Welcome to Sarasota Neurology: Your PRP (Platelet Rich Plasma) Specialist – Video

sarasotaneurology.com Dan Kassicieh, DO, leading Sarasota Neurologist, discusses the many uses of PRP therapy. Platelet Rich Plasma is used to treat joint pain, knee pain, shoulder pain, back pain, plantar fasciitis, heel spurs and many other conditions. PRP is drawn from your own blood, and is a safe, remarkably effective therapy that provides for the regeneration of tissue

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Welcome to Sarasota Neurology: Your PRP (Platelet Rich Plasma) Specialist - Video

"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.

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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:

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

Image source: OpenClipArt.org.

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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.

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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:

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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 ?-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 ?-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.

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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.

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