AskaPatient.com – Medication Ratings and Health Care Opinions

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This website "reports patient ratings and rankings of pharmaceuticals and prescription drug side effects. Database includes FDA-approved pharmaceuticals."

http://www.askapatient.com

You can Search by Drug Name:

http://www.askapatient.com/rateyourmedicine.htm

You can add ratings for the medications you take or look at ratings and comments from other patients.

For example:

cetirizine
http://www.askapatient.com/viewrating.asp?drug=19835&name=ZYRTEC

simvastatin (scores rather low)
http://www.askapatient.com/viewrating.asp?drug=19766&name=ZOCOR

Please note that I am not sure how useful the site is, and obviously, this post is not an endorsement or recommendation.
Image source: AskaPatient.com.

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Standardized patient: Over the course of three days, I had 23 head-to-toe physicals from 23 medical students

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From Slate:

"I was the first person these would-be doctors had ever fully examined on their own. Some were shaking so violently when they approached me with their otoscopes—the pointed device for looking in the ear—that I feared an imminent lobotomy.

A "standardized patient" is a trained person who is paid $15 an hour to be poked and prodded by inexperienced fingers, so that med students can learn communication and examination skills before they are sicced on actual sick people.

Now there are standardized patients trained for genital duty (they're called GUTAs, for genitourinary teaching associates).

Dr. N wasted the first eight minutes of the exam trying repeatedly to get a blood pressure reading. The panic in his eyes seemed to say, "She appears to be alive, yet she has no vital signs."

Comments:
Lakshman Swamy - Don't forget that some of them were capable! I have to say, in my experience as an MS2 at Wright State, our standardized patients are amazing teachers. It is much easier to learn physical exam skills and even interviewing when the patient can give you precise feedback. The author is right on with the characters that patients can portray... it is shocking when they break character to give feedback! Just recently I learned how to do the male exam with two standardized patients ("GUTA" -- never heard of that term before). I was definitely feeling a little ... awkward before the session began-- this was by far the most invasive thing I had ever done to another person. But the standardized patients were amazing about the whole process, even acting out the different hesitations that we might encounter in patients, emphasizing the importance of the exam, etc. Without being too graphic, I can't emphasize how much I learned about how to do those exams and what I was actually supposed to be finding. It was a totally different experience than I expected, and after it, I feel really confident about the whole process.

I can't even IMAGINE what it would be like to do that with my classmates-- and how much less I would have understood. Wow.

References:
Oh, no! I'm the first patient these 23 medical students have ever examined. Slate, 2010.
Image source: OpenClipArt.org, public domain.

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Better Sleep, Better Learning? Obstructive sleep apnea can reduce a child’s IQ by 10 points

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From Science Life Blog at the University of Chicago:

Pediatric obstructive sleep apnea, or OSA, can have long-term, detrimental effects on a child’s cardiovascular and respiratory health. But it can also create neurocognitive effects, such as a reduced ability to learn and retain information.

OSA can reduce a child’s IQ by as many as 10 points, while treatment in children with OSA can improve grades.

References:

Better Sleep, Better Learning? « Science Life Blog « University of Chicago.
http://sciencelife.uchospitals.edu/2010/02/15/better-sleep-better-learning

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Mobile Medicine via iPod/iPhone/iPad Apps

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NatureVideoChannel — March 31, 2010 — "You might not realize it, but with an iPhone, you also have a stethoscope and a CPR trainer within reach. These are just a few of the more than 2,000 medical applications available on the iPhone, and here we've rounded up ten for you to check out. Whether you're a researcher, doctor, or patient, get ready for your medicine to go mobile."

Smartphones and portable devices for medical education
I use an iPhone Touch to listen to lectures and watch presentations (PDF and video). Amazon Kindle works for the same purpose (PDF only, no video).
However, the external speaker of the iPhone Touch leaves much to be desired in terms of sound quality and volume, and recently, I started downloading the lectures directly to my cell phone (HTC Touch Pro2). The HTC Touch Pro interface is not as polished as the one on the iPod Touch but the device itself is not tied to iTunes and I can easily download audio files from the mobile sites of Google Reader, Bloglines and Google Docs.
Related:

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Vitamin D deficiency occurs frequently in COPD and correlates with severity

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Serum 25-hydroxyvitamin D (25-OHD) levels were measured in 414 (ex)-smokers older than 50 years and the link between vitamin D status and presence of COPD was assessed. The rs7041 and rs4588 variants in the vitamin D-binding gene (GC) were genotyped and their effects on 25-OHD levels were tested.

In patients with COPD, 25-OHD levels correlated significantly with forced expiratory volume in 1 s (FEV1).

Compared with 31% of the smokers with normal lung function, as many as 60% and 77% of patients with GOLD (Global Initiative for Obstructive Lung Disease) stage 3 and 4 exhibited deficient 25-OHD levels lower than 20 ng/ml.

25-OHD levels were reduced by 25% in homozygous carriers of the rs7041 at-risk allele.

76% and 100% of patients with GOLD stage 3 and 4 homozygous for the rs7041 allele exhibited 25-OHD levels lower than 20 ng/ml.

Vitamin D deficiency occurs frequently in COPD and correlates with severity of COPD. The data warrant vitamin D supplementation in patients with severe COPD, especially in those carrying at-risk rs7041 variants.

References:
Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene. Thorax 2010;65:215-220 doi:10.1136/thx.2009.120659.
Image source: Lungs, Wikipedia, public domain.

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The College of American Pathologists unveils a new patient website MyBiopsy.org

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The site is easy to navigate, well-organized and it looks helpful. Check the navigation menu in the left sidebar.

MyBiopsy.org redirects to:
http://www.cap.org/apps/docs/reference/myBiopsy/index2.html

RSS feed is also available: http://feeds2.feedburner.com/MybiopsyFeeds

This is the "fan page" on Facebook: http://www.facebook.com/MyBiopsy.org

(link via @Berci)

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Taking charge of your toddler’s vaccination record is the best way to ensure they don’t miss any shots

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From Reuters:

"In our country, we think the doctor should have all the medical records," said Dr. James McElligott, a pediatrician at the Medical University of South Carolina who worked on the study. "I like the idea of putting the ownership back in Mom's hands and empowering her a little bit."

When parents kept a so-called shot card, their child's odds of being up-to-date on vaccinations rose by more than half.

40 percent of the toddlers had a shot card, and 84 percent of these had up-to-date vaccinations. By contrast, only 79 percent of the children without a card had all their shots.

Use the card: it doesn't have a downside and it's cheap."

References:

Want kids' vaccinations up to date? Keep the record | Reuters, 2010.
http://www.reuters.com/article/idUSTRE61E37I20100215

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How to use Google Docs Drawings for medical mind maps

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Google Drawings is a new collaborative drawing editor - part of the updated Google Docs. It is free to use, just like the rest of Google Docs. The new standalone drawings editor lets you collaborate in real time on flow charts, designs, diagrams and other fun or business graphics. You can copy these drawings into documents, spreadsheets and presentations using the web clipboard, or share and publish drawings just like other Google Docs.

Until now, my service of choice for medical mind maps was Bubbl.us and I have made more than 100 diagrams with it for AllergyCases.org:

Mind Map Diagrams in Allergy and Immunology

Bubbl.us works very well but I was concerned about embedding the mind maps in case the service goes down temporarily or if the company closes down in the future (mind maps can be exported in XML format for backup). None of these should be a problem with Google Docs. Drawings is obviously behind Bubbl.us in terms of features but it works for basic mind maps and I am planning to use it frequently in the future.

You can embed the minds maps as images, just like you do with YouTube videos, or provide a link to the original mind map and share it for collaboration:

Example: Accidental Injection of Epinephrine Into Finger

Every time you update the mind map in Google Docs/Drawings, the image updates too.

See a few mind maps created with Drawings below:

In order to publish the mind map diagram on the web, you have to click the "Share" button in the top right corner of the Google Docs menu. After the diagram is published, you will see the options to embed the image with different sizes and the link to share the original drawing with options to be edited by collaborators.

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Australian grandmother beats off attacking shark – BBC

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From BBC:

"An Australian grandmother has survived a shark attack by repeatedly punching and kicking the animal after it "ripped off" part of her body.

Surgeon Mark Flanagan said: "We can estimate that she lost about 40 per cent of her blood volume from the degree of shock that she had when she came in, and the fact that we required to give her several units of blood."

Mrs Trumbull said she was happy to be alive."

Shark Tunnel and Aquarium at Omaha Zoo, Nebraska.

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Start metformin early when diabetes type II is first diagnosed

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Initiating metformin soon after diabetes diagnosis and while A1C is low might preserve ?-cell function, prolong the effectiveness of metformin, reduce lifetime glycemic burden, and prevent diabetes complications.

These findings support the current treatment algorithm for hyperglycemia management that recommends metformin initiation when diabetes is first diagnosed.

Video: How the Body Works - The Pancreas.

References:

Secondary Failure of Metformin Monotherapy in Clinical Practice. Diabetes Care March 2010 vol. 33 no. 3 501-506.

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Increasing Diet Polyunsaturated Fat in Place of Saturated Fat Reduces Risk of Coronary Heart Disease

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Reduced saturated fat (SFA) consumption is recommended to decrease coronary heart disease (CHD), but there is an absence of strong supporting evidence from randomized controlled trials (RCTs) of clinical CHD events and few guidelines focus on any specific replacement nutrient. Additionally, some public health groups recommend lowering or limiting polyunsaturated fat (PUFA) consumption, a major potential replacement for SFA.

The overall pooled risk reduction was 19% (RR = 0.81), corresponding to 10% reduced CHD risk (RR = 0.90) for each 5% energy of increased PUFA.

These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.

References:
Image source: Varieties of meat, Wikipedia, public domain.

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Preventing diabetes, biological passport for athletes and more from the Lancet

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Low-dose combination therapy with rosiglitazone and metformin was highly effective in prevention of type 2 diabetes in patients with impaired glucose tolerance, with little effect on the clinically relevant adverse events of these two drugs.

Preventing type 2 diabetes with low-dose combinations: Lifestyle interventions aimed at reducing bodyweight, and use of metformin, thiazolidinediones, acarbose, and orlistat, reduce the risk of diabetes by 25—60% over 3—6 years

The biological passport and doping in athletics: A biological passport monitors an athlete's blood and body chemistry values over time to assess whether there has been a deviation from an established baseline, thus indirectly detecting illegal manipulation.

A long look at obesity: Even with their primitive understanding of nutrition, our neolithic forebears somehow made the “right choices”, thriving on a wholesome diet of nuts, seeds, and fruits with the occasional piece of meat. And what is more, their rare intake of animal protein could only have been obtained through vigorous exercise, which they would, of course, indulge in every day.

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Contact lenses change color when blood glucose increases in diabetics

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In the future, diabetics may be able to wear contact lenses that continuously alert them to variations in their glucose levels by changing colors - potentially replacing the need to routinely draw blood throughout the day.

The non-invasive technology, developed by Chemical and Biochemical Engineering professor Jin Zhang at The University of Western Ontario, uses extremely small nanoparticles embedded into the hydrogel lenses. These engineered nanoparticles react with glucose molecules found in tears, causing a chemical reaction that changes their color.

References:
Nanocomposites could change diabetes treatment. The University of Western Ontario, 2010.

Image source: OpenClipArt.org.

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Mipomersen – antisense technology to lower LDL cholesterol

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Homozygous familial hypercholesterolaemia is a rare genetic disorder in which both LDL-receptor alleles are defective, resulting in very high concentrations of LDL cholesterol in plasma and premature coronary artery disease. This study investigated the use of an antisense inhibitor of apolipoprotein B synthesis, mipomersen, to lower LDL cholesterol.

Patients aged 12 years and older who were already receiving the maximum tolerated dose of a lipid-lowering drug, were randomly assigned to mipomersen 200 mg subcutaneously every week or placebo for 26 weeks.

34 patients were assigned to mipomersen and 17 to placebo. Mean concentrations of LDL cholesterol at baseline were 11·4 mmol/L in the mipomersen group and 10·4 mmol/L in the placebo group. The mean percentage change in LDL cholesterol concentration was significantly greater with mipomersen (?24·7%) than with placebo (?3·3%).

The most common adverse events were injection-site reactions in 76% of patients in mipomersen group vs 24% in placebo group. 12% of patients in the mipomersen group had increases in alanine aminotransferase of three times or more the upper limit of normal.

Inhibition of apolipoprotein B synthesis by mipomersen represents a novel, effective therapy to reduce LDL cholesterol concentrations in patients with homozygous familial hypercholesterolaemia who are already receiving lipid-lowering drugs, including high-dose statins.

References:
Mipomersen, an apolipoprotein B synthesis inhibitor, for lowering of LDL cholesterol concentrations in patients with homozygous familial hypercholesterolaemia: a randomised, double-blind, placebo-controlled trial. The Lancet, Volume 375, Issue 9719, Pages 998 - 1006, 20 March 2010.

Lipoprotein structure (chylomicron) (left). Image source: Wikipedia, GNU Free Documentation License.

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Acupuncture can spread serious diseases: bacterial infections, hepatitis B and C, even HIV

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To prevent infections transmitted by acupuncture, infection control measures should be implemented, such as use of disposable needles, skin disinfection procedures and aseptic techniques.

Acupuncture may be risky as needles are inserted up to several centimeters beneath the skin. In the 1970s and 1980s most infections associated with acupuncture were sporadic cases involving pyogenic bacteria.

There is a new syndrome - acupuncture mycobacteriosis - infection caused by mycobacteria that rapidly grow around the acupuncture insertion point as a result of contaminated cotton wool swabs, towels and hot-pack covers. There is a long incubation period and the infection usually leads to large abscesses and ulcers.

References:

Image source: Needles being inserted into a patient's skin, Wikipedia, public domain.

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"Europeans Work to Live and Americans Live to Work" But Who is Happier?

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Americans work 50% more than the Germans, the French and the Italians. Americans may work more than Europeans because of domestic tax rates - there are lower tax rates in the US than in Europe, and hence working more pays off more in the US. In other words, working longer hours pays off more in the US than in Europe.

This study compares the working hours and life satisfaction of Americans and Europeans using the World Values Survey, Eurobarometer and General Social Survey.

The purpose is to explore the relationship between working hours and happiness in Europe and America. Is it possible that working more makes Americans happier than Europeans?

The findings suggest that Americans may be happier working more because they believe more than Europeans do that hard work is associated with success.

References:
Europeans Work to Live and Americans Live to Work (Who is Happy to Work More: Americans or Europeans?). Adam Okulicz-Kozaryn. Journal of Happiness Studies, 2010.

Image source: Wikipedia, GNU Free Documentation License.

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29 Debates About the "Right Way" to Blog

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ProBlogger collected 29 Debates Bloggers Have about Blogging. Some of my responses are listed below, see ProBlogger's site for the complete list. Please share your thoughts in the comments.

RSS Feeds - Full vs Partial Feeds
- My opinion: Full feed.

Comment Sections – Comments vs No Comments
- Comments always open.

Post Frequency – Post More vs Post Less
- Short posts daily.
How Many Blogs? – Focus upon One Single Blog vs Having Many Smaller Blogs.
- I have 3-4 blogs.

Domain Names – long vs short, hyphens vs non hypens, .com vs other extensions (like .net, .org), local vs global domain extensions
- Short names, free domain names by Blogger.com.

Hosting – hosted vs self hosted
- Hosted by Blogger.com.

Post Titles – descriptive vs keywords
- I use natural language post titles - descriptive.

Content – Link content vs Original content
- Mostly links and comments, I wish I had more time to write lomg-form original content.

Design – Professional Design vs Templates
- I modify the templates to create my "own" designs. It's quite enjoyable actually.

Ownership – Use Social Media vs Build Your own properties
- I think your blog should be your "home" on the web.

Post Length – Long in Depth Posts vs Short, Sharp Posts
- Again, I wish I had the time to write long posts but I don't.

Topic – Niche vs Broad Topics
- Niche topic blogs work better.

Blogger Name – Anonymous blogging vs Using Your Name
- Using your name is a much better approach for medical bloggers.

Subscribers – RSS is Best vs Email is Best
- I like RSS better.

SEO – Writing for Search Engines vs Writing for Humans
- I write for humans only.

Personal Blogging – Sticking to Topic vs Injecting Personality and Personal details
- I try to write objectively from a scientific perspective. Personal stories are probably better suited for a paper diary.

Comment Moderation – Highly Regulated and Moderated vs Anything Goes
- I moderate all comments and delete all self-promotional and possibly offensive material.

Social Media vs Search – focus upon social media rather than search engines as traffic sources
- If you write quality content, Google will find you.

LinkBait – Anything goes (e.g.. Personal Attacks) vs Strong Boundaries Around What is and Isn’t Acceptable
- I don't use link baits and I have never posted anything even close to a personal attack on my blogs.

Bloggers Participation in Comments – Respond to Every Single Comment vs Let Readers Talk to Each Other and Don’t Interact
- I don't feel compelled to respond to every single comment. Let readers interact.

This Google video shows that it takes about 2 minutes to start a blog on Blogger.com. Creating a web site has never been easier.

References:
29 Debates Bloggers Have about Blogging. ProBlogger, 2010.

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Johns Hopkins Medicine podcast now has a blog

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The weekly podcast by Johns Hopkins Medicine now has a blog hosted for free at Blogger.com by Google:

http://hopkinspodblog.blogspot.com

I have been a regular listener for years and have found the podcast to be both educational and enjoyable - not a common combination.

The weekly podcast looks at the top medical stories of the week for people who want to become informed participants in their own health care. The presenters are Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange M.D., professor of medicine at Johns Hopkins and vice chairman of medicine at the University of Texas Health Science Center at San Antonio.

Image source: Johns Hopkins

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