Are doctors ready for virtual visits? Telemedicine may not be accurate enough.

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Are Doctors Ready for Virtual Visits? Many fear telemedicine will jeopardize the doctor-patient bond. NYT http://bit.ly/7c2RA8

Telemedicine has a place for second opinion when initiated by a physician but primary assessment is more problematic. One successful example of telemedicine is Cleveland Clinic's second opinion service for physicians abroad. For reference, please see our blog post from a few years ago: Cleveland Clinic Offers a Second Opinion Online for $565 http://bit.ly/4NQyer

The accuracy of teledermatology was inferior to real-life clinic dermatology for melanoma diagnosis http://bit.ly/8A4oiu.

Embedded video from CNN Video

CNN Video: Doctor will see you now -- on Webcam. Telemedicine takes a new turn. Now you can see the doctor while you shop, as CNN's Elizabeth Cohen reports.

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Eradication of nasal colonization with S. aureus associated with a decrease in postoperative surgical-site infections

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Nasal carriers of Staphylococcus aureus are at increased risk for health care–associated infections with this organism.
Eradication of colonization with S. aureus by screening at admission and subsequent decolonization (with intranasal mupirocin and chlorhexidine skin washes) were associated with a decrease in postoperative surgical-site infections.
In a randomized, double-blind, placebo-controlled trial, S. aureus nasal carriers were treated with mupirocin nasal ointment and chlorhexidine soap.
A total of 6771 patients were screened on admission, 1270 nasal swabs from 1251 patients were positive for S. aureus. All the S. aureus strains identified on PCR assay were susceptible to methicillin and mupirocin.
The rate of S. aureus infection was 3.4% in the mupirocin–chlorhexidine group, as compared with 7.7% in the placebo group (relative risk of infection, 0.42). The effect of mupirocin–chlorhexidine treatment was most pronounced for deep surgical-site infections (relative risk, 0.21).
References:

Preventing Surgical-Site Infections in Nasal Carriers of Staphylococcus aureus. NEJM, 1/2009.
GIANTmicrobes in Toys & Games section of Amazon.com http://goo.gl/gMrf

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Martina Navratilova Fighting Breast Cancer – ABC Video

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In February 2010, the tennis legend was diagnosed with an aggressive form of ductal carcinoma in situ (DCIS), considered the earliest form of breast cancer. Navratilova had a lumpectomy in February, during which her doctors determined that the cancer had not spread to her lymph nodes. She says there is only a "very small chance of it coming back."

Navratilova's cancer was diagnosed during a routine mammogram, after not having one for four years, and she hopes that speaking out will inspire other women to get mammograms.

"The reason I wanted to speak about this is to encourage these woman to have mammograms," she said. "I just want to encourage women to have that yearly check-up."

References:
Martina Navratilova Fighting Breast Cancer

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How does clinical evidence work?

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Ben Goldacre's Moment of Genius on BBC4 radio:

"Clinical trials in medicine are designed to be free from bias. They test, as objectively as possible, the effectiveness of a particular intervention.
When you bring the results of all these individual trials together, however, how do you weigh up what evidence is relevant and what is not? In 1993, a method of "systematic review" was introduced that enables us to get the clearest possible view of the evidence."

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How To: Getting Smart During Your Daily Commute

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"The average American spends a good 100 minutes per day commuting to and from work. That amounts to about 433 hours per year! Now imagine using that time to learn something new — to read a great book, to take a class from a top university, to learn a new language.

We highlight our free audio resources that will maximize your drive time. Before getting started, make sure you have a big mp3 player and a way to listen to your mp3 player over your car speakers."

References:
Getting Smart During Your Daily Commute | Open Culture

Related:

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Scaring physicians aways from using social media

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Is there a doctor who wants to spend 3 hours per day on social media while running the risk of being sued?

This useful critical review by a freelance journalist at the NEJMJobs site has a focus on some of the litigation risks inherent to the use of social media in healthcare:

http://www.nejmjobs.org/career-resources/social-media-and-physicians.aspx

"Dr. Pho, who spends up to three hours a day in social media activities, is surely in a minority of physicians who devote considerable time to blogging, Twittering, or engaging in Facebook updates.

Social Media Activity Risks Difficult to Predict

Despite the potential professional benefits of social networking participation, some physicians are approaching the social media realm with trepidation, for fear that personal and professional presences will overlap in a manner that increases liability exposure.

That’s a valid concern, because the medico-legal aspect of social media activities has been little explored and is not well understood. In addition, the obvious risks of incurring HIPAA violations should patients’ health information be unwittingly exposed are a deterrent. “The laws haven’t caught up with social media and networking, so to be safe I don’t blog about my patients,” Dr. Pho said. “Even though I think that interesting or challenging cases can be used as a learning tool, too much of my professional livelihood is at stake.”

None of the physicians interviewed for this article have accepted patients’ requests to become Facebook friends, and all cited concerns that doing so would “cross the boundary” between a personal and professional relationship.

"I think that very few doctors are interacting with patients directly on Facebook because we’re so terrified of being accused of practicing medicine and getting sued. Whatever you type is eternal and a perfect record of whatever you said,” she said. “That makes it all even more scary.”

“We’re concerned about this because there have been instances in which physicians have used Facebook in an inappropriate manner,” said David Troxel, MD, The Doctors Company’s medical director. “Social media networks are not HIPAA compliant and are just not appropriate for any physician-patient communication, so it’s a real liability threat because it’s so easy to lapse into a casual conversation.”

The NEJMJobs article linked in the paragraph above does not discuss the use of social media for medical education of students, residents and patients.

Another area that was not highlighted enough was the widespread use of Facebook "fan pages" by hospitals and physicians to attract patients and create relationships. Does this mean that the patients can be "your fans" but not "your friends"?

Overall, this article is a good review of some of the risks involved with the social media adoption in healthcare.

However, for a more nuanced approach to social media use by physicians, please review this detailed primer by the cardiologist Dr. Wes:

http://drwes.blogspot.com/2010/03/for-cardiologists-twitter-primer.html

Related:
Facebook Friend Request - A young doctor gets a message from a dying patient - NYTimes, 2010.

Image source: OpenClipArt.org, public domain.

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Serotonin Blocker May Build New Bone in Osteoporotic Mice by Decreasing GI Serotonin Levels

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From WebMD:

When investigators treated mice with an experimental drug that stopped the gut from synthesizing serotonin, they were able to reverse severe bone loss and essentially cure osteoporosis in the animals.

Serotonin May Hold Key to Halting Osteoporosis. NatureVideoChannel — February 05, 2010 — A drug that reverses osteoporosis in mice looks like a promising candidate for treating the human version of the disease. Gerard Karsenty and his colleagues at Columbia University Medical Center have shown that blocking the neurotransmitter serotonin--secreted from the gut--promotes bone growth. The research appears on-line at http://www.nature.com/naturemedicine - Yadav et al. Nature Medicine, 7 February 2010. DOI: 10.1038/nm.2098.

Most bone treatments work to block bone loss and make existing bone stronger. One drug, Forteo (teriparatide), does build new bone, but it requires daily injections and is limited to two years of use.

References:
Serotonin May Be a Key to Treat Osteoporosis. WebMD.

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The two current heavyweight world boxing champions both have PhDs, believe or not

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Believe or not, but the two current heavyweight world boxing champions both have PhDs... The two researchers are the Ukrainian heavyweight boxers and brothers Wladimir and Vitali Klitschko.

Wladimir Klitschko, called "Dr. Steel Hammer"(born 25 March 1976, Semipalatinsk, Kazakhstan), currently holds the IBF, WBO, IBO and Ring Magazine world heavyweight titles. His older brother, Vitali Klitschko, is the current WBC world heavyweight champion.
In the summer of 1996, Klitschko finished Pereyaslav-Khmelnitsky Pedagogical Institute (Ukraine) and was accepted in the postgraduate study program of Kiev University. On 18 January 2001 in a conference hall of Kiev University of physical science and sports, Klitschko presented his doctoral dissertation and was awarded a Ph.D. in Sports Science. Klitschko speaks four languages: Ukrainian, Russian, German and English.
Image source: Wikipedia, GNU Free Documentation License.
Vitali Klitschko, called "Dr. Ironfist", (born 19 July 1971 in Belovodsk, Kirghiz SSR, Soviet Union (now Kyrgyzstan) is a Ukrainian professional heavyweight boxer and the current WBC world heavyweight champion. He has the highest knockout percentage (94.9%) of any heavyweight boxing champion in overall fights.
Vitali is the first professional boxing world champion to hold a Ph.D. In 1996, he graduated from the Pereyaslav-Khmelnytsky Pedagogical Institute (Ukraine) and was accepted into the postgraduate study program at Kiev University. On 29 February 2000, he presented his doctoral thesis on "talent and sponsorship in sports" at the Kiev University of Physical Science and Sports, and his Ph.D. in Sports Science was conferred.
Image source: Wikipedia, GNU Free Documentation License.

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Non-surgical Baldness Treatments Rated Ineffective by Most Patients

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Only 27% of men who used Propecia (finasteride) said it was “very” effective. Finasteride is a 5-alpha reductase inhibitor used to treat prostate enlargement symptoms and baldness. Finasteride has 2 trade names: Propecia for baldness and Proscar for BPH.

Over-the-counter minoxidil (Rogaine) is applied directly to the scalp and is the only hair regrowth drug approved for use by women. Just 4% of respondents said it was very effective, with 43% of users saying it was not effective at all.

Only 2% of men surveyed underwent hair transplants; but of these, 49% were either very or completely satisfied with the results of their surgery, the poll shows.

Image source: Finasteride, Wikipedia, public domain.
Comments from Facebook:
"Ah...so you are supposed to rub it on the scalp.. I've been drinking it all these years, no wonder it has had no effect"

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2 in 3 people with known risk factors for COPD don’t know they have the disease

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One in five heavy smokers over age 40 have findings of COPD, but only one-third have been previously diagnosed with the common lung disease.

10% of people worldwide over the age of 40 are affected by COPD.

Researchers screened 1,003 people aged 40 and over who were current or former heavy smokers. Heavy smoking was defined as a smoking history of 20 pack-years or more.

The results showed that 20.7% of the people screened met the criteria for a diagnosis of COPD but only 32.7% had previously been diagnosed with the disease or were aware of their COPD diagnosis.

References:
Many Unaware They Have COPD. WebMD.
Image source: Lungs, Wikipedia, public domain.

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"With UpToDate, students and interns may be as capable of teaching the resident (or attending) as visa versa"

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From Wachter's World:

"In 1984, one resident even wrote a letter to the New England Journal of Medicine called “Ripping and Filing Journal Articles,” taking the Journal to task for its habit of beginning an article on the back of the last page of the previous one (which meant the page needed to be photocopied if you wanted to tear both articles out of your personal copy of the journal). Fair point, but talk about a resident who needed to get a life.

Today, as in so many other parts of our lives, the computer, with its magical access to the universe of on-line resources, has democratized the learning of clinical medicine. At UCSF, by the time morning rolls around, the students and interns have often already read the on-line UpToDate synopsis of the topic at hand, and may be as capable of teaching the resident (or attending) about it as visa versa."

Note: UpToDate is a peer reviewed medical information resource (paid, not free access) published by a medical company called UpToDate, Inc. It is available both via the Internet and offline. An update is published every four months. The material is written by over 3600 clinicians and has over 7300 topics. The website was launched in 1992 by Dr. Burton D. Rose along with Dr. Joseph Rush. A new online subscription for 1 year costs $495, $195 for trainees (source: Wikipedia).

References:
Substituting Coffee Cake for Journal Articles: Another Unforeseen Consequence of IT. Wachter's World.

Image source: UpToDate.

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Tai Chi and Cardiac Rehabilitation – Mayo Clinic Video

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For hundreds of years people have practiced the Chinese martial art of Tai Chi for its many health benefits. Researchers who study Tai Chi say it can help reduce blood pressure, decrease anxiety, improve flexibility and much more. For these reasons, some doctors at Mayo Clinic have embraced Tai Chi and are teaching it to their patients.

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Science 2.0: More publishing but less (legitimate) publishers?

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Science 2.0 will come: More publishing but less (legitimate) publishers? http://bit.ly/dmx37u and http://bit.ly/bJyxkw

Publish or post? Paradigm shift for scientists http://ff.im/-oYYKH
References:
Science 2.0 (change will happen….). Burgelman, Jean-Claude, Osimo, David, AND Bogdanowicz, Marc. UIC.edu, Volume 15 Number 7 (5 July 2010).

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Video Lecture: Anne Wojcicki from 23andMe Personal Genomics

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Direct link here.

23andMe is a personal genomics company based in Mountain View, California that is analyzes saliva samples for genetic information (the average cost for the service is decreasing and is currently $399-$499).

The company name is a play on the 23 pairs of chromosomes that carry every individual’s DNA. 23andMe was co-founded by Anne Wojcicki, wife of Google co-founder Sergey Brin.


"Genes load the gun. Lifestyle pulls the trigger" - Dr. Elliot Joslin.

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Updates in Pediatrics

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You can find this information on PubMed but this is a nice summary from UpToDate (only brief highlights are posted below, check the source link for full text):

Sexually transmitted infections

25% of urban adolescent females (14-17 years of age) were diagnosed with a sexually transmitted infection (STI) within one year of first intercourse.

Attention deficit hyperactivity disorder (ADHD)

ECG screening should not be required before initiating stimulant therapy for patients with ADHD.

Autism prevalence

The prevalence of autism spectrum disorders (ASD) among eight-year-old children in the United States increased from 1 in 150 children in 2000 to 2002 to approximately 1 in 111 in 2006. No clear reason for increase has been found.

The choking game

5.7% of eighth-graders had participated in the self-strangulation activity known as "the choking game". Recognize signs of these activities: bruising or red marks on the neck; wearing high-necked shirts, even in warm weather; bloodshot eyes or pinpoint bruising around the eyes; petechiae on the face, especially the eyelids or conjunctiva.

HPV vaccine

The US Food and Drug Administration (FDA) approved the use of quadrivalent human papillomavirus vaccine in males aged 9 through 26 years to reduce their likelihood of acquiring genital warts.

13-valent PCV

The FDA approved a 13-valentpneumococcal conjugate vaccine (PCV13). PCV13 adds serotypes 1, 3, 5, 6A, 7F, and 19A to those contained in the PCV7, the 7-valent vaccine (4, 6B, 9V, 14, 18C, 19F, and 23F). The six additional serotypes accounted for 63% of invasive pneumococcal disease among children younger than five years of age.

References:
What's new in pediatrics. UpToDate.

Image source: OpenClipArt.org, public domain.

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98% of People Cannot Drive Safely Using Cell Phones According to a Study

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Driving while talking on a cell phone is extremely hazardous for most people.

Only a tiny fraction of “supertaskers” can do both simultaneously without ill effect - 2.5% of people studied could successfully drive and use a cell phone at the same time.

It took most people 20% longer to hit the brakes and increased following distances 30%, meaning they failed to keep pace in the simulator with virtual traffic. Also, their memory performance dropped 11% and their ability to do the math fell 3%.

Video: Stop texting while driving (http://bit.ly/S6osm). Terrifying. All drivers should watch this. Warning: This video may not be suitable for minors.

References:
97.5% Can't Drive Safely Using Cell Phones. WebMD.
Video: Stop texting while driving. Terrifying. All drivers should watch this.
Texting while driving increases crash risk 23 times

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People behaved more selfishly and dishonestly when working in a dimly lit room or when wearing sunglasses

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Researchers found that people working in a dimly lit room were more likely to cheat about their own performance on a task in order to earn more money than people working in a well-lit room.

Darkness may create a sense of illusory anonymity that disinhibits self-interested and unethical behaviors. It appears to induce a false sense of concealment, leading people to feel that their identities are hidden.

References:
Dim Lighting and Sunglasses Encourage Unethical Behavior in Study. WebMD.
Image source: Ray Ban Original Wayfarer, Wikipedia, Creative Commons Attribution-Share Alike 3.0 Unported license.

Comments from Twitter and Facebook:

@scanman: RT @DrVes: when working in a dimly lit room http://goo.gl/fb/erLEf

@doctorwhitecoat: Clubbing/bars? RT @DrVes People behaved more selfishly/dishonestly when in a dimly lit room or when wearin sunglasses http://goo.gl/fb/erLEf

Mike Cadogan: "Recently started working in the office with the light on...feeling better and more energetic already, though not sure about the selfish/dishonest part..."

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Glycated hemoglobin as a diagnostic test for diabetes predicts mortality more accurately than fasting glucose

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Fasting glucose is the standard measure used to diagnose diabetes in the United States. Recently, glycated hemoglobin was also recommended for this purpose.

The glycated hemoglobin value at baseline was associated with newly diagnosed diabetes and cardiovascular outcomes.

For glycated hemoglobin, values of less than 5.0%, 5.0-5.5%, 5.5-6.0%, 6.0-6.5%, and 6.5% or greater, the hazard ratios for diagnosed diabetes were 0.52, 1.00, 1.86, 4.48, and 16.47, respectively.

For coronary heart disease, the hazard ratios were 0.96, 1.00, 1.23, 1.78, and 1.95, respectively. The hazard ratios for stroke were similar.

In contrast, glycated hemoglobin and death from any cause were found to have a J-shaped association curve.

The association between the fasting glucose levels and the risk of cardiovascular disease or death from any cause was not significant.

In this community-based population of nondiabetic adults, glycated hemoglobin was associated with a risk of diabetes and more strongly associated with risks of cardiovascular disease and death from any cause as compared with fasting glucose. These data add to the evidence supporting the use of glycated hemoglobin as a diagnostic test for diabetes.

References:

Image source: OpenClipArt.org, public domain.

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