celebrate the beauty of what they do each day, she says.

Editor's note: Allergists should do something similar. We already highlight beautiful pollen allergens on the monthly covers of the ACAAI journal.

“Art can be seen in every aspect of life,” Dr. Lehman says. “You just have to have an open mind and be looking for it.”

References

Dermatology Art Shows Beauty Really Is Skin Deep. Mayo Clinic News.

Diary-Writing Has Psychological Benefits - Journal of Happiness Studies

Writing has long been used as a coping strategy and has been applied to improve psychological well-being. One study found that suicidal poets used more first-person singular pronouns (I, me, my) than the control group of poets.

This study from Taiwan, published in the Journal of Happiness Studies, investigated the psychological displacement paradigm in diary-writing (PDPD) and its supposed psychological benefits.

Study participants were randomly assigned to write about their recent negative life experiences two times a week for 2 weeks in PDPD group (diary-writing), or comparison group (no diary-writing).

The diary-writing group (PDPD) showed a decrease in negative emotion and an increase in positive emotion immediately after each writing session (short term effect).

They also had an increase in psychological well-being for at least 2 weeks (long term effect).

References:

The Psychological Displacement Paradigm in Diary-Writing (PDPD) and its Psychological Benefits. Jen-Ho Chang, Chin-Lan Huang and Yi-Cheng Lin. JOURNAL OF HAPPINESS STUDIES 2012, DOI: 10.1007/s10902-012-9321-y

Comments from Google Plus and Twitter:

Lin W: I guess blog writing might have the same effect?

Ves Dimov, M.D.: It depends on the type of blogging you do, but yes, blogging can be a positive experience too.

Dr. Amal Hasan @DrFloona: Diary-Writing Has Psychological Benefits bit.ly/wwMDmr” Until someone else reads it

Dean Giustini @giustini: Diary-Writing Has Psychological Benefits bit.ly/wwMDmr [Isn't this why we blog Ves?]

@DrVes: Well, I'm not sure. I don't blog about "negative experiences". Blog = archive for me

Best of Medical Blogs - weekly review, blog carnival

The “Best of Medical Blogs - weekly review, blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs is published every Tuesday, just like the old Grand Rounds.

Social Networks for Doctors: Are We There, Yet?

Twitter can be as inane, or as useful, as the accounts you follow. Sure, doctors use Facebook like everyone else, but – by and large – they haven’t tapped into the educational potential that online social networks offer. Once viewed as a trivial hobby by more eminent researchers and writers, blogs now serve as the elder statesmen of social media - and they can act as a base of operations for social networking. An excellent summary by Shiv Gaglani & Nicholas Genes: http://goo.gl/9DVbI

A Twitter Primer for Physicians (aka Twitter 101 for Docs)

Here are Dr. Ryan Madanick's suggestions: http://goo.gl/gNS5d. Dr. Madanick is a gastroenterologist at the University of North Carolina School of Medicine, as well as the Program Director for the GI & Hepatology Fellowship Program.

1. Consider starting with a private account.

2. Start following some accounts: Specialty societies and journals, let Twitter suggest some accounts, search for accounts with similar interests.

3. Listen to what others are saying.

4. Decide what to tweet.

5. Find a hashtag.

The incredible frailty of life

Realizing the incredible frailty of life and the battle to avoid irrational exuberance: a journey into the NICU as a Med-Peds uncle. This is a heartfelt article by Dr. Moises Auron from Cleveland Clinic: http://goo.gl/KvUbN

The NYTimes gets it wrong on ECG screening of young athletes

Dr. John Mandrola, a cardiac electrophysiologist, comments on a NYTimes article that included numerous inaccuracies and failed to tell important facts about the complexities of widespread screening of athletes. http://goo.gl/siEEp

How one patient uses Social Media

"Personally.. I don’t want to be a patient.. It’s totally the last thing I want to be…Before my diagnosis I shamefully has no idea what Rheumatoid arthritis (RA) was or what the consequences were of having a Chronic Illness. Patients and Doctors will find a solution together." A guest post at Dr. Ronan Kavanagh's blog. Dr. Kavanagh is rheumatologist from Ireland: http://goo.gl/daRfd

Krokodil is a devastating homemade opiate

Krokodil (or crocodile) refers to homemade batches of the opiate desomorphine (currently available without a prescription in Russia), and ingredients such as gasoline, paint thinner, hydrochloric acid, iodine, and red phosphorous. When injected, this highly impure mixture often causes skin to turn greenish grey and scaly, which may explain the drug’s name. Another explanation is that subsequent ischemia, gangrene and amputation has the same effect as a crocodile biting off a victim’s limb. From The Poison Review: http://goo.gl/VAq28

How to straighten a guidewire with one hand

The Australian blog Life in the Fast Lane is one of the best blogs focused on emergency medicine. Here is one of their shorter posts: How to straighten a guidewire with one hand http://goo.gl/mC9zY

GruntDoc: It’s my 10th Blogging Anniversary http://goo.gl/TkBc7 - Congratulations! A great reflection on a long journey.

10 Bad Assumptions Patients Make - a post by Dr. Rob http://goo.gl/EpmUO

All papers at PLoS Medicine now reflect the public Twitter debate | Medical Museion http://goo.gl/Xmu5Y

Caffeine and Sleep In Kids: It is a good rule of thumb to avoid soda entirely | Craig Canapari, MD http://goo.gl/W5HGS

Using fruit to improving anaphylaxis care - use your expired injectable epinephrine on an orange, an allergists suggest http://goo.gl/AQIxw

Are we too concerned with confidentiality? Former BMJ editor provides a personal example: http://goo.gl/0J3dp

Comments from Twitter:

John Mandrola, MD @drjohnm: Thx 4 shout out. Wow, lots of other great posts.

Mike Cadogan @sandnsurf: Concise, pithy and diverse - great read

Craig Canapari @DrCanapari:  Honored to be included