So, you feel some trembling and you decide to see what the options might be on WebMD Symptom Checker... After a couple of clicks, the computerized algorithm suggests that you may be a cannibal:
This is exactly why you need to see a real doctor instead of relying on online symptom checks, Google and Facebook.
Link via FailBlog and Berci.
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Plasticity and functional recovery in neurology
From BMJ:
A case described 5 surgeons who were working in a hospital and using a similar technique to operate on their patients. Surgeon B left the academy after a while to work in the private sector. Surgeon A decided to write a manuscript about their experiences and was the first author. Surgeons C, D, and E were named in the byline of the manuscript, but surgeon B was excluded. The question is whether surgeon B can claim to be an author of the article as well.
Using the International Committee of Medical Journal Editors (ICMJE) guideline without considering the ethical aspects of people’s contributions may lead to this guideline being abused, which is worse than not having any guideline at all.
References:
Behrooz Astaneh: Authorship criteria – use or abuse
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As well know, the iPad contains a touchscreen liquid crystal display that, like computer screens and television sets, emits light. Exposure to such abnormal light sources inhibits the body's secretion of melatonin.
All light-emitting devices, including cellphones, "tell the brain to stay alert." Because users hold those devices so close to their face, staring directly into the light, the effect is amplified compared with, for example, a TV across the room or a bedside lamp.
Reading on iPad before bed can affect sleep habits. LA Times.
Comments from Twitter:
Related products from Amazon:
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Blogging helps you grow and meet wonderful people all over the world
"What have I learned as a blogger?", a 79-year-old blogger counts the ways:
1. Blogging gives me a focus
2. Blogging helps me stay young
3. Blogging helps me meet wonderful people all over the world
4. Blogging gives me an opportunity to grow
5. Blogging has the potential to create an income
It doesn’t matter if anyone reads it
From an interview of Seth Godin and Tom Peters:
"Blogging is free. It doesn’t matter if anyone reads it. What matters is the humility that comes from writing it. What matters is the metacognition of thinking about what you’re going to say. No single thing in the last 15 years professionally has been more important to my life than blogging. It has changed my life, it has changed my perspective, it has changed my intellectual outlook, it’s changed my emotional outlook. And it’s free."
Doctor, you can be a Twitter superstar in two easy steps
Here is how to start a medical blog today: For doctors: How to start using social media. Indeed, you can be a Twitter superstar in two easy steps.
References
Is it Too Late to Start Blogging?
Why you should start blogging in 2011
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Please feel free to grab and embed the free widgets below in your own practice website or blog:
BMI calculator
Electronic Preventive Services
Did you know: U.S. Department of Health & Human Services has 40 blogs?!
More social media resources:
Flickr: The U.S. Food and Drug Administration's Photostream
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From NHS Choices YouTube channel:
- Take a few deep breaths
- Get plenty of exercise
- Socialize - don't stress alone, talk to someone and have a laugh
- Get out - go to the park
If nothing else helps, consider this: Chewing gum may reduce stress and improve memory
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Helicobacter pylori is associated with benign and malignant diseases of the upper gastrointestinal tract. Increasing antibiotic resistance has made alternative treatments necessary.
Empirical triple therapy (proton-pump inhibitor, clarithromycin, amoxicillin) is currently the first choice for eradication of Helicobacter pylori. As antibiotic resistance to clarithromycin (which has a crucial role in eradication) has increased. The eradication rate with triple therapy has gradually decreased below 80%, and even less.
The aim of this study reported in The Lancet was to assess the efficacy and safety of a new, single-capsule treatment versus the gold standard for H. pylori eradication (triple therapy).
A randomised, open-label trial of adults with H. pylori infection compared the efficacy and safety of:
- quadruple therapy: 10 days of quadruple therapy with omeprazole plus a single three-in-one capsule containing bismuth, metronidazole, and tetracycline
- standard therapy: 7 days of omeprazole, amoxicillin, and clarithromycin (editor note: why not 14 days of therapy?)
H. pylori eradication was established by negative 13C urea breath tests at 28 and 56 days after the end of treatment.
The eradication rates were 80% in the quadruple therapy group versus 55% in the standard therapy group.
The study authors concluded that quadruple therapy should be considered for first-line treatment in view of the rising prevalence of clarithromycin-resistant H. pylori. Quadruple therapy provides superior eradication with similar safety and tolerability to standard therapy.
References:
Helicobacter pylori eradication with a capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline given with omeprazole versus clarithromycin-based triple therapy: a randomised, open-label, non-inferiority, phase 3 trial. The Lancet, Volume 377, Issue 9769, Pages 905 - 913, 12 March 2011.
Quadruple or triple therapy to eradicate H pylori. The Lancet, Volume 377, Issue 9769, Pages 877 - 878, 12 March 2011.
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From NHS Choices YouTube channel: Alan was 55 when he was diagnosed with haemochromatosis or iron overload disorder, a condition where the body contains too much iron. In this video, he describes how he learned to manage the condition by changing is diet and having venesection treatment several times a year.
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From The Lancet:
Graham Hughes, who first described antiphospholipid syndrome (APS) in 1983, urged for more efforts to raise awareness of this disorder. APS often remains undiagnosed and untreated with catastrophic consequences, such as multiple miscarriages, or stroke at a young age.
The coagulation cascade. Black arrow - conversion/activation of factor. Red arrows - action of inhibitors. Blue arrows - reactions catalysed by activated factor. Grey arrow - various functions of thrombin. Image source: Wikipedia
References
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A 2001 survey by the Commonwealth Fund found that doctor-patient communication often fell short. One in 5 American adults had trouble communicating with their doctors, and 1 in 10 felt they had been treated disrespectfully during a recent health care visit.
Just funded through a generous $42-million grant, the University of Chicago aims to fix the communication errors and bring the patient-physician relationship back where it belongs.
Here is the example that started the whole process:
Kay Bucksbaum, whose husband made multi-billion fortune developing shopping centers around the world, said she was inspired by Dr. Mark Siegler, a medical ethicist at the University of Chicago who became the couple's internist when they moved to Chicago from Iowa 10 years ago.
In contrast, she recalled a doctor years ago who didn't listen to her when she told him what she thought was wrong with her -- and didn't apologize when she turned out to be right.
When her husband needed surgery, she said, Siegler "took my husband by the hand to meet the surgeon, introduced him, and told the surgeon something about my husband. He even scrubs up and watches his patients' surgeries when he can, she said. "And he encourages patients to call him "Mark."
The video below introduces the Bucksbaum Institute for Clinical Excellence which is funded through $42 million grant to the University of Chicago to create a unique initiative that aims to improve the doctor-patient relationship and communication in medicine:
Disclaimer: I am an Allergist/Immunologist and Assistant Professor of Medicine and Pediatrics at the University of Chicago.
NBC video:
References:
New Bucksbaum Institute fosters doctor-patient communication
Benefactor Gives U of Chicago $42 Million to Work on Bedside Manner
A $42 Million Gift Aims at Improving Bedside Manner
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More than 50% of U.S. adults are habitual coffee drinkers. Americans get more antioxidants from coffee than anywhere else (?!). Coffee drinkers may be at lower risk of liver and colon cancer, type 2 diabetes, and Parkinson's disease.
"Most people drink it for the caffeine but it's the Number 1 source of antioxidants in the U.S. diet. Polyphenols are the "the good guys in coffee." Is coffee a "health food" now?
70% of Americans with an annual household income of $150,000 or more drink coffee, compared with 54% of Americans in a household making less than $25,000 a year.
Can drinking coffee even help you live longer? Maybe (same with alcohol).
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These are some selected presentations from the 2011 Medicine 2.0 Congress that took place on the Stanford University campus last weekend:
Lee Aase, manager of Syndication and Social Media for Mayo Clinic, has uploaded more than 100 of his presentations on SlideShare.
Other presentations: Epocrates and medical apps.
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Update 09/21/2011: DEA Moves to Make 'Bath Salts' Illegal as Overdoses Rise
What are these “bath salts”?
The abuse of psychoactive “bath salts” (PABS) has become commonplace, and patients with PABS overdoses are presenting to emergency departments with increasing frequency. The main ingredient of the synthetic designer drugs in these bath salts, which are not related to any hygiene product, is methylenedioxypyrovalerone (MDPV).
What is the clinical presentation?
From the NYTimes: "Doctors could not believe what he was seeing this spring in the emergency room: people arriving so agitated, violent and psychotic that a small army of medical workers was needed to hold them down.
They had taken new stimulant drugs that people are calling “bath salts,” and sometimes even large doses of sedatives failed to quiet them. Director of Poison Center. “If you gave me a list of drugs that I wouldn’t want to touch, this would be at the top.”
Bath salts contain man-made chemicals like mephedrone and methylenedioxypyrovalerone, or MDPV, also known as substituted cathinones. Both drugs are related to khat, an organic stimulant found in Arab and East African countries that is illegal in the United States." These products are easily obtained over the Internet under such names as Ivory Wave or Vanilla Sky.
What to do when evaluating and treating a patient intoxicated with psychoactive “bath salts” (PABS)?
Clinicians need to be aware of several issues (source: NEJM):
- severity and potential lethality from overdoses often require admission to the intensive care unit (ICU)
- routine drug screens do not detect PABS
- PABS can be cut with other psychoactive substances, which can confound the clinical presentation
- patients may need physical restraints and high doses of sedatives to prevent self-harm or harm to others.
Treatment is largely supportive, with IV benzodiazepines (for sedation or to control seizures) and IV fluids, particularly if there is rhabdomyolysis
References:
An Alarming New Stimulant, Sold Legally in Many States. NYTimes.
“Bath Salts” Intoxication. NEJM.
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Emergency medicine physician, world-class educator and blogger extraordinaire Dr. Mike Cadogan was recently interviewed by Elsevier Australia:
Interviewer:
What are the best and worst parts of night shifts? Do you have any tips for surviving nights?
Mike Cadogan:
I love night shifts. The dark corridors, the cool air, the rising moon, the autonomy of decision-making, the authority, the midnight snacks and the sense of joyous achievement walking home with the sun rising and against the tide of tired, depressed faces gripping their morning coffees and bemoaning the need to be at work on such a glorious sunny day…
Think positive, be strong and enjoy autonomy. Remember that everybody else is on night shift with you, and most of them don’t want to be there either…but there is no need to be grumpy, rude, or pompous. Make friends with the night owls and collaborate, you will find your workload will dramatically decrease… Make enemies with the permanent night staff at your peril!
References
Interview with Mike Cadogan, author of the acclaimed On Call: Principles and Protocols by Student Ambassador Emma Sharp.
Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.
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A medical student emailed the Kindle team: "What you have here is a great product. I am a third year medical student out of New York, and have loaded a bunch of my textbooks onto the Kindle. Those once 40lb volumes of ill-fated tree trunks, are less than a pound, and now in the pocket of my white coat. Really a great asset!"
A former law student commented: "If I had a Kindle in law school, I think I would be 2 inches taller, and not need glasses..."
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Insulin has been identified as one of the top 10 high risk medicines worldwide. Errors are common - the first national audit in England and Wales showed prescribing errors in 19.5% of cases.
Not only are mistakes common, they often lead to harm - 3% of medication errors are related to insulin, but these errors were also twice as likely to cause harm as errors for other prescribed drugs.
Errors relating to insulin arise because insulin has a narrow therapeutic range and requires precise dose adjustments with careful administration and monitoring.
Over 20 different types of insulin are in use, in various strengths and forms, and with a range of delivery devices, including insulin syringes (from vials), insulin pens (prefilled or reusable), or infusion pumps.
References:
Safer administration of insulin: summary of a safety report from the National Patient Safety Agency. BMJ 2010; 341:c5269 doi: 10.1136/bmj.c5269 (Published 13 October 2010).
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Target pushes hard the ads for its in-store clinics - 4 of them in the Sunday edition of The Chicago Tribune:
Walmart is also entering the field of NP-staffed clinics in a major way, followed by CVS Pharmacy:
Walmart has been adding health clinics to its stores during the last 3 years as part of its drive for "one-stop shopping." There were 100 in-store clinics in 21 states in 2010.
In fact, Minute Clinic is the largest retail clinic chain in the country, with 600 clinics in CVS stores in 24 states. Almost half of Minute Clinic's clientele don't have a primary-care doctor of their own.
Comments from Twitter:
@napernurse: Pharm son works for #Walgreens. Costs them $5 to be seen by NP for whatever 🙂 Can just walk-in & now WAG on "Blue Button" campaign.
Related:
"The Clinic" at Walmart - Operated by "Family Medicine Specialists"
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Doctors are not impervious to stresses of daily life. Physician distress is common and has been associated with negative effects on patient care.
This JAMA study of internal medicine residents used data collected during 2008-2009 Internal Medicine In-Training Examination (IM-ITE). Participants were 16,000 IM residents, representing 74% of all eligible US internal medicine residents - approximately 7700 US medical graduates and 8500 international medical graduates (IMGs).
Quality of life was rated “as bad as it can be” or “somewhat bad” by 15% of residents.
Burnout, emotional exhaustion and depersonalization were reported by 51%, 46%, and 29% of residents, respectively.
Burnout was less common among international medical graduates than among US medical graduates (45% vs 59%),
Greater educational debt was associated with the presence of at least 1 symptom of burnout (61% vs 44%; for debt greater than $200 000 relative to no debt).
Residents reporting QOL “as bad as it can be” and emotional exhaustion daily had exam scores 2.7 points and 4.2 points lower than those with QOL “as good as it can be” and no emotional exhaustion, respectively.
Residents reporting debt greater than $200,000 had exam scores 5 points lower than those with no debt.
Suboptimal QOL and burnout were common among IM residents. Burnout was associated with higher debt and was jess frequent among international medical graduates (IMGs).
Low QOL, emotional exhaustion, and educational debt were associated with lower IM-ITE scores.
References:
Quality of Life, Burnout, Educational Debt, and Medical Knowledge Among Internal Medicine Residents. JAMA, 2011;306(9):952-960. doi: 10.1001/jama.2011.1247
Stress overdose for doctors. Star Tribune.
Image source: OpenClipArt.org, public domain.
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Interesting fact: Traces of cocaine taint up to 90% of paper money in the United States. Paper money become contaminated with cocaine during drug deals and directly through drug use, such as snorting cocaine through rolled bills. Amounts of cocaine found on U.S. bills ranged from 0.006-1,240 micrograms of cocaine per banknote (50 grains of sand) (http://bit.ly/27V5Yt).
Since 2005, levamisole (commonly used as to treat worm infections in humans and animals), has increasingly been used to mix cocaine for street use.
See the dramatic photos from a similar case published in the NEJM here: Toxic Effects of Levamisole in a Cocaine User
References:
Bilateral Necrosis of Earlobes and Cheeks: Another Complication of Cocaine Contaminated With Levamisole. Ann of Int Med, June 1, 2010, vol. 152 no. 11 758-759.
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