The Best Medical Blogs of 2005 on Medgadget.com

The nominations for the Best Medical Blogs of 2005 are currently underway on Medgadget.


Who Were the Winners Last Year?

You can check the results of the 2004 competition on EchoJournal. Too bad that CodeBlueBlog, one of the last year winners, has not posted since April 2005. May be the blog did not make it through the last code blue?...


No Cheating

In 2004, there were some voting irregularities, like voting multiple times from a single IP address and "cookie dropping", which hopefully will be avoided this year. By the way, "cookie dropping" is erasing the poll-organizer's cookie from the browser history and voting again (explained last year).


Suggestions for Fair Voting

Dr. Charles suggested last year that the organizers should count one vote per medblog author (via email), which perhaps would be more authentic.

Grunt Doc had another interesting idea: "I say we forget the online voting, all meet at a neutral site, and thumb-wrestle for the winner."

MSSP Nexus Blog proposes another approach:

"Since MedGadget started this, the onus is on them to create, manage, and of course fund the Academy of Blogging Arts and Sciences. Nominations shall be restricted to select members of the Academy. I'm not sure how they'll be selected, that would be Medgadget's problem to figure out. Once the field has been narrowed to no more than five nominees in each category, all members of the Academy of Blogging Arts and Sciences shall be permitted to vote for one Bloscar winner in each category.

The annual Award Ceremonies will, of course, be lavish. Each nominee will be required to submit an 8x10 glossy suitable for framing of themselves (or a face of their choice if they blog anonymously) to Medgadget for posting. "


Conclusion

Enjoy the nomination and voting for the Best Medical Blogs of 2005 and let the best blogs win. I am not sure that nominating your own blog is the best approach... :-)

Image sources: Echojournal, Medgadget , MSSP Nexus Blog(used with permission)

Clinical Case: Foot Drop in a Diabetic Patient

72 yo CM woke up this morning with weakness in his left leg. He noted difficulty in lifting up his left foot from the floor. He has no other complaints.

The patient has bought a computer recently and has been browsing the web, sitting with legs crossed for prolonged periods.

PMH:
DM 2, HTN

Medications:
Lisinopril, Cardizem, Insulin 70/30

Read more on ClinicalCases.org....

Image source: Wikipedia

Cleveland Clinic Offers a Second Opinion Online for $565

From Washington Post:

A patient with mitral valve prolapse was prepared to fly to Cleveland to get a second opinion regarding the need for surgery until she realized that the consult can be done online.

"My Consult" is a secure web-based second opinion service offered by the Cleveland Clinic. For $565, a staff physician provides a consultation and treatment recommendation within a week.

Dr. Harris, who is the chief information officer of the Cleveland Clinic, says that the hospital has been working on the second opinion program for three years.

Limitations of the Online Second Opinion

Not all states are covered, the Clinic second opinion (or E-pinion, as The Washington Post calls it) is not available in Georgia, Kentucky, Louisiana, Nevada, North Dakota, South Dakota, Oklahoma and Wyoming.

Few insurance companies pay for the web-based second opinions.

What happened in the end?

The Cleveland Clinic specialist recommended surgery. After some time and a few more tests, the patient and her doctors agreed that, indeed, that was the best option.

Bloggers Matter

Washington Post has a new feature called "Who's Blogging?" with links to bloggers who posted about the article. KidneyNotes, who reported the story first, is listed in this Technorati-powered section.



The Clinical Cases and Images - Blog was a close second:



This type of blogs exposure gives the Washington Post readers a chance to get a broader view of what other people think about a particular article.

It is also a smart marketing move by the newspaper because it may stimulate bloggers to link more often to Washington Post articles.

References:
Second E-pinion. The Washington Post.
Second opinion counts for a lot. USA Today, 3/12/2006.
Image source: eClevelandClinic, The Washington Post.

Related:
Talk To a Doctor Now: Online! ScienceRoll.com, 03/2008.

Updated: 03/21/2008

Perioperative Medicine Update: Flomax Associated with Intraoperative Floppy Iris Syndrome (IFIS) During Cataract Surgery

The original study was published in J Cataract Refract Surg, Apr 2005: Intraoperative floppy iris syndrome associated with tamsulosin. The study was also mentioned on the American Academy of Ophthalmology website - Beware Floppy Iris During Phaco.

FDA requested the drug manufacturer Boehringer Ingelheim to send a letter informing medical professionals about the association between Flomax and IFIS.

Pending further studies, the current advice is to ask patients before cataract surgery if they are taking Flomax, and discontinue the drug two weeks before surgery.

It seems like the new mnemonic is "F" x 3:

F lomax
F low improvement (urine)
F loppy iris (63% of patients)


References:
(link via mdredux.blogspot)
Perioperative Evaluation for Noncardiac Surgery
Image source: Wikipedia

Interesting Medical Links

A case of gastric bypass surgery that went wrong
Source: Struggling with Body Image During the Holidays - NPR 11/05

Doctors for Oil
Venezuelan President Chavez and Cuban President Fidel Castro have arranged Cuban doctors to be sent to Venezuela in return for cheap oil. Now Venezuelans come to Cuba for free eye surgery.
Source: Medical Care Draws Cuba, Venezuela Closer - NPR 11/05

ACP Journal Club: Blacks and whites have similar responses to different hypertension drugs
This report is from a sub-study of ALLHAT

Survey: Medical error rate highest in U.S. among six nations
One-third of U.S. patients experienced medical, medication or test errors. Other countries included in the survey were Australia, Canada, Germany, New Zealand and the UK.


Links via KevinMD:

Blood pressure is in 80s. Call a "pre-code"
A new approach to prevent the dreaded "code blue": call a pre-code when any of 6 predetermined parameters are abnormal.
Source: Hospitals try to break a deadly 'code' - Boston Globe

To die from a toothache
A tooth abscess lead to a brain abscess and the patient's death.
Source: First Coast Man Dies After Toothache - First Coast News

Dedicated Doctor Still Practicing at Age 92 - KATV
"I love medicine. I still have the desire and the passion to practice. I enjoy my patients", says the Arkansas physician.

How to be more efficient in your busy clinic?
The Medical Economics magazine editor offers some advice in You can get home in time for dinner. Nitty-gritty advice on how to make your day more efficient.

How to confirm a nasogastric tube (NGT) placement? By CXR or KUB?

Case scenario:

A 65-year-old Caucasian female (CF) has a new-onset dysphagia secondary to stroke. The speech therapist did a swallow evaluation and found out that the patient is at high risk for aspiration even with soft mechanical diet and honey-thick liquids. She recommended placing a fine-bore feeding tube, Isocal HN with a goal of 90 ml/hr and a repeat swallow evaluation in 3-4 days.

The patient understands and agrees. You have just placed a Corpak tube and tested its postion by pushing 30 cc of air through the tube.

How to confirm the nasogastric tube (NGT) placement? By CXR or KUB?

NGT placement is confirmed by CXR. It is important to see that the NGT is below the diaphragm. One JAMA report concluded that the traditional physical examination-based methods of assessing proper NGT placement are inadequate when applied to the small-bore tubes (for example, Corpak). Only a CXR can assure placement in the stomach.

Why not KUB? What are the complications of NGT placement?

Most of the important complications of NGT placement are related to penetrating the esophagus or passing the tube in the trachea and bronchi. Occasionally, an NGT can penetrate the brain. These misplacements will not be shown on the abdominal x-ray (KUB) and the consequences can be deadly:

In 2000, a 78 year old patient died after she was fed through an NGT which was wrongly placed. The prosecutor case was that the junior doctor had been asked by nurses to look at an x-ray that would have shown that the tube was protruding into a lung and had given the go ahead for feeding to start. When the patient was fed, the food passed into her lung, and she died from acute pneumonia (Source: BMJ 2003).

Examples of NGT misplacement:


NGT in right main bronchus. Report of KUB/Abdomen - portable: A Corpak feeding tube is in place with the tip extending into the right mainstem bronchus. The staff was aware and the feeding tube had been pulled. There is no bowel obstruction.

This X-ray clearly shows why NGT placement should be confirmed with CXR. KUB almost missed the NGT tip.


NGT is too high, in the esophagus and above the diaphragm, not in the stomach. This placement is associated with high risk for aspiration. The NGT must be advanced further down and the new placement should be confirmed with a CXR.

Some important things to remember:



- Measure the expected lenght to reach the stomach (the suggested method is shown here, image source: CPEM.org)
- Sit the patient upright, if possible
- Flex the neck a little. This is just the opposite of the neck extension which is essential for tracheal intubation. In NGT placement you want to avoid the tracheal intubation. This is the reason for flexing the neck.
- Never force the NGT, it should go down smoothly. Ask the patient to swallow.
- Read more about the procedure in the references listed below

If you are not sucessful in placing an NGT on the first attempt, do not despair. Ask somebody (a senior colleague) to help you. Even Dr. Genes, the founder of the online Grand Rounds, had trouble passing a NGT as an intern.

References

Nasogastric Intubation. NEJM Videos in Clinical Medicine.
Pneumothorax complicating small-bore feeding tube placement - JAMA 3/1991
Thoracic complications of nasogastric tube: review of safe practice - Interact CardioVasc Thorac Surg 2005
Nasogastric tube insertion - Department of Emergency Medicine, University of Ottawa
Junior doctor is cleared of manslaughter after feeding tube error - BMJ 2003
The accidental introduction of the nasogastric tube into the brain. Case report. Acta Chir Scand. 1978
Blueprints Clinical Procedures - Google Book Search
Handbook of Gastroenterologic Procedures - Google Book Search
Core Clinical Skills: How to Succeed in Osces in Medicine - Google Book Search
Practical Procedures (PDF, 500 kb) - FleshandBones.com
Insert a Nasogastric Tube - Naval Medical Center, Portsmouth
Assessing placement of feeding tubes. Am J Nurs. 2001 May (subscription required)
Procedure guidelines: Nasogastric intubation with tubes using an introducer
Insertion of NGT - ICU Procedure Manual - medicineau.net.au
Nasogastric Intubation - MedicineClinic.org
Practical procedures - WHO
Insertion and management of fine bore feeding tubes - Leeds Hospital
Doctors feed Pope by nasal tube - BBC News
Read more about dysphagia and diets - ahrq.gov, cedwvu.org, gicare.com
Image source: CPEM.org

Motivating Patients to Exercise

Dr. RW links to a Medical Economics article with tips on helping patients to start an exercise program.

You can even download free exercise videos for your iPod from the iPod Gym.

Another option is iWorkout iPod (Mac-only).

According to a study reviewed by Science Blog, daily brisk exercise reportedly decreases the risk of pemature death by 70%. The study found that “highly fit” men had half the risk of death compared to “low fit” men. For every 1-MET increase in exercise capacity, the risk for death from all causes was 13% lower.

Prticipation in sport is associated with a with a 20—40% reduction in all-cause mortality compared with non-participation. Exercise might also be considered as a fifth vital sign, according to the Lancet: http://goo.gl/gyxYf

References:
Your most powerful Rx - memag.com
Download free exercise videos for your iPod - LifeHacker.com
Download of the Day: iWorkout iPod. LifeHacker.com
Getting Closer to Medical Procedures on a Video iPod
Image source: iPod Gym

Updated: 01/23/2008

The Lessig Method of Presentation

Using 200 slides... One word per slide...

It does not sound right.

It doesn't but it can be visually compelling and believe me, it drives the message home.

The "Lessig Method" of presentation was invented by the Stanford law professor, Lawrence Lessig. His slides often contain just a single word, short quote, or a photo.

See Dick Hardt using the Lessig method to deliver a "barn-burner" of presentation. To me, it looks a little bit dumbed down, especially with the "one-word-per-slide " rule and when he says the exact word that is shown on the screen but it seems to work. Dick is a CEO and founder of the internet company Sxip but the content of the presentation does not really matter, just focus on the style.

Hardt speaks for 15 minutes and synchronizes his talk smoothly to what must be several hundred slides. Most slides are no more than a word or two, or a photo, and visible no more than a few seconds.

This is an example of the Lessig Method. If you are bored by the same old PowerPoint templates and animations, it is time to give the Lessig Method a try. You audience may just like what they see.

On the opposite spectrum, Guy Kawasaki talks about the 10/20/30 Rule of PowerPoint: “a PowerPoint presentation should have 10 slides, last no more than 20 minutes, and contain no font smaller than 30 points.” (link via LifeHack.org)

References:
The corporate hip-hop presentation style - Communication Nation.blogspot
The "Lessig Method" of presentation - PresentationZen.blogs.com
Open Thread: Your best tip on doing presentations - 43folders.com
PowerPoint Presentations: Tips To Avoid Last Minute Surprises. Digital Inspiration, 12/2007.

Further reading:
Keys to a Successful Presentation. Medscape, 01/2008.
PresentationZen: can academics use this approach? Dr Shock MD PhD, 01/2008.
How to create a great powerpoint without breaking the law. Medical Education Blog, 04/2008.

Updated: 04/07/2008

NurseTV Reality Show

NurseTV features is an Internet-based reality show about the work and life of nurses.

The show is called 13 WEEKS and presents the story of 6 nurses who travel on assignment in Southern California. They live in a $10 million mansion, go surfing and skydiving, and (amazingly) find time to work in hospitals in Orange County... :-)

Embedded Flickr Slideshows

This is a test post for another cool Flickr feature - a website-embedded slideshow.

The idea belongs to Paul Stamatiou who is a 19-year-old student at the Georgia Institute of Technology. He explains how to get a Flickr slideshow on your website here.

You need to get the Flickr ID with the appropriately named idgetr, then specify which photos you want to show within the blog post. Place a little bit of code within a blog post and the Flickr slideshow is ready to go.

Medical Use

For example, when you describe a case of pneumonia, you can embed the pneumonia images from Flickr.


Note: Images shown above are not tagged with "pneumonia" and represent a variety of clinical cases.

References:
HOW TO Quickie: Embedded Flickr Slideshows - PaulStamatiou.com
How to find the best photos on Flickr. Lifehacker.com

Updated 11/21/2007:

Paul Stamatiou developed a Flickr slideshow widget which can embedded in the blog sidebar and sold it later to a Swedish company for $ 3,000.

Flickr launched an uploader for batch of images from the desktop which is beginning to look more like Google Picasa.

Surviving Lobotomy - Recent History of Medicine

In 1946, the psychiatrist Walter Freeman performed the first transorbital or "ice-pick" lobotomy. He believed that by cutting the brain he can cure mental illnesses like schizophrenia. Dr. Freeman was a graduate of some of the most prestigious schools in the U.S., the Yale University and the University of Pennsylvania Medical School.

He performed lobotomies on thousands of patients, despite the fact that some of them died or were incapacitated for life. One such patient was Rose Marie Kennedy who was the third child Joseph and Rose Kennedy and a sister of the Massachusetts senator Ted Kennedy. She underwent a lobotomy when she was 23 and after that she was in a nearly vegetative state for the rest of her life. The procedure is described in chilling details by Dr. Freeman's partner, Dr. Watts:

"We went through the top of the head, I think she was awake. She had a mild tranquilizer. I made a surgical incision in the brain through the skull. It was near the front. It was on both sides. We just made a small incision, no more than an inch." The instrument Dr. Watts used looked like a butter knife. He swung it up and down to cut brain tissue. "We put an instrument inside," he said. As Dr. Watts cut, Dr. Freeman put questions to Rosemary. For example, he asked her to recite the Lord's Prayer or sing "God Bless America" or count backwards. ... "We made an estimate on how far to cut based on how she responded." ... When she began to become incoherent, they stopped (Kessler, 226, Wikipedia).

Dr. Freeman conducted a national campaign traveling around the country in his van called a "lobotomobile". His goal was to educate and train surgeons and psychiatrist in the 10-minute procedure he pioneered. He was featured regularly on the front pages of the national newspapers like the New York Times.

One of Dr. Freeman's patients is the 56-year-old bus driver Howard Dully who describes his story in 'My Lobotomy': Howard Dully's Journey featured on NPR (audio) and CNN (video).

This type of treatment looks barbaric today but at that time rather gruesome methods were used to treat psychiatric disorders. One example is the insulin shock therapy which involved injecting a patient with massive amounts of insulin, which caused convulsions and coma. It was discovered by Polish researcher Manfred Sakel in 1933 and was used until the 1950s.

The discovery of the first antipsychotic medication, thorazine, put an end to these forms of treatment.

References:
From Wikipedia
Walter Freeman
Manfred Sakel
Rose Marie Kennedy
Psychosurgery

The Lobotomist by Jack El-Hai
Lobotomy.info

Image source: Wikipedia 1, 2

Pandora Music Discovery is Now Free (ads-supported)

Pandora is a music discovery service and player which streams your favorite music and suggests similar songs and artists.

Pandora is based on the so called Music Genome Projects. The project started 5 years ago and includes 30 musicians who have analyzed 400 attributes of songs, like melody, rhythm and vocals. Users choose an artist or song to get started, and create a “channel” to stream music, then Pandora suggests similar songs. One user can have up to 100 channels.



Favorites
You can keep track of the music you are discovering on Pandora by using the "favorites" feature to add songs to your own personal page. Just click on the album art when you hear a song you like and select "Add to Your Favorites Page" from the menu.

Buy a song
You can buy a song by clicking on the links to Amazon or iTunes on the page.

References:
Pandora is now free - TechCrunch.com

"Women Don't Have Heart Attacks." So Wrong

"Women don't have heart attacks." It seems like this is what several different doctors thought when they treated a 37 year old woman with shortness of breath and an abnormal EKG.

The patient in question was the forensic psychologist Dr. Helen Smith. Her must-read story is published on her blog: More Than You Wanted to Know About My Heart Attack.

She indeed had a heart attack and developed complications like a ventricular aneurysm and VF/VT which required treatment with an ICD (implantable cardioverter defibrillator) and Tikosyn. The T-shirt sign "Death. Been There. Done That" is no joke.

Dr. Hele (a.k.a.InstaWife) is the spouse of the popular political blogger and a law professor InstaPundit. She has been blogging for only 2 months but her website already gets 1800 visitors daily.

It is important to spread the awareness that the number one cause of death in women is cardiovascular disease (not breast cancer). In fact, according to the American Heart Association, cardiovascular disease claims more women's lives than the next six causes of death combined.

It looks like Dr. Helen has made a good recovery. We wish her all the best of health for the future.

She also wrote about the downsides of the one-payer socialist-type health system in Canada.

Update 3/5/06:

Dr. Helen and her husband Glenn Reynolds (a.k.a. Instapundit) have a podcast on iTunes. The
latest issue is a Heart Health Podcast: cardiac experts answer listeners' questions.


References:
FAQ - Heart and Cardiovascular Disease - U.S. Department of Health
Focusing on heart disease in women - The Health Show #922 Podcast
A malpractice case from the Massachusetts Medical Law Report. KevinMD.com
Wikipedia: Instapundit, Libertarian
Violent Kids.com
Thanksgiving - Glenn Reynolds.com
Image source: DrHelen.blogspot (used with permission)

Related:
Dangers of unrecognized heart disease: Husband dies while giving wife CPR (both found dead, age 60, 59) http://goo.gl/LZ39U

Automatic photo recognition: Tell me if this chest x-ray shows pneumonia

Just ask your computer: does this CXR shows pneumonia? One day it may be possible.

Of course, we all know that no machine can replace the human intelligence but the computers help us overcome our human limitations every day.

A company called Riya claims that their algorithms recognize facial features and can be trained to sort photos. Just include your nephew's photo in the program and tag it, let's say, Matthew. The program will then find with surprising accuracy all photos showing Matthew on your hard disk or on the web.

The Riya has not officially launched their product yet but Google already bought them for $ 30 million (this is the rumor, at least). This could be better than Flickr. Click to see the Riya tour and the founder's blog. See a video demonstration of how Riya works.

Google will continue their quest to organize all the world's information, including your photos.

Update 3/25/06:
Google did not buy Riya.com and it does not look they have any plans to do so. Riya is officially launched today. Click to register.

Update 11/8/06:
Riya changes its business model. Read more in Riya, vaporware, and hard problems, Geeking with Greg.

References:
First Screen Shots of Riya - TechCrunch
Video: Searching for the right face. News.com
Image source: Riya

Hospitals Use Websites to Attract Patients

Managers consider internet as the front door to their hospital. According to Jim Blazar, the Cleveland Clinic's chief marketing officer, the majority of patients that come to CCF for subspecialty care have found them on the internet.

About 10 to 15% of the monthly visitors become patients and subsequently generate revenue.

Most people think that the top three search results on Google are the best. Since it is so important to be at the top on GYM (Google, Yahoo, MSN), most big hospitals maintain elaborate websites aiming at informing the web surfers who are (hopefully) future patients.

My suggestions is not to trust the search engines so much. Just to give you an example: my website is the number one hit for "CHF exacerbation" on Google and I am in no way the world's top authority on CHF.

Reference:
Hospitals use websites to attract out-of-town patients - USA Today
Healthcare Marketers Prescribe Online Presence - Medical Informatics Insider

Definition of "Hospitalist" Added to Merriam-Webster Dictionary

According to the new edition, "hospitalist is a physician who specializes in treating hospitalized patients of other physicians in order to minimize the number of hospital visits by other physicians."

Somehow this definition does not imply much respect for the hospitalist...

The Springfield-based dictionary publisher has a list of 17 million entries it monitors. It takes about 10 years for a new word to get into the dictionary from the first time it is noticed.

The term "hospitalist" was first coined by Dr. Wachter in 1996 in the NEJM article The Emerging Role of "Hospitalists" in the American Health Care System.

Use of Hospitalists is on the Rise (NPR) but many people still do not know what a hospitalist is. One of them is CNN's Larry King who interviewed the head of Section of Hospital Medicine at the Cleveland Clinic:

"Dr Michota, Cleveland Clinic Foundartion: Well, actually I'm a hospitalist.

King: A what?

Dr Michota: A hospitalist.

King: A hospitalist?

Dr Michota: A hospitalist, yes.

King: What is that?

Dr Michota: It's a medical doctor who focuses on the general medical care of a hospitalized patient.

King: Have you ever heard of a hospitalist? I've never heard of that."

References:
Merriam-Webster's Collegiate Dictionary defines 18 new terms - USA Today
Wachter RM, Goldman L. The emerging role of "hospitalists" in the American health care system. N Engl J Med. 1996;335:514-7
Merriam-Websters Dictionary Officially Recognizes Hospitalists - Presbyterian Healthcare
Another Study Questions the Value of Hospitalists
CNN Larry King Live, Interview with Melanie Bloom, widow of NBC News correspondent David Bloom, aired March 9, 2005
The SHM 2005-2006 Survey: The Authoritative Source on the State of the Hospitalist Movement. Medscape.com.

Further reading:
Retired doc's thoughts and Musings of a Distractible Mind comment on the implications of switching to hospitalist care for inpatients.
Hospitality. Surgeonsblog, 09/2007.
Practicing cost-effective medicine. One clinician's top 10 tips. Robert M. ACP Hospitalist, 2007.
"You're a What? A Hospitalist" The Happy Hospitalist, 11/2007.
Adventures in Bizarro Land: My Don Imus Interview. Wachter's World, 12/2007.
Image source: sxc.hu

Updated: 12/04/2007

The NEJM Audio Summary

The New England Journal of Medicine offers an audio summary of the journal's weekly content. You can listen to the 14-minute summary online or download the 6 mb file to an MP3 player.

Feed:

http://podcast.nejm.org/nejm_audio_summaries.xml



The NEJM Audio Summary is a good way to time-shift you CME to any time convenient to you and make it portable. Get that iPod Nano ready...

References:
Medical Podcasts - Direct Links to Subscribe on iTunes

Updated: 08/18/2007

Google Maps: Celebrities

This latest Google Maps mash-up shows where some of the world's most famous people live.



The map does not seem very accurate, at least according to some Digg.com users:

"Not sure it's accurate since it shows Yasmine Bleeth living in the middle of the East River!"

"Most of these are the addresses of their offices or agencies. That or both Clooney and Bale are shacking up in the William Moriss reception area."


"Wow, I had no idea the guys from Kiss AND Stone Temple Pilots all lived together! How Partridge Family of them!"

The whole mash-up is posted on i-am-bored.com, so if you are bored, be sure to check it out.

(link via Digg.com)

Blog This! - American Society of Nephrology Renal Week 2005

If you write (or read) Blogger.com blogs, you have seen the "Blog this!" shortcut in the navigation bar at the top.

A group of nephrologists are doing exactly that (blogging, that is) at the American Society of Nephrology Renal Week 2005 in Philadelphia.

This is a great way to stay in touch with what is going on at an event if you cannot go there. Blogging from business meetings is a common practice in the tech industry but quite new in the medical world.

(link via KidneyNotes)

Image source: Wikipedia

The Strip Search at McDonald's as an Example of Social Psychology Deviation

This terrifying story was reported on ABC News Primetime: a caller to a McDonald's restaurant pretended to be a police officer investigating a theft and demanded an 18 year old employee to be strip searched and do outrageous things in front of the McDonald's managers.

The criminal who made the phone call was discovered in part because the investigators ran a Google search and found that the event was not isolated. Now the caller and the people who participated in the strip search are on the way to get long prison sentences but the real question is how this terrible thing was allowed to happen in the first place.

The story was linked on the technology web site Digg.com which uses the "wisdom of crowds" to promote stories to its front page. As one of the Digg.com readers pointed out, the strip search story is an example of a deviation in social psychology confirmed by infamous experiments in the past:

- In the Milgram experiment, the experimenter (E) persuades the participant (S) to give what the participant believes are painful electric shocks to another participant (A), who is actually an actor. Many participants continued to give shocks despite pleas for mercy from the actor (source: Wikipedia)

- In the Stanford Prison Experiment, students ended up acting the role of guards all too realistically

These psychology experiments show that "common sense is not so common" (Voltaire) but there is something more. We all know that it is difficult to confront authority but if the directions given just do not make sense, somebody has to stand out and do the right thing. Knowing that we, as humans, are prone to blindly follow orders, hopefully will make us more vigilant in the future and help us to avoid repeats of the strip search story and similar abuses.

The New York Times recently featured an article about the Archives of the History of American Psychology. The museum is in the basement of a former department store in Akron, Ohio and contain more than 1,000 bizarre instruments including the uniforms and billy clubs used in the 1971 Stanford Prison Experiment. The Archives building is just 45 minutes from the Rock and Roll Hall of Fame and Museum in Cleveland and two blocks from the Inventors Hall of Fame in Akron downtown.

Update 10/06/2007:
Jury: McDonald's should pay 6 millions for strip-search hoax. USA Today.

References:
Restaurant Shift Turns Into Nightmare - ABC News Primetime.
A hoax most cruel - The Courier-Journal.
Milgram experiment - Wikipedia.
Stanford prison experiment - Wikipedia.
New Modeling Gig - Dr. Helen.
Bizarre and Infamous Join Scholarship in an Archive of Psychology - NY Times.
Image source: Wikipedia, created by Wapcaplet in Inkscape
Stanford Prison Experiment Videos on YouTube. Scientific American.
5 Psychological Experiments That Expose Humanity's Dark Side. Alexandra Gedrose


New Studies in the Medical Journals

One Key Question Makes a Difference in Patients with Chest Pain

18,000 patients with known or suspected CAD were asked the simple question "Do you have shortness of breath?". Those who answered "yes" were four times more likely to die of a cardiac cause during the next 3 years than patients who had just chest pain and no dyspnea. The study was published in NEJM.

Read more in Dyspnoea predicts high risk of death in patients with known or suspected CAD - BMJ 11/05


Inspired O2 Reduces Wound Infections

Extra oxygen during and after surgery reduced the risk of abdominal wound infections from 24% to 15%. The study was published in JAMA. Is looks like the local oxygen therapy device like EpiFLO may not be such a crazy idea after all...

Read more in High concentration of inspired oxygen can reduce postoperative wound infections - BMJ 11/05

Image sources: Wikipedia 1, 2

Obstructive Sleep Apnea (OSA) Doubles Stroke Risk

Sixteen percent of Americans have obstructive sleep apnea (OSA). A 7-year study included 1,000 patients with OSA and was conducted at the Yale University School of Medicine. The study showed that people with OSA were twice as likely to develop a stroke.

CPAP treatment decreased daytime fatigue, which is a common symptom of OSA, but did not change significantly the stroke risk. The question is what treatment we should use to decrease the risk.

According to the researchers, sleep apnea seems to be an independent risk factor for CAD, HTN and stroke.

Obesity is a known association of OSA and a part of what some Cleveland Clinic doctors call Diabesity - a common combination of DM2 and obesity. Diabesity® is a registered trademark of Shape Up America!©

Check out this clinical case presentation of a patient with OSA.

References:

Obstructive Sleep Apnea as a Risk Factor for Stroke and Death - NEJM 11/05
Continuous Positive Airway Pressure for Central Sleep Apnea and Heart Failure - NEJM 11/05
Sleep -— A New Cardiovascular Frontier - NEJM Editorial 11/05
Mavs Fan at the Finals - Photos - SI.com http://goo.gl/tIdL3
Sleepiness and sleep-disordered breathing may be found in 19-29% of children with positive allergy test (http://goo.gl/AfCWZ).
Image source: FDA.gov

BCG vaccine may prevent TB infection, not just active disease

BMJ 11/2005:

Researchers studied 979 Turkish children who were living with an adult with active pulmonary tuberculosis. Children with a BCG scar were 24% less likely to test positive for infection than children without a BCG scar. Vaccinated children were also less likely to have active tuberculosis (relative risk reduction 92%).

The difference was detected by a new test, which measures the T cell response to M. tuberculosis antigens and is unaffected by previous vaccination. The traditional PPD, which has been used for the past 100 years, cannot distinguish between past vaccination and recent infection.

The study was published in Lancet but due to the small sample size and the observational design, the results are still inconclusive.

BCG vaccination is highly cost-effective according to another Lancet article. The investigators found the cost of vaccination is $ 200 per year of healthy life gained

References:
Effect of BCG vaccination on childhood tuberculous meningitis and miliary tuberculosis worldwide: a meta-analysis and assessment of cost-effectiveness.
The Lancet 2006; 367:1173-1180
Neonatal BCG vaccination induces IL-10 production by CD4(+) CD25(+) T cells. http://goo.gl/grZJ
Protective effect of BCG vaccination: time to reconsider the vaccination threshold? Thorax http://goo.gl/nztVL
BCG vaccination: 90 years on and still so much to learn - Thorax http://goo.gl/2tyRj
Comparing the Tuberculin Skin Test and T-SPOT.TB Blood Test in Children: blood test was better http://goo.gl/AlM8O
Image source: CDC

Getting Closer to Medical Procedures on a Video iPod

The technology is there, we just have to find the time to do it.

We already have the slide shows of two common procedures - central line placement and thoracentesis. We have to make a movie showing the procedures step-by-step with audio directions. Then just transfer the movie to a video iPod.

A research project:

Give video iPods to 20 medical residents and compare the effect of the procedure training to another group of 20 residents without iPods. Let's see if the residents who use the teaching video files achieve proficiency in performing a particular procedure faster and with fewer complications.

Russell Beattie has a similar idea - make Portable How-To Videos.

Yahoo search blog describes how you can transfer videos that you find on Yahoo to a video iPod.

You can try Photocasting with Flickr or BubbleShare, Digital Inspiration.

References:
Video Search To Go! - ysearchblog.com
Quick Idea: Portable How-To Videos - Russell Beattie
Podcasting Becomes Mainstream Overnight. Medical Procedure Guides on the iPod
Between the Earbuds: Neuroanatomy for the iPod, iPods In The Hospital - MedGadget
Hack Attack: Get the most out of an old iPod. Lifehacker.com
Image source: sxc.hu

Interesting Links

Reading Blogs at Work

New research shows than many blog readers check out their favorite blogs at work: "Forget lunch breaks -- blog readers essentially take a daily 40 minute blog break."
Source: Yahoo News


How to contribute to Wikipedia

"Wikipedia'’s advice to editors is to be bold but not reckless. It is a pretty good life advice, as well", notes Gina Trapani.
Source: Geek to Live: How to contribute to Wikipedia - LifeHacker.com


Attack of the Blogs - Forbes.com

Another anti-blogging article... By the way, the editor of Medscape's MedGenMed Journal who was against medical blogging on Medscape is podcasting on iTunes now. Hear the other side of the story in Bullish on Blogs.
Source: Forbes Cover Story Blows It, Calling Bloggers Lynch Mobs - Micro Persuasion.com


A Single RSS subscription button with drop-down options

This all-in-one button is an elegant solution for those bloggers who offer multiple subscription options to their RSS/Atom feed, like Yahoo, Bloglines, MSN, etc. Of course, the plain old XML is still an option.

A Morbidly Obese Man is Diagnosed with PE. Can I use Lovenox? EBM Q&A

Question:

A 25 yo morbidly obese man is admitted with PE. His weight is 516 lbs. He is on heparin IV but he hates the IV infusion. You are planning to switch him to Lovenox and start Coumadin. Is this OK?


Answer:

No. Lovenox (enoxaparin) was not studied in patients with weight more than 150 kg or less than 45 kg. This is the reason why the maximal recommended dose of enoxaparin is 150 mg sc q 12 hr. Patients who weigh more than 150 kg should be treated with IV heparin until fully anticoagulated with warfarin.

References:
Enoxaparin Clinical Pearl - CCF MedEd
Anticoagulation in special patient populations: Are special dosing considerations required? - CCJM
Arixtra is the New Contender for the LMWH Throne
Image source: sxc.hu

Pulse Oximeter the Size of a Matchbox

Question:

A COPD patient on chronic O2 therapy at 3 L/min comes to your office and asks if he can use a portable pulse oximeter. He wants to take the device with him when he goes outside. Are there any available?


Answer:

Yes, there are ultra-portable pulse oximeters. One patient showed up at the office recently with a pulse oximeter the size of a match box. The oximeter is fully portable and is powered by a AAA battery which needs replacement every 4-5 months. Similar devices are used to alert climbers at high altitude to the potential onset of acute mountain sickness. Not all of them are certified for medical use though.

Nonin Medical, Inc. makes a portable pulse oximeter called Onyx. The price is about $ 300. See a flash movie.

Disclaimer: I am not connected to Nonin Medical, Inc. in any way and I do not recommend the device. It is just an example of a portable pulse oximeter.

Image source: Nonin.com

Microsoft is Joining Web 2.0 with Windows Live

Live.com is the Microsoft attempt to keep up with Web 2.0. Even if you don't like the software produced at Redmond, you have to admit that Live.com portal is pretty slick. It is a spiced-up version of Start.com, which was around for a while, functioning as a RSS reader.

Live.com works only with Internet Explorer for now. The new portal will be the default start page in IE 7. "If this will be the default home page for millions of users, it is definitely a trend worth watching", writes Greg Linden of Findory.com.

Subscribing to RSS is very easy. By the way, KidneyNotes is the first result for "NEJM feed", before the official NEJM URL.

Supposedly, "you can add podcasts directly to your home page by subscribing to the feed and the latest entry will appear with Windows Media Player loading the content right away" (via niallkennedy.com).

Microsoft Office Live is coming soon too, in early 2006. It sounds interesting: "Office Live will provide your company with its own domain name, Web site, and e-mail accounts for free". It looks like Blogger.com plus GMail.



"Did you notice how fit Bill Gates is looking these days? Fighting Trim, is the word that comes to mind", writes Om Malik.

Office Live will not offer word processing or spreadsheets. Microsoft says that "22 applications that automate accounting and project management" will be included but who cares of there is no Word and Excel? Writely.com, the online word processor will still have its users. For now... Russell Beattie predicted Monopoly 4.0 instead of Web 2.0 after this new Microsoft initiative was announced.

References:
Gates Intros Live Software Services - PC World
Microsoft's introduction of its Live platform in San Francisco on November 1, 2005 - niallkennedy on Flickr
Screenshots of Windows Live - Torres Talking
The Best Web 2.0 Software of 2005 - Dion Hinchcliffe's Web 2.0 Blog
Image sources: Microsoft.com, niallkennedy.com

Chest X-rays with Annotations on Flickr

It is nice to see that other physicians have started posting interesting chest X-rays and CT scans on Flickr (at one point I was the sole owner of the tags "CXR" and "CT" there).

Just a reminder: the compliance with the HIPAA rules is a must.

Flickr notes make the experience even more interactive. If you are logged in as a Flickr user, you can put notes on images posted by other people.

The folks at PulmonaryRoundtable should be interested - the discussion about the CXR can be posted on the CXR itself!




Physicians using Flickr to post clinical images:

- Medicine & Surgery by Jon Mikel

- The Teaching Files: X-rays by Mjagbayani

- Chieh-Li Wang / copper0722


Image source: mjagbayani

Steve Rubel is Blogging About His Skin Cancer

Steve is the author of the popular IT blog Micro Persuasion. This morning he learned that he has been diagnosed with basal cell carcinoma:

"One of my favorite pastimes was sitting in front of a Starbucks, reading books or listening to podcasts and soaking up the sun. I neglected to wear sunscreen or a hat, even though I am follicly challenged. Now I am paying the price.

I have a blog with 5,000+ daily readers as well as a significant media profile. I am in a position to help in ways others can't. If one person starts wearing sunscreen regularly because of what they read here then I have done my job."

Steve is launching a new blog called The Skin Cancer Blog where he will track his progress and provide links to information and stories from others.

Some doctors are encouraging their patients to blog because they will feel better. Read more in Blogging for health - MSNBC.

Update:
On 11/16/05, Steve had the Moh's surgery to remove a very small basal cell carcinoma on his upper lip and is now cancer free.

References:
Why I am Blogging About My Skin Cancer. Micro Persuasion
Everything You Ever Wanted to Know About Sunscreen - WCVB-TV in Boston
Basal-Cell Carcinoma - NEJM
I've Been Rocketboomed. Micro Persuasion.

What do NEJM RSS feed and medical tag cloud have in common? KidneyNotes. The host of Grand Rounds

KidneyNotes hosts this week's Grand Rounds.

Among many other things, the nephrologist from NYC is the creator of the NEJM RSS and podcast feed (when they did not have one) and the medical tag cloud.

Enjoy the weekly best of the medical blogosphere.

Image source: TaglCloud.com
Blog Widget by LinkWithin