Vincent van Gogh: "I'd like to show by my work what such an eccentric, such a nobody, has in his heart"

How a genius feels: "I'm a nonentity, an eccentric, an unpleasant person"

March 30th is the birthday of Vincent van Gogh, born in Holland in 1853, a famous painter and also great letter-writer. His letters were lively, engaging, and passionate; they also frequently reflect his struggles with bipolar disorder.

He wrote: "What am I in the eyes of most people — a nonentity, an eccentric, or an unpleasant person — somebody who has no position in society and will never have; in short, the lowest of the low. All right, then — even if that were absolutely true, then I should one day like to show by my work what such an eccentric, such a nobody, has in his heart."

He wrote thousands of letters to his brother Theo over the course of his life. Theo's widow published the van Gogh's letters to her husband in 1913.

Doctors' Day in a high-risk profession: suicide rate of U.S. doctors is one per day

This quote serves as a good reminder how people with depression may have an altered perception of themselves. March 30 is also National Doctors' Day in the U.S. Other countries celebrate Doctors' Day on different dates.

More than a quarter of primary care doctors reported being "burnt out." The United States loses the equivalent of at least one entire medical school class (approximately 400 physicians) each year to suicide.

In other words, 300-400 doctors in the United States kill themselves every year, or roughly 1 per day. Male doctors have suicide rates 1.4 times that of the general population, while female doctors have twice the rate of depression and 2.3 times the suicide rate when compared with women who are not physicians.

A conversation could save a life: "Are you OK?" Day

Hugh Jackman shows his support for R U OK?Day, a national day of action in Australia that aims to prevent suicide by encouraging people to connect with colleagues, friends and loved ones and ask simply: "Are you OK?" This may help your medical colleagues too:



References

Writer's Almanac. NPR, 2012.
High-risk profession: Suicide rate of U.S. doctors is one per day
Help for Today's Tense, Frustrated Doctors. Medscape, 2009.
http://www.medscape.com/viewarticle/710904
Doctors have higher rates of suicide than the general population: 40% higher for male doctors, 130% for female doctors http://goo.gl/ckTm
R U OK? Day
Image source: Vincent van Gogh's 1890 painting At Eternity's Gate. Wikipedia, public domain.

Crohn's disease - 2011 review

Crohn's disease is a chronic inflammatory condition affecting the GI tract at any point from the mouth to the rectum.

Symptoms and signs may consist of:

- diarrhea
- abdominal pain
- fever
- weight loss
- abdominal masses
- anemia

Extraintestinal manifestations of Crohn's disease include:

- osteoporosis
- inflammatory arthropathies
- scleritis
- nephrolithiasis
- cholelithiasis
- erythema nodosum

Laboratory findings

Acute phase reactants, such as CRP and ESR, are often increased with inflammation and may correlate with disease activity.

Levels of vitamin B12, folate, albumin, prealbumin, and vitamin D can help assess nutritional status.

Procedures often used to diagnose Crohn's disease:

- colonoscopy with ileoscopy
- capsule endoscopy
- computed tomography (CT) enterography
- small bowel follow-through

Diagnostic tools for extraintestinal manifestations or complications (e.g., abscess, perforation):

- ultrasonography
- computed axial tomography (CT)
- scintigraphy
- MRI

Medical management

Mesalamine products are used for mild to moderate colonic disease. Antibiotics (e.g., metronidazole, fluoroquinolones) are often used for treatment.

Patients with moderate to severe Crohn's disease are treated with:

- corticosteroids
- azathioprine
- 6-mercaptopurine
- anti-tumor necrosis factor agents (e.g., infliximab, adalimumab)

References

Diagnosis and management of Crohn's disease. Wilkins T, Jarvis K, Patel J. Am Fam Physician. 2011 Dec 15;84(12):1365-75.

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

"Lifestyle 180": Cleveland Clinic 1-year program promises to reverse chronic disease through lifestyle modification

During the past 5 years, the Cleveland Clinic has moved aggressively to expand from illness management to wellness management. They even have a Wellness Institute. One example of its programs is Lifestyle 180 (R) which is "designed to reverse" the effects of chronic disease through lifestyle modification.

Here is a 5-minute video about the program from the Clinic YouTube channel:



The program focuses on nutrition, exercise, and stress management. The yearlong program is available at the Cleveland Clinic Wellness Institute campus located in Lyndhurst, Ohio.

References:

Lifestyle medicine

Interactive wellness guide by Cleveland Clinic

Lifestyle 180 (PDF)

Disclaimer: I was on faculty at Cleveland Clinic and Case Western Reserve University as Assistant Professor of Medicine until 2008.

Comments from Twitter:

Meenakshi Budhraja @gastromom: Like>>

Linda Pourmassina,MD @LindaP_MD: "the $3,000 fee for this program represents a fraction of the increasingly high co-pays for doctor visits and medications."

Cirrhosis - 2011 update from Am Fam Physician

Cirrhosis is the 12th leading cause of death in the United States. The mortality rate is 9.7 per 100,000 persons.

The most common causes of cirrhosis are:

- alcohol abuse
- viral hepatitis
- nonalcoholic fatty liver disease is emerging as an increasingly important cause

Patients with cirrhosis should be screened for hepatocellular carcinoma with imaging studies every 6-12 months.

Causes of hepatic encephalopathy include:

- constipation
- infection
- gastrointestinal bleeding
- some medications
- electrolyte imbalances
- noncompliance with medical therapy

Treatment

Lactulose and rifaximin are aimed at reducing serum ammonia levels.

Ascites should be treated initially with salt restriction and diuresis. Physicians should be vigilant for spontaneous bacterial peritonitis.

Patients with acute GI bleeding should be monitored in an intensive care unit, and should have endoscopy performed within 24 hours.

Prevention

Mechanisms to reduce the incidence of cirrhosis:

- treat alcohol abuse
- screen for viral hepatitis
- control risk factors for nonalcoholic fatty liver disease

Cirrhosis: Phil's story (video):



From NHSChoices: Many people enjoy a drink in the pub after work without realising how social drinking can damage health. Phil didn't realise the harm his alcohol intake was doing until he was diagnosed with cirrhosis of the liver. He talks about his experience and the shock he felt at being diagnosed.

References

Cirrhosis: diagnosis, management, and prevention. Starr SP, Raines D. Am Fam Physician. 2011 Dec 15;84(12):1353-9.

Cirrhosis - JAMA Patient Page, 2012.

The Number of Tweets Predicts Future Citations of a Specific Journal Article

Citations of journal articles and the impact factor are widely used measures of scientific impact. Web 2.0 tools such as Twitter, Facebook, blogs and social bookmarking tools provide the possibility to construct article-level or journal-level metrics to gauge impact and influence.

Between 2008 and 2011, all tweets containing links to articles in the Journal of Medical Internet Research (JMIR) were data mined.The tweets were compared to subsequent citation data 17-29 months later.

4,000 tweets cited 280 JMIR articles. The distribution of tweets followed a power law, with most tweets sent on the day when an article was published (44% of all tweets in a 60-day period) or on the following day (16%), followed by a rapid decay.

The Pearson correlations between "tweetations" and regular citations were moderate and statistically significant (0.42 to 0.72).

Highly tweeted articles were 11 times more likely to be highly cited than less-tweeted articles.

Top-cited articles could be predicted from top-tweeted articles with 93% specificity and 75% sensitivity.

Tweets can predict highly cited articles within the first 3 days of article publication.

Social media activity may:

- increase citations
- reflect the underlying qualities of the article

Social impact measures based on tweets are proposed to complement traditional citation metrics. The study author proposed a "twimpact" factor that measures uptake and filters research resonating with the public in real time.

After the initial publication, some science blogs have pointed out potential issues and conflicts of interests in relation to the topic and the single author who is also the founder, owner, and Editor-in-Chief of the journal. You can find more by performing a Google search for "twimpact" factor or checking the references section at the end of this post. Overall, I think this is an interesting concept and Gunther Eysenbach did a great job focusing the attention of the journal publishers on Twitter and Facebook as distribution channels that can also guide in measuring the impact of their articles.

References:

Can Tweets Predict Citations? Metrics of Social Impact Based on Twitter and Correlation with Traditional Metrics of Scientific Impact. Gunther Eysenbach. J Med Internet Res 2011;13(4):e123.

New research plus twitter. Does it make a difference in the clinic. Heidi Allen Digital Strategy in Health.

'Highly Tweeted Articles Were 11 Times More Likely to Be Highly Cited'. The Atlantic.

Twimpact factors: can tweets really predict citations? BMJ.

Tweets, and Our Obsession with Alt Metrics

Image source: Twitter.com.

Comments from Twitter:

@paediatrix:  Interesting. Makes sense

Harris Lygidakis @lygidakis: And Twimpact Factor is a good sign of what's ahead!

Internal medicine residents spent little time reading, and prefer electronic resources, specifically UpToDate

This study from the Mayo Clinic assessed residents' reading habits and preferred educational resources at 5 internal medicine training programs via a survey.

78% of residents reported reading less than 7 hours a week.

81% of residents read in response to patient care encounters.

The preferred educational format was electronic, and UpToDate was the big winner among the surveyed group:

- 95% of residents cited UpToDate as the most effective resource for knowledge acquisition
- 89% of residents reported that UpToDate was their first choice for answering clinical questions

The study authors concluded that residents spent little time reading and sought knowledge primarily from electronic resources. Most residents read in the context of patient care.

The abstract does not mention anything about social media sources such as Wikipedia, blogs, and Twitter, but the residents encounter a lot of those through Google searches.

References:

A multi-institutional survey of internal medicine residents' learning habits. Edson RS, Beckman TJ, West CP, Aronowitz PB, Badgett RG, Feldstein DA, Henderson MC, Kolars JC, McDonald FS. Med Teach. 2010;32(9):773-5. Image source: UpToDate.

Motion sickness - what to do?

From a 2011 BMJ review:

Travel by car, train, or other transport is part of everyday life for most people, and therefore motion sickness is a quite common problem. It was recognized in the early days of sea travel and the word for sickness, “nausea,” derives from the Greek word νανς, meaning “ship.”

Motion sickness is also a potentially disabling problem, thought to be due to sensory conflict or “mismatch” involving the vestibular system.

Symptoms can be provoked by:

- externally imposed motion
- implied self motion from a moving visual field, such as in a cinema

Symptoms

Motion sickness manifests with:

- nausea, vomiting, and stomach awareness
- increased salivation
- belching
- pallor
- sweating
- headache
- dizziness
- apathy, drowsiness, and malaise
- hyperventilation

Habituation

Behavioral treatments such as habituation can be effective but at the same time they can be unpleasant and time consuming

Hyoscine

Hyoscine is an effective preventive medication. There are oral forms and transdermal patches. Hyoscine nasal spray is also effective in preventing motion sickness

Evidence to support the use of other drugs is weaker, especially taking into account the trade off between efficacy and adverse effects. Traditional remedies such as ginger and acupressure bands have not been effective.

References:

Managing motion sickness. BMJ Review 2011; 343 doi: 10.1136/bmj.d7430
Image source: OpenClipArt.org, public domain.