How do you keep up with health news?

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Steve Rubel asks How do you keep up with industry news - RSS, email newsletters, Twitter, Facebook or other (elaborate)? He now primarily uses newsletters, Twitter and Facebook to follow several dozen sources. He uses his RSS reader as an archive:

http://www.facebook.com/steverubelstream

This does not work very well for me. Google Reader is still one of my primary sources for health information - I channel Twitter feeds, YouTube subscriptions, Flickr and podcasts through it as well.

The RSS reader collects all rich media in one place - a true "inbox for the web". The disjointed approach described by Steve Rubel above can be confusing to many and a time-waster to even more. Everybody has their own preferences, of course.

For example, Steve abandoned his popular blog MicroPersuation to move to life-stream, then Facebook. Alternatively, I decided to stay with my blogs and send their updates to Twitter and Facebook. My blog is still my home on the web. You can build a professional profile on LinkedIn, Google and (may be) on Facebook but I decided to keep a separate website just for profile information. You can build it for free on Blogger.com by Google, control every aspect of it, and the only expense is the fee for domain registration ($10).

Comments from Google Buzz:
Tim Sturgill - I've started to use GR as you are for Twitter. I wish Twitter had RSS for direct messages as well.
Vamsi Balakrishnan - I use Google Reader for my news sites (both tech and health). And, for the individual people I follow, like you, I'd use my Buzz. Every few days I log on to Twitter to check messages / replies / etc.
Lakshman Swamy - GR and buzz!

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Tiotropium for COPD: A good foundation therapy for most patients

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From a BMJ Editorial:

Tiotropium is a once daily, inhaled, long acting anticholinergic drug (LAMA) that provides 24 hour improvement in airflow and hyperinflation in patients with chronic obstructive pulmonary disease (COPD).

Clinical trials have consistently shown that these physiological effects translate into improvements in:

- lung function
- exercise tolerance
- health related quality of life
- fewer exacerbations

References:

Tiotropium and chronic obstructive pulmonary disease. BMJ, 2010.
http://www.bmj.com/cgi/content/short/340/feb19_1/c833
Image source: Wikipedia, public domain.

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Approach to evaluation and management of syncope in adults – BMJ Review

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Syncope is common in all age groups, and it affects 40% of people during their lifetime, usually described as a "faint" or "blackout".

Neurally mediated syncope, which is benign, is the most common cause

Cardiac syncope as a result of arrhythmias or structural cardiopulmonary disease is more common with increasing age. Cardiac syncope is associated with increased mortality and must be excluded.

Brain imaging, carotid Doppler ultrasound, electroencephalography, and chest radiography are often not needed in patients with syncope.

References:

An approach to the evaluation and management of syncope in adults. BMJ 2010;340:c880.
http://www.bmj.com/cgi/content/short/340/feb19_1/c880
Image source: Illustration of the human brain and skull. Wikipedia, Patrick J. Lynch, medical illustrator, Creative Commons Attribution 2.5 License 2006.

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Should Doctors ‘Prescribe’ a Drink a Day? No.

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From the NYTimes:

The evidence regarding wine versus other beverages like grape juice is mixed.

For most people, low-risk drinking is not harmful to health — and may be helpful. However, I would discourage people from drinking in order to improve their health.
Compared with non-drinkers, men who consumed wine, beer, or spirits had a 36% lower risk of all-cause mortality and a 34% lower risk of cardiovascular mortality.
Before you recommend wine for cardiovascular risk reduction, consider this:
- One in five men at risk of drinking problem during their lifetimes
- Women have an 8 to 10 percent chance of becoming dependent on alcohol during their lifetimes
- Men have 15% lifetime risk for alcohol abuse, 10% risk for alcohol dependence. Each cuts your life short by 10-15 years.
- Heavy drinking increases risk of depression by 40%, and 80% of people dependent on alcohol are smokers

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Turning medical residents away from copy-and-paste culture facilitated by EMR

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Cleveland VA is trying to cut out the burgeoning subculture of “copy-and-paste”: A phenomenon made possible by electronic medical records in which physicians copy old information about a patient and paste it into a new section of the chart.

The practice is seen by medical residents as a time-saver but the attendings consider it an “egregious problem” because the practice has the potential to perpetuate mistakes. For example, someone might copy and paste information from a patient’s medical history without verifying that the information is correct. Any errors that might exist will be repeated.

EMR can’t just disable the copy-and-paste function, since such a move would impact other programs.

References:

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Some nurses paid more than family doctors – CNN

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Primary care doctors were offered an average base salary of $173,000 in 2009 compared to an average base salary of $189,000 offered to certified nurse anesthetists, or CRNAs.

It's the fourth year in a row that CRNAs were recruited at a higher pay than a family doctor.

Comments from Google Buzz:

Jeffrey Benabio, MD - And soon doctor of nursing programs will graduate nurses who call themselves "doctor" in clinic. Physicians have been asleep at the wheel.

http://en.wikipedia.org/wiki/Doctorate_in_Nursing

Francesco Diana - without words

Anne Marie Cunningham - Both of these are very high salaries. As @scanman points out, they are unobtainable for most people working in health in India and countries. Can we tolerate such global inequality?

How should salaries in any part of the world be determined? Are both these groups paid too much?

At the moment there is a great deal of uncertainty on how the role of a doctor differs to the role of a nurse. Professor Alan Maynard suggests that professions are bad for healthcare. http://www.healthpolicyinsight.com/?q=node/458 What do you think?

Image source: OpenClipArt.org, public domain.

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High deductible health insurance can be bad for your health

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See why:

"The individual health insurance policy they bought to replace Janie's group coverage at work has such a high deductible that they've sharply cut back doctor visits, skipping some routine care and going only when absolutely necessary.


Freelancers Janie and Chris Peterson love the freedom of life without a boss. But it comes with a high price -- dwindling savings, erratic cash flow, and a ton of financial anxiety."

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

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6 (reasonable) things to do in a doctor’s waiting room

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1. Make a list of your top health concerns.

2. Write questions down.

3. Make a list of all your medications.

4. Ask the office to check on your test results.

5. Confirm that the office has the correct insurance information.

6. Read something besides the magazines.

References:
6 things to do in a doctor’s waiting room. ConsumerReportsHealth.org.

Image source: picturestation.net, free license.

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The men behind famous eponymous diseases

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From CNN:

"Having a disease named after you is a decidedly mixed bag. On the one hand, your scientific developments are forever commemorated. On the other hand, though, you're stuck with the knowledge that no patient will ever be happy upon hearing your name."


Daniel Elmer Salmon (1850 – 1914) was a veterinary surgeon. He earned the first D.V.M. degree awarded in the United States, and spent his career studying animal diseases for the U.S. Department of Agriculture. He gave his name to the Salmonella genus of bacteria, which were discovered by an assistant, and named in his honor. Image source: Wikipedia, public domain.
New medical conditions that are being discovered are not named after scientists or physicians anymore. The eponymous system is non-descriptive and generally confusing.

References:

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Medical school letters of recommendation have formally been replaced by tweets

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Doctor_V's tweets in Brizzly (click to enlarge the image) - read from the bottom of the screenshot.

If you are a medical school I highly suggest you admit @beccacamp .@LeeAase I don't know if Mayo School of Medicine takes Twitter recommendations but I formally recommend @beccacamp. Medical school letters of recommendation have formally been replaced by tweets.

Indeed. And if the tweets are by Doctor_V, they should be strongly considered in the admission process... 🙂

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Glaucoma eye drops drug Latisse used OTC to make long eyelashes but some now face side effects

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From the NYTimes:

Latisse is the same formula as Lumigan, Allergan’s eyedrops for glaucoma, which reduces eye pressure but also happens to grow lashes. Both are also known as bimatoprost ophthalmic solution. In early 2009, Allergan introduced the drug as a lash enhancer.

A former primary care doctor runs http://www.latisse.bz, which boasts that it is the “largest Latisse retailer.” All it takes to get Latisse mailed out — without ever seeing him — is filling out a medical history, which he reviews, and typing in a valid credit card number.

But if people use Latisse without seeing a doctor, the side effects may come as a big surprise.

Eyelid discoloration “may be reversible” according to the manufacturer. A rare side effect that has captured the most attention is the chance that one’s hazel or blue eyes could turn brown — forever.

Image source: Eyelashes, Wikipedia, Steve Jurvetson, Creative Commons Attribution 2.0 Generic license.

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Fish out of pills – Pharmaceuticals in drinking water

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Fish out of pills - Pharmaceuticals in drinking water, NationalGeographic, April 01, 2010. Design Editor Oliver Uberti shows what went into the making of an information graphic about pharmaceuticals that make their way into our watersheds and end up in fish. Click here to see the full-size illustration.

A vast array of pharmaceuticals — including antibiotics, anti-convulsants, mood stabilizers and sex hormones — have been found in the drinking water supplies of at least 41 million Americans. The concentrations of these pharmaceuticals are tiny, far below the levels of a medical dose but the long-term consequences to human health are unknown.
The pharmaceutical industry points out the amount of medication in the water supply is the equivalent of a single pill in an Olympic-size swimming pool. Still, if you a have glass of water in Philadelphia, you are drinking tiny amounts of at least 56 medications.

References:

Antibiotics, anticonvulsants, antidepressants and sex hormones in drinking water of 41 million Americans http://goo.gl/HiXa

Pollution: Fish Pharm. NGM Blog Central.

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3-gram reduction in daily salt intake would decrease coronary heart disease, stroke, and death

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The U.S. diet is high in salt, with the majority coming from processed foods. Reducing dietary salt is a potentially important target for the improvement of public health.

Reducing dietary salt by 3 g per day (1200 mg of sodium per day) is projected to reduce the annual number of new cases of CHD by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. Such an intervention would be more cost-effective than using medications to lower blood pressure in all persons with hypertension.
The cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels.

References:

Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease. NEJM, 2010.
http://content.nejm.org/cgi/content/short/362/7/590
Image source: Single-serving salt packets. Wikipedia, GNU Free Documentation License.

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Good and Bad Health Habits in U.S.: drinkers outnumber exercisers

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The CDC study shows that six in 10 American adults were regular drinkers in 2005-2007, but only about three in 10 regularly exercised.

Since 1997, rates of cigarette smoking have declined by several percentage points, rates of obesity have climbed, and rates of alcohol use, exercise, and sleep have remained relatively unchanged.

Men were more likely than women to be drinkers (68% vs. 55%).

The more educated people were, the more likely they were to drink. 74% of people who have a graduate degree were drinkers, compared with 44% of people with a high school diploma.

Adults with higher levels of education were less likely to be smokers, be physically inactive, and be obese and to sleep six hours or less per night.

Twitter comments:

@kcb704: "The more educated people were, the more likely they were to drink." http://goo.gl/JDv1 // work hard, play hard..

@BrettLinda: Hold on... good or bad? RT @DrVes Good and Bad Health Habits in U.S.: drinkers outnumber exercisers http://goo.gl/JDv1

References:
Good and Bad Health Habits in U.S. WebMD.

Images source: Wikipedia, Free Documentation License.

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Occupation may be a key factor in lung cancer

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While cigarettes are by far the most important cause of lung cancer, chemicals and other on-the-job hazards "play a remarkable role" in lung cancer risk.

5% of lung cancers in men are job-related. Men in the known to be risky occupations were 74% more likely to have been diagnosed with lung cancer.

The strongest associations were seen for ceramic and pottery jobs and brick manufacturing, as well as for those working in manufacturing of non-iron metals.

A CXR shows a right upper lobe (RUL) mass due to lung cancer. Source: Finger Clubbing due to Lung Cancer. Clinical Cases and Images.

References:

Occupation a key factor in men's lung cancer risk. Reuters, 2010.
http://www.reuters.com/article/idUSTRE61E53920100215

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FDA: High-dose simvastatin increases risk of muscle injury – caution with lower doses plus Amiodarone, Verapamil, Diltiazem

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Based on review of data from a large clinical trial and data from other sources, the U.S. Food and Drug Administration (FDA) is informing the public about an increased risk of muscle injury in patients taking the highest approved dose of the cholesterol-lowering medication, Zocor (simvastatin) 80 mg, compared to patients taking lower doses of simvastatin and possibly other drugs in the "statin" class.

The muscle injury, also called myopathy, is a known side effect with all statin medications. The most serious form of myopathy is called rhabdomyolysis. Patients with myopathy generally have muscle pain, tenderness or weakness, and an elevation of a muscle enzyme in the blood (creatine kinase). The higher the dose of statin used, the greater the risk of developing myopathy. The risk of myopathy is also increased when simvastatin, especially at the higher doses, is used with certain drugs (see Simvastatin Dose Limitations below).

The data come from the SEARCH study, in which myopathy was seen in nearly 1% of patients taking the 80 milligram dose of Zocor but in only 0.02% of patients taking the 20 milligram dose of Zocor.

Rhabdomyolysis was rare in the SEARCH study. It happened in only 11 of 6,031 patients (0.02%) in group taking the 80 milligram dose of Zocor, but was not seen in patients taking the 20 milligram dose.

New data also suggest that people of Chinese descent should not take Zocor at the 80 milligram dose -- and should be careful even when taking lower doses -- if they also take niacin-containing products.

Simvastatin Dose Limitations

These limitations apply to ALL patients taking simvastatin.

Do not use simvastatin with these medications:

Itraconazole
Ketoconazole
Erythromycin
Clarithromycin
Telithromycin
HIV protease inhibitors
Nefazodone

Do not use more than 10mg of simvastatin with these medications:

Gemfibrozil
Cyclosporine
Danazol

Do not use more than 20mg of simvastatin with these medications:

Amiodarone
Verapamil

Do not use more than 40mg of simvastatin with this medication:

Diltiazem

References:

Image source: Simvastatin. Wikipedia, public domain.

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500 repetitions of 4 cardiac murmurs improved auscultatory proficiency of medical students

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According to a 2004 study in Chest, the ability of medical students to recognize heart murmurs is poor (20%), and does not improve with subsequent years of training.

Five hundred repetitions of four basic cardiac murmurs significantly improved auscultatory proficiency in recognizing basic cardiac murmurs by medical students. These results suggest that cardiac auscultation is, in part, a technical skill.

Related resources
The Heart Sounds Tutorial by Blaufuss.org is a fancy flash-based simulator with animations. The McGill University Virtual Stethoscope is another useful website. Click here for more web-based teaching resources for hearts sounds from UCLA and breath sounds from Loyola University.
References:
Mastering cardiac murmurs: the power of repetition. Barrett MJ, Lacey CS, Sekara AE, Linden EA, Gracely EJ. Chest. 2004 Aug;126(2):470-5.

http://www.ncbi.nlm.nih.gov/pubmed/15302733

Image source: Modern stethoscope. Wikipedia, public domain.

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Rock legend Ronnie James Dio is fighting stomach cancer

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On 25 November 2009, Dio's wife and manager announced that he was diagnosed with stomach cancer:

"Ronnie has been diagnosed with the early stages of stomach cancer. We are starting treatment immediately at the Mayo Clinic. After he kills this dragon, Ronnie will be back on stage, where he belongs, doing what he loves best, performing for his fans. Long live rock and roll, long live Ronnie James Dio. Thanks to all the friends and fans from all over the world that have sent well wishes. This has really helped to keep his spirit up." -- "He has had a few hiccups between Christmas and New Year's," she said in a statement to fans. "He has had a blood clot, a trip to the emergency room, and a three-day stay at the hospital."

ArtisanNewsService — April 13, 2010 — "One of heavy metal's premiere vocalists Ronnie James Dio shares his thoughts on his battle with stomach cancer at the Revolver Golden Gods awards."

On 14 March 2010, Dio's wife and manager Wendy posted an online update on his condition:

"It has been Ronnie's 7th chemo, another cat scan and another endoscopy, and the results are good - the main tumour has shrunk considerably, and our visits to Houston (MD Anderson Cancer Center in Texas) are now every three weeks instead of every two weeks."

References:
Ronnie James Dio. Wikipedia.
http://www.nme.com/news/black-sabbath/49346
Black Sabbath, Dio singer Ronnie James Dio gives cancer update. NME.com.

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Hockey-puck-on-a-rod test checks for concussion after head trauma

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From NPR:

The hockey-puck-on-a-rod test was invented by a Michigan high school student.

It works like this: Tester suspends the device while injured athlete sits with forearm on table, fingers loosely circling the stick. Without warning, tester drops stick. Athlete grabs stick as fast as possible. Place where athlete grabs gives an instant readout of reaction time.

It all happens in milliseconds - too fast to measure with a stopwatch. Athletes with concussions had reaction times that were 15% slower.

References:
Comments:

Nicholas Genes - Neat idea. I like how it's free of stopwatches and all the variability they introduce. But it seems that athletes would need to have a baseline measurement pre-trauma to really compare (maybe they can do it when they're signing waivers at the start of the season...)

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