What’s new in infectious diseases from UpToDate

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- Brain MRI may be useful in patients with endocarditis. In one study including 53 patients, early use of cerebral MRI led to the reclassification from possible to definite IE in 30% of cases.

Figure 1. TEE shows AV Endocarditis in a patient with IVDA. There is a large vegetation on the aortic valve with 2-3+ AI (click to enlarge the image). Source: Double Hit – Right and Left-Sided Endocarditis in a Heroin Abuser.
- Cotrimoxazole prophylaxis was associated with a 50 percent reduction in deaths in patients starting antiretroviral therapy with CD4 counts lower than 200 cells.

- Universal influenza immunization: In 2010, the CDC expanded the recommendation for influenza vaccination to include all individuals 6 months of age and older. Previous guidelines recommended influenza vaccination for individuals over age 50 and for those at increased risk of influenza complications and close contacts of such individuals.

35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via "What's new" page.

The page does not provide RSS feed for the different specialties. One solution is to copy/paste the URL address of each subspecialty page you are interested in the Google Reader "Add a subscription" field (top left corner). Google Reader will automatically create a RSS feed from this "feedless" page.

References:
What's new in infectious diseases. UpToDate, 2010.

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Sexual life expectancy is longer for men than women

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A BMJ study of middle aged and older adults showed that men were more likely than women to be sexually active, report a good quality sex life, and be interested in sex.

These gender differences increased with age and were greatest among the 75 to 85 year old group: 38.9% of men compared with 16.8% of women were sexually active, 70.8% versus 50.9% of those who were sexually active had a good quality sex life, and 41.2% versus 11.4% were interested in sex.

People in very good or excellent health were 1.5 to 1.8 times more likely to report an interest in sex than those in poorer health. At age 30, sexually active life expectancy was 34.7 years for men and 30.7 years for women compared with 14.9 to 15.3 years for men and 10.6 years for women at age 55.

At age 55, men in very good or excellent health on average gained 5-7 years of sexually active life compared with their peers in poor or fair health. Women in very good or excellent health gained 3-6 years compared with women in poor or fair health.

References:

Image source: OpenClipart.org, public domain.

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The Lancet is alive and kicking on social media networks

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As per its editor Richard Horton, the journal Lancet is alive and kicking on social media networks with a Twitter and Facebook pages. He commented on the social media involvement of the journal on the regular podcast available from the links below:

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Electronic Prescribing Decreases Prescribing Errors Seven Fold

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For e-prescribing adopters, error rates decreased nearly sevenfold, from 42.5 per 100 prescriptions at baseline to 6.6 per 100 prescriptions one year after adoption.

For non-adopters, error rates remained high at 37 per 100 prescriptions at baseline and 38 per 100 prescriptions at one year.

Illegibility errors were very high at baseline, and not surprisingly, were completely eliminated by e-prescribing (87.6 per 100 prescriptions at baseline for e-prescribing adopters, 0 at one year).

Prescribing errors may occur much more frequently in community-based practices than previously reported. This study findings suggest that stand-alone e-prescribing with clinical decision support may significantly improve ambulatory medication safety.

References:
Electronic Prescribing Improves Medication Safety in Community-Based Office Practices. Journal of General Internal Medicine, 2010.

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18% tax on pizza and soda can decrease U.S. adults’ weight by 5 pounds (2 kg) per year

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From Reuters:

With two-thirds of Americans either overweight or obese, policymakers are increasingly looking at taxing as a way to address obesity on a population level.

"Sadly, we are currently subsidizing the wrong things including the product of corn, which makes the corn syrup in sweetened beverages so inexpensive."

Instead, the agricultural subsidies should be used to make healthful foods such as locally grown vegetables, fruits and whole grains less expensive.

References:
Tax soda, pizza to cut obesity, researchers say | Reuters.

Image source: Soft drinks, Wikipedia, public domain.

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Health Benefits of Pets – Mayo Clinic Video

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May 10, 2010 — Health Benefits of Pets.

People will do a lot for their pets - see below:
- Somebody found a solution: Smokers are motivated to quit to protect their pets from secondhand smoke http://is.gd/iZ58
- "Do it for Fido: smokers may quit smoking because of their pet" http://is.gd/iZtQ

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Are Almonds a Good Source of Calcium?

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Over all, you would still get some calcium by eating almonds, but at a lot higher calorie cost than from other foods, like milk.

The amount of calcium in a cup of whole almonds, 378 milligrams, is slightly more than in a cup of milk, about 300 milligrams, but you would be consuming about eight times as many calories.

References:
Q and A - Almonds for Calcium? - Question - NYTimes.com.

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Oral factor Xa inhibitor apixaban – more effective than enoxaparin for thromboprophylaxis after knee replacement

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Low-molecular-weight heparins such as enoxaparin are preferred for prevention of venous thromboembolism after major joint replacement. Apixaban, an orally active factor Xa inhibitor, might be as effective, have lower bleeding risk, and be easier to use than is enoxaparin.

The primary outcome in this Lancet study was the composite of asymptomatic and symptomatic deep vein thrombosis (DVT), non-fatal pulmonary embolism (PE), and all-cause death during treatment. The primary outcome was reported in 15% of apixaban patients and 24% of enoxaparin patients (relative risk 0·62), absolute risk reduction 9·3%.

Major or clinically relevant non-major bleeding occurred in 4% of patients receiving apixaban and 5% of treated with enoxaparin.

The authors concluded that apixaban 2·5 mg twice daily, starting on the morning after total knee replacement, offers a convenient and more effective orally administered alternative to 40 mg per day enoxaparin, without increased bleeding.

References:

Image source: Apixaban, Wikipedia, public domain.

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Former FDA commissioner on the killer combination of salt, fat and sugar – our food

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David A Kessler, former commissioner of the FDA (the US Food and Drug Administration):

"Our favourite foods are making us fat, yet we can't resist, because eating them is changing our minds as well as bodies

For example, KFC's approach to battering its food results in "an optimised fat pick-up system". With its flour, salt, MSG, maltodextrin, sugar, corn syrup and spice, the fried coating imparts flavour that touches on all three points of the compass while giving the consumer the perception of a bargain – a big plate of food at a good price."

The ranks of overweight adults and children continue to increase. For the first time in history, overweight persons actually outnumber those who are malnourished. Obesity now kills more men and women in developed nations than war, terrorist attacks, or climate changes. On average, obese individuals forfeit about 9 years of life.
More on the same topic in the video below:

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

References:
Obesity: The killer combination of salt, fat and sugar | David A Kessler. Guardian.

JAMA - Fat, Gluttony and Sloth: Obesity in Literature, Art and Medicine, July 7, 2010, Miksanek 304 (1): 101 http://goo.gl/eEos

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Misconceptions about medical blogs

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From the newsletter Australian Pharmacists:

"At the heart of social media is the blog, an online diary where news, gossip, industry issues, opinion and scandal jostle for space."

I cover medical news from educational perspective on CasesBlog but I try not to include "gossip, industry issues, opinion and scandal" and with one post per day, they never "jostle for space".

There are many different types of medical blogs, of course.

Image source: public domain.

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Gendercide or the worldwide war on baby girls

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From The Economist:

"Gendercide" is often seen as an unintended consequence of China’s one-child policy, or as a product of poverty or ignorance. The surplus of bachelors—called in China guanggun, or “bare branches”— seems to have accelerated between 1990 and 2005, in ways not obviously linked to the one-child policy, which was introduced in 1979. And, as is becoming clear, the war against baby girls is not confined to China.

The use of sex-selective abortion was banned in India in 1994 and in China in 1995. It is illegal in most countries. But since it is almost impossible to prove that an abortion has been carried out for reasons of sex selection, the practice remains widespread. An ultrasound scan costs about $12, which is within the scope of many—perhaps most—Chinese and Indian families. In one hospital in Punjab, in northern India, the only girls born after a round of ultrasound scans had been mistakenly identified as boys, or else had a male twin.

References:
Image source: Wikipedia, GNU Free Documentation License.

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TTMed Urology – free multimedia educational site by Reuters

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According to the website, TTMed Urology is a multimedia educational platform aimed at delivering continuing education to urologists.

The website includes:

- Webcasts
- Articles (full text) and Congress Reports
- Clinical Scenarios
- Expert Interviews
- Online Courses
- Ask the Expert section
- Surgical Video Library
- Teaching Slides
- Multimedia Animations
- Podcasts

This is the link to the Editorial Board of the website - most of the experts are from Europe but a large portion of the content is from U.S.-based conferences. The project is sponsored by Prous Science S.A.U., a part of Thomson Reuters.

The access to most of the resources requires free registration.

References:
Urology Podcast
Urology News
Urology online Courses

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How do you blog?

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A nurse writing a paper for school focusing on the value of blogs for advanced practice nurses asked me the questions listed below. It would be great if you can post your own answers in the comment section below.

How many blog post do read a week?

The blog posts and news items from the RSS feeds are about 2,000-3,000 per day = 20,000 per week.

You read blog posts about?

The big five among the general medical journals (NEJM, JAMA, Lancet, BMJ, Annals of Int Medicine) plus 10 allergy journals, plus Medscape, Reuters Health and WebMD.

How many new topics do you personally post under each sub heading, i.e. Endocrine, Cardiac, etc each week?

1-2 blog posts per day, for example, cardiac topics once a week, endocrine topics once a month.

Some helpful references:

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Couple addicted to the internet let their baby starve to death while raising a virtual daughter online

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From BBC:

A South Korean couple who were addicted to the internet let their three-month-old baby starve to death while raising a virtual daughter online, police said.

An autopsy showed her death was caused by a long period of malnutrition.

The couple had become obsessed with nurturing a virtual girl called Anima in the popular role-playing game Prius Online.

Some psychiatrists still have doubts if Internet addiction exists but it looks pretty much for real in this video:

References:

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How Twitter Brings Patients to Mayo Clinic

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From Mayo Clinic: May 11, 2010 — People use Twitter to share information: The latest news, current events, what people are talking about, even what's for dinner. Now, people are using it to get access to health care. Last year Mayo Clinic teamed up with USA today and scheduled a Twitter chat about a painful wrist injury. Today a woman who joined that chat is pain free.

Related:
Erin Turner's Mayo Clinic e-Patient Success Story.

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Doctors should blog with their real name – agree or disagree?

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From KevinMD:

"Martin Young still has "nagging doubts about doctors who post blogs or replies about healthcare issues without giving their names.

My blog as an extension of who I am as a doctor, putting a carefully considered face to the experience of caring for the sick, as a means of drawing attention to issues that do not get into medical journals. As do most other doctors who host their own blogs.

I often look at those replies to my postings that are anonymous and think, “Who are you? Why do you think the way you do? Why will you not put a name and face to your thoughts?” My personal belief is that the anonymous person may lack conviction, confidence or courage.

I would not accept a referral from an anonymous doctor, or give advice to one. In the same way, I may read anonymous replies to my postings, but they carry much lower weight."

Although I encourage physicians to blog under their own name, I do not think we should "force" them to do so. They should not feel obliged to host their own blog either if they can use such perfectly reasonable free services such as Blogger.com by Google and WordPress.

I assembled a short list of suggestion for medical bloggers several years ago. Here it is:

Tips for Medical Bloggers

- Write as if your boss and your patients are reading your blog every day
- Comply with HIPAA
- Do not blog anonymously. List your name and contact information.
- If your blog is work-related, it is probably better to let your employer know.
- Inquire if there are any employee blogging guidelines. If there are, comply with them strictly.
- Use a disclaimer, e.g. "All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."
- Get your blog accredited by the Heath on the Net Foundation

References:
Image source: public domain.

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"I’m a Medicare doctor. Here’s what I make"

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From CNN:

Dr. Schreiber sees 120 patients a week - 30% of them are enrolled directly in Medicare, while another 65% have private insurance plans that peg their payments on Medicare's rates. Only 5% pay on their own.

Medicare pays between 63-72% of the costs for Schreiber's patients.

Four billing codes make up the "bread and butter" of claims submitted to Medicare:
- The first code represents a simple visit, which might include blood pressure and cholesterol checks. Schreiber gets about $44 from Medicare for the $70 fee he charges.

- The second and third codes correspond to a sick visit, when he spends 15 to 20 minutes evaluating a patient for symptoms such as coughing or shortness of breath. Schreiber charges $92 for a sick visit, of which Medicare pays about $58.

- The last billing code is a complex visit. "This is where a patient comes in with many problems like heart disease, hypertension, diabetes," he said. Such a visit requires about 30 minutes of his time.

Schreiber charges $120 for these visits, and Medicare pays $88 of that.

References:

Image source: United States one-dollar bill. Wikipedia, public domain.

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Oral Tolvaptan (Samsca) Is Safe and Effective in Chronic Hyponatremia

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Vasopressin antagonists increase the serum sodium concentration in patients who have euvolemia and hypervolemia with hyponatremia in the short term (30 days), but their safety and efficacy with longer term administration is unknown.

In a study, 111 patients with hyponatremia received oral tolvaptan (Samsca) for 700 days.

The most common adverse effects attributed to tolvaptan were pollakiuria, thirst, fatigue, dry mouth, polydipsia, and polyuria.

Mean serum sodium increased from 130.8 mmol/L at baseline to greater than 135 mmol/L throughout the observation period.

Responses were comparable between patients with euvolemia and those with heart failure but more modest in patients with cirrhosis.

In conclusion, prolonged administration of tolvaptan maintains an increased serum sodium with an acceptable margin of safety.

Samsca (tolvaptan) Black Box Warnings
Appropriate Use
Initiate and re-initiate tx only in hospital with serum Na monitoring.
Monitor Serum Sodium
Osmotic demyelination may occur w/ rapid correction of hyponatremia (faster than 12 mEq/L/24h), resulting in dysarthria, mutism, dysphagia, lethargy, affective changes, spastic quadriparesis, seizures, coma, and death; slower rates of correction advised in pts w/ severe malnutrition, alcoholism or advanced liver disease.
Cost comparison of conivaptan (Vaprisol) versus tolvaptan (Samsca)
Conivaptan is administered IV only, the average cost per day is $573.
Tolvaptan is administered PO only, the average cost per day is $300.

References:

Oral Tolvaptan Is Safe and Effective in Chronic Hyponatremia. Journal of the American Society of Nephrology, 2010.
Image source: Tolvaptan, Wikipedia, public domain.
From Twitter:
@kidney_boy: tolvaptan is safe for the patient but not their wallet at $250 per pill!

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