Disease-Specific, Social Network-Initiated Study by Mayo Clinic and Dr. Tweet

Mayo Clinic is the clear leader in social media use by hospitals at this time. Mayo has published 1,500 YouTube videos, has a social media center with approximately 20 employees, and external advisory board with experts that span the globe. They have a social media "residency" program where (for a fee) they are ready to teach you how to blog, Twitter, Facebook and YouTube in 3.5 days. Unhappy with the Facebook use for healthcare, Mayo launched their own social network for patients. But why stop there? Mayo Clinic figured out that you can collect data from the clusters of patients with rare conditions that form spontaneously in social networks. This pilot study is a novel example of “patient-initiated research.” I think this is great and potentially very useful to patients and science. Let's hope more hospitals follow in the footsteps of these pioneers.

The two videos below illustrate the start of Disease-Specific, Social Networking Community-Initiated Study Focused on Spontaneous Coronary Artery Dissection (SCAD):



The chest pain experienced by the woman you're about to meet was much more than a difficult recovery. She had a heart attack when a rare and deadly condition stopped blood flow to her heart. The same thing happened to another woman. After sharing their stories on social networking sites they found more women with the same problem. That's when they contacted Mayo Clinic to convince cardiologists to use the information they gathered on the internet to research this condition.



Dr. Sharonne Hayes, Professor of Medicine in Cardiovascular Diseases at Mayo Clinic in Rochester, MN, discusses her article appearing in the September 2011 issue of Mayo Clinic Proceedings on using social media to research and treat spontaneous coronary artery dissection (SCAD).

After being approached by several members of an international disease-specific support group on a social networking site, the researchers used it to identify patients who had been diagnosed as having at least 1 episode of spontaneous coronary artery dissection and recruited them to participate in a clinical investigation of their condition. Medical records were collected and reviewed, the original diagnosis was independently confirmed by review of imaging studies, and health status (both interval and current) was assessed.

Recruitment of all 12 participants was complete within 1 week of institutional review board approval. All participants completed the study questionnaires and provided the required medical records and coronary angiograms and ancillary imaging data.

This study involving patients with spontaneous coronary artery dissection demonstrates the feasibility of and is a successful model for developing a “virtual” multicenter disease registry through disease-specific social media networks to better characterize an uncommon condition. This study is a prime example of patient-initiated research that could be used by other health care professionals and institutions.

A cute factoid? The lead author of this social network-initiated study is actually called Dr. Tweet (as in a message on Twitter).

References

Electronic Communication and Medical Research: Beyond the Record

Spontaneous Coronary Artery Dissection: A Disease-Specific, Social Networking Community–Initiated Study

Another related video:



Dr. Sharonne Hayes, director of the Mayo Clinic Women's Heart Clinic, Dr. Marysia Tweet and Lee Aase, director of the Mayo Clinic Center for Social Media, discuss findings of a pilot study of SCAD (spontaneous coronary artery dissection) published in September 2011 in Mayo Clinic Proceedings.

Adult stem cell infusion to treat MS - collaboration trial between Cleveland Clinic and Case

Cleveland Clinic, University Hospitals Seidman Cancer Center and Case Western Reserve University are collaborating on a clinical trial designed to treat the debilitating effects of multiple sclerosis by using a patient's own adult stem cells.

Mesenchymal stem cells, or MSCs, are found in the bone marrow. More than 150 clinical trials are currently testing MSCs' ability to encourage tissue repair as a way to treat a variety of conditions such as osteoarthritis, diabetes, emphysema and stroke.

In this trial, a patient's MSCs are harvested at Case's University Hospital, cultivated in a special laboratory and then injected intravenously back into the patient at the Cleveland Clinic.

See the two videos below that describe the project - the first is from the Cleveland Clinic and shows one of the patients, the second is from Case and focuses on the researchers:





Multiple Sclerosis Overview - Mayo Clinic YouTube http://bit.ly/181FCi4



References:

Clinical trials using adult stem cells to treat MS. Cleveland Plain Dealer.
Anti-CD20 monoclonal antibody ocrelizumab helps patients with relapsing-remitting multiple sclerosis (MS) (Lancet, 2011).

Related:

Survival Guide - Chigoe Flea - National Geographic Video

Survival Guide - Chigoe Flea - National Geographic Video.

Tunga penetrans is hyperendemic in East Asia, India, and South America, where it originated, and in Sub-Saharan Africa, where it was introduced from South America in the late 19th century.

Tungiasis is caused by the penetration of the gravid female chigoe flea into the epidermis to feed on blood and tissue juices, usually on the feet and under the toenails or in the interdigital web spaces.

Management strategies for tungiasis include extracting all embedded fleas immediately with sterile needles or curettes, administering tetanus prophylaxis, and treating secondary wound infections with appropriate antibiotics. For heavy infestations with multiple lesions, oral therapy for 3 days with either thiabendazole or a single oral dose of niridazole (30 mg/kg) has been recommended.

References:

The Epidemiology, Diagnosis, Management, and Prevention of Ectoparasitic Diseases in Travelers. James H. Diaz MD, Dr PH. Journal of Travel Medicine, Volume 13, Issue 2, pages 100–111, March 2006.

Related reading:

AMA Guide to Assessing and Counseling Older Drivers

Motor vehicle injuries are a leading cause of injury-related deaths in the older population (persons 65 years and older). Per mile driven, the fatality rate for drivers 85 years and older is 9 times higher than the rate for drivers 25 to 69 years old.

Physicians play an important role in the safe mobility of their older patients. The AMA encourages physicians to make driver safety a routine part of their geriatric medical services and the guide is freely available as PDF documents here:

AMA Physician's Guide to Assessing and Counseling Older Drivers

For example, dementia is just one of the risks that older drivers face:



Evaluation of driving risk in dementia (click to enlarge the image).

For patients with dementia, the following characteristics are useful for identifying
patients at increased risk for unsafe driving:

- Clinical Dementia Rating scale (Level A)
- caregiver’s rating of a patient’s driving ability as marginal or unsafe (Level B)
- history of crashes or traffic citations (Level C)
- reduced driving mileage or self-reported situational avoidance (Level C)
- Mini-Mental State Examination scores of 24 or less (Level C)
- aggressive or impulsive personality characteristics (Level C)

References:

AMA Physician's Guide to Assessing and Counseling Older Drivers

Evaluation of driving risk in dementia - practice parameter update

Q&A from CCJM: When should I discuss driving with my older patients? http://buff.ly/1xeoBTw

The diabetes pandemic: 1 in 4 U.S. adults now has diabetes

The number of adults with diabetes has doubled within the past 30 years.

70% of the increase is attributed to population growth and ageing. However, the number also reflects the unfortunate global shift towards a western lifestyle of unhealthy diet and physical inactivity, with obesity as the outcome.

Between 1980 and 2008, the global body-mass index (BMI) increased by 0·4—0·5 kg/m2 per decade.

In the USA, 10% of infants and toddlers already carry excess weight. More than 20% of children between the ages of 2 years and 5 years are overweight or obese.

By 2030, the number of individuals with diabetes worldwide is expected to rise to half a billion (470 million) - almost 80% of whom will be in low-income and middle-income countries. In these regions, diabetes drugs and insulin are often inaccessible or are too expensive.

References:
The diabetes pandemic. The Lancet, Volume 378, Issue 9786, Page 99, 9 July 2011.
Image source: Wikipedia, public domain.

Related from Amazon - pancreas plush toy:

Vitiligo: Robert's story

From NHS Choices YouTube channel:

Robert, 19, was diagnosed with vitiligo (loss of skin colour) when he was eight. He describes how the condition spread, how it first affected his confidence, and his treatment.

Persistent Sexual Side Effects Related to Finasteride (Popecia) Use for Male Hair Loss

Finasteride (Propecia) has been associated with reversible adverse sexual side effects in multiple trials for the treatment of male pattern hair loss (MPHL).

This study included 71 otherwise healthy men aged 21–46 years who reported new onset of sexual side effects associated with the temporal use of finasteride, and in which the symptoms persisted for 3 months despite the discontinuation of finasteride.

Patients reported the following new-onset persistent sexual dysfunction associated with the use of finasteride:

- 94% developed low libido
- 92% developed erectile dysfunction
- 92% developed decreased arousal
- 69% developed problems with orgasm

The mean duration of finasteride use was 28 months and the mean duration of persistent sexual side effects was 40 months from the time of finasteride cessation to the interview date.

Physicians treating MPHL should discuss the potential risk of persistent sexual side effects associated with finasteride


Minoxodil - Costco.

References:

Persistent Sexual Side Effects of Finasteride for Male Pattern Hair Loss. Michael S. Irwig MD, Swapna Kolukula. The Journal of Sexual Medicine, 2011.

"Netiquette" and married couples

From the study:

Men are more associated with activities that have been associated with internet addiction. Men usually take more risks in their online activity.

Women are more likely to have lower computer self-efficacy and less positive internet attitudes. Women are more aware of privacy and economic risks in online transactions.

6% of married internet users have met their partner online.

In 30% of the couples at least one person checked their partner’s emails or read their partner’s SMS messages without them knowing. In 20% of the couples at least one the partners had checked their spouse’s browser history.

References:
Netiquette within married couples
Online Snooping: Is Your Partner Secretly Watching You?

Helsper, E., & Whitty, M. (2010). Netiquette within married couples: Agreement about acceptable online behavior and surveillance between partners Computers in Human Behavior DOI: 10.1016/j.chb.2010.02.006

Management of Hirsutism (Excess Hair)

Hirsutism is a source of significant anxiety in women. While polycystic ovary syndrome (PCOS) or other endocrine conditions are responsible for excess androgen in many patients, other patients have normal menses and normal androgen levels (“idiopathic” hirsutism).

The finding of polycystic ovaries on ultrasound is not required for the diagnosis of polycystic ovary syndrome (PCOS). Gonadotropin-dependent ovarian hyperandrogenism is believed to cause PCOS. However, mild adrenocorticotropic-dependent adrenal hyperandrogenism also is a feature in many cases.

Even women with mild hirsutism can have elevated androgen levels, and thus, they may benefit from a laboratory evaluation.

Laser treatment does not result in complete, permanent hair reduction, but it is more effective than other methods such as shaving, waxing, and electrolysis. It produces hair reduction for up to 6 months. The effect is enhanced with multiple treatments. Interestingly, a portable laser hair removal device is currently available from Amazon (this post is not a recommendation or endorsement of the product).

References:

Update on the management of hirsutism. Cleveland Clinic Journal of Medicine June 2010 vol. 77 6 388-398.

Image source: Skin layers. Wikipedia, public domain.

A home hair removal laser device is available without prescription from Amazon.com (not a recommendation to buy any product, see the link below). A similar device is available from Costco.

"The Clinic" at Walmart - Operated by "Family Medicine Specialists"

Medical clinics debut at Walmart stores and the photos from one Chicago location are included in this blog post (click to enlarge the images to see the details such as pricing, etc.).

Walmart has been adding health clinics to its stores during the last 3 years as part of its drive for "one-stop shopping." There were 100 in-store clinics in 21 states in 2010.

The clinics are staffed by nurse practitioners. Does that fit the description of "Family Medicine Specialists"?

Services include $14 for a pregnancy test, $29 for a flu vaccine, and $49 for treatment of a sinus infection or physical examination. The most expensive services cost $75, for treatment of bladder infections and ear wax removal.



CVS Pharmacy is not too far behind with their own model for in-store clinics called the "Minute Clinic". In fact, Minute Clinic is the largest retail clinic chain in the country, with 600 clinics in CVS stores in 24 states. Almost half of Minute Clinic's clientele don't have a primary-care doctor of their own.

A patient's mother: "The beauty of it is we're maybe 30 feet from diagnosis to pharmacy. I'm very busy and this is one-stop shopping."

References:

Medical clinic debuts at city's Walmart store
Medical clinics in retail settings are booming - USA Today.
Number of patients receiving care at retail clinics (Target, Walmart, etc.) increases http://goo.gl/9B74c
"The Family Doctor, Minus the M.D." - NYTimes keeps pushing the idea of "The Nurse as Family Doctor" http://buff.ly/R1rbn9

Comments from Twitter:

@langdon: False advertising. That would actually be sanctioned here in Ontario as per recent guidance about specialty titles from our College.

@napernurse: Pharm son works for #Walgreens. Costs them $5 to be seen by NP for whatever :) Can just walk-in & now WAG on "Blue Button" campaign.

Reinaldo B. @basanezrx: at least they are clear about the pricing, same as the clinics in Walgreens. I’d love to see specific prices for hospitals.

Exercises to Avoid with Osteoarthritis of the Knee or Hip

Participation 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

Exercises to Avoid with Osteoarthritis of the Knee or Hip include:

- Running and jogging. The difference between how much force goes through your joints jogging or running, as opposed to with walking, is sometimes more than 10-fold your whole body weight
- Jumping rope
- High-impact aerobics
- Any activity where, at any time, you have both feet off the ground at once, however briefly (basketball, jumping)

Fortunately, that leaves a lot of activities that are OK for people with knee and hip osteoarthritis and that can help keep you mobile - see the list at WebMD.

Research Finds Exercise is Good for Arthritis (a Cleveland Clinic video):



References:

Knee and Hip Exercises for Osteoarthritis. WebMD.
Image source: OpenClipart.org, public domain.

Can a Happy Relationship Predict a Happy Life? Apparently, Yes

The association between overall life satisfaction (LS) and relationship satisfaction (RS) was investigated longitudinally among 67,000 mothers in Norway.

Data were collected twice during pregnancy, and at 6 and 36 months postpartum:

- Satisfaction increased during pregnancy.

- However, relationship satisfaction decreased immediately following birth.

- Life satisfaction showed an initial increase followed by a decrease postpartum.

Relationship satisfaction predicted change in life satisfaction. Having a satisfying romantic relationship was important for retaining and increasing future life satisfaction.

References:

Can a Happy Relationship Predict a Happy Life? A Population-Based Study of Maternal Well-Being During the Life Transition of Pregnancy, Infancy, and Toddlerhood, Journal of Happiness Studies, Volume 11, 663-793, Number 6 / December 2010.

Image source: OpenClipArt.org, public domain.

Hepatitis C: Teenager Jazzy's Story

NHS Choices: Teenager Jazzy was born with hepatitis C. This is her video diary about living with the condition.

Comments from Twitter:

@napernurse: Fortunate to live in UK where extensive med/psych prescriptions for HepatitisC covered by NHS. If liver transplant needed, that is covered too!

New treatments for diabetes type 2

There is urgent need for new treatment strategies for diabetes type 2.

Some new approaches include:

- Long acting (eg, once weekly) agonists of the glucagon-like-peptide-1 receptor - they improve prandial insulin secretion, reduce excess glucagon production, and promote satiety

- inhibitors of dipeptidyl peptidase 4 (DPP-4), which enhance the effect of endogenous incretin hormones

- inhibitors of the sodium—glucose cotransporter 2, which increase renal glucose elimination

- inhibitors of 11β-hydroxysteroid dehydrogenase 1, which reduce the glucocorticoid effects in liver and fat

- Insulin-releasing glucokinase activators and pancreatic-G-protein-coupled fatty-acid-receptor agonists, glucagon-receptor antagonists, and metabolic inhibitors of hepatic glucose output are also being assessed


Figure 1. Action of DPP-4 inhibitors. Note that DPP-4 normally inactivates GLP-1. DPP-4 inhibitors block DPP-4 which in turn leaves GLP-1 active. Click to enlarge the figure. Created with Gliffy. The diagram Action of DPP-4 inhibitors is now on Wikipedia.

References:

Management of type 2 diabetes: new and future developments in treatment. The Lancet, Volume 378, Issue 9786, Pages 182 - 197, 9 July 2011.

Comments from Google+:

Emily Lu - Question is - how many of these treatments will actually be available to minority groups that have the higher prevalence of diabetes?

Ves Dimov - Excellent question. Check this one too: "By 2030, the number of individuals with diabetes worldwide is expected to rise to half a billion (470 million) - almost 80% of whom will be in low-income and middle-income countries. In these regions, diabetes drugs and insulin are often inaccessible or are too expensive." Early diet intervention may be the answer in type 2 diabetes.

Emily Lu - "Early diet intervention may be the answer in type 2 diabetes." -- True enough, but much much easier said than done! Patient education in general seems to me to be critical as well.

Ves Dimov - Diet is difficult to implement from patient's perspective. Activity did not bring the expected benefits in the latest trial - reported in the July 2011 issue of the Lancet.

Porphyrias

From a Lancet review:

Hereditary porphyrias represent a group of 8 metabolic disorders of the haem biosynthesis. They are characterised by acute neurovisceral symptoms, skin lesions, or both.

Every porphyria is caused by abnormal function of a separate enzymatic step, resulting in a specific accumulation of haem precursors:

- 7 porphyrias are the result of a partial enzyme deficiency

- a gain of function mechanism is present in one new porphyria

Acute porphyrias present with acute attacks - severe abdominal pain, nausea, constipation, confusion, and seizure - and can be life-threatening.

Cutaneous porphyrias present with painful photosensitivity, skin fragility and blisters.

Porphyrias are still underdiagnosed. Screening of families to identify presymptomatic carriers and avoidance of precipitants is important.

References:

Porphyrias. The Lancet, Volume 375, Issue 9718, Pages 924 - 937, 13 March 2010.

Social media tips for employees of Dartmouth-Hitchcock medical center: What you write is forever

From Dartmouth Hitchcock YouTube channel:

Social media is everywhere... and what you write is forever.

A simple rule of thumb: if you wouldn't say something in a loud voice in the crowded cafeteria, you shouldn't say it on Facebook, Twitter, or other social media sites.

When can I use social media? Even if you have your own phone and you're just sending a quick tweet, you may only use social media for personal reasons on your own time, such as during scheduled breaks or meals.

What's not allowed?

- Posting protected health information or patient identifiable information

- Using information created by or for Dartmouth-Hitchcock - such as logos, pictures, and videos - without the approval of Public Affairs and Marketing department. It's copyrighted content.

- Creating social media sites that are branded as Dartmouth-Hitchcock without the approval of Public Affairs and Marketing.

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

Tips for Medical Bloggers

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

Here is how to facilitate the Rise of the ePhysican who works hand in hand with the ePatient:



Related reading

What are the Downsides of Social Media for Doctors? Dr. Wes shares insights from 6 years of blogging

Basal Cell Carcinoma - Mayo Clinic Video

Jerry Brewer, M.D., Mayo Clinic dermatologist, describes the common form of skin cancer, basal cell carcinoma.

Secondhand smoke is nothing to kid about - CDC video

CDC: This 30-second TV ad features vignettes of children talking about when they're exposed to secondhand smoke. As the narrator points out, secondhand smoke is nothing to kid about. It can hurt lung growth and damage lung function in children. When smoking around your kids, it's like they're smoking.

When are you starting a Journal Club on Google Plus?

One of the BMJ blogs recently asked if Twitter Journal Club is yet another ‘revolution’ in scientific communication.

I think Twitter Journal Club is an incremental change in the way the scientists and physicians communicate. It is a good idea but limited by the medium of Twitter.

Does anybody have plans for a Journal Club on the newly-launched Google Plus? It is the fastest growing social network in history (25 million members in month) and it seems like a natural platform for that.

Comments from Google+:

Arin Basu - Google + is a very natural medium for hosting journal clubs or say even grand rounds! I am more than happy to start giving it a shot!

Ves Dimov - We first tried Journal Club on Twitter in 2008 but didn't like it that much:

http://casesblog.blogspot.com/2011/06/first-journal-club-on-twitter-then-and.html

This 2011 version is "Twitter-only" (with a blog that provides some background) but can't go beyond the natural limitations of the medium.

Google+ seems like a better fit for a more involved discussion with a richer background. And you can actually follow the conversation...

Related reading:

Virtual Journal Club for Hospital Medicine by the Washington University in St. Louis

Worldwide number of new TB cases is higher than any other time in history

From the 2011 Lancet review:

The worldwide number of new TB cases is more than 9 million - higher than at any other time in history.

22 low-income and middle-income countries account for more than 80% of the active cases in the world.

Due to the devastating effect of HIV on susceptibility to TB, sub-Saharan Africa has been disproportionately affected and accounts for 4 of every 5 cases of HIV-associated tuberculosis.

Management problems include:

- In highly endemic areas, TB diagnosis continues to rely on century-old sputum microscopy

- No vaccine with adequate effectiveness (although BCG works to some extent). According to a recent report, BCG vaccination not only protects against tuberculosis but the number needed to treat (NNT) is 11.

- TB treatment regimens are protracted and have a risk of toxic effects

- Increasing rates of drug-resistant tuberculosis in eastern Europe, Asia, and sub-Saharan Africa

Promising progress includes improved tuberculosis diagnostics with biomarkers of disease activity. New and improved drugs, biomarkers, and vaccines need to be developed.

Diagnosing tuberculosis with cytokines IL-15, IL-10 and MCP-1, in addition to interferon-gamma

A pattern of two cytokines, called MCP-1 and IL-15, was reasonably good at differentiating between persons sick with TB and persons infected but not sick.

Monocyte chemotactic protein-1 (MCP-1) is a small cytokine belonging to the CC chemokine family. According to the new nomenclature, MCP-1 is called chemokine (C-C motif) ligand 2 (CCL2).

A third cytokine called IP-10 also showed promise at differentiating between people who are infected and those who are not.

Interferon gamma-induced protein 10 kDa (IP-10) is also known as C-X-C motif chemokine 10 (CXCL10). It belongs to the CXC chemokine family.

These 3 cytokines could form the basis of a new test to quickly detect whether tuberculosis is dormant or active and infectious.

52 chemokines from 4 families have been described. They interact with 20 receptors (click here for a larger image).

References:

Tuberculosis. Stephen D Lawn MRCP, Prof Alimuddin I Zumla FRCP. The Lancet, Volume 378, Issue 9785, Pages 57 - 72, 2 July 2011.

Immune system could be used to test for TB. Reuters.

Immunology Made Simple: "What are These People Talking About?"

Cytokines

Xpert MTB/RIF is a rapid diagnostic test for tuberculosis with high sensitivity (90%) and specificity (99%). Lancet, 2011.

Image source: PPD, CDC, public domain.

Comments from Twitter:

@sdietrich17: How discouraging. We just keep going backwards with so many infectious diseases...

Varicose veins: an animation

From NHSChoices YouTube channel: This animation explains in detail what varicose veins are, their causes, symptoms and the various treatment options.

Doctors are natural communicators - social media is extension of what they do every day

Doctors are natural communicators

My Google+ Circle labeled "Social Media in Medicine" now has 140 members - just one month after Google+ was launched. I think that's great.

Doctors are natural communicators and should do very well on social media platforms. Patients, and society in general, would only benefit from physicians who share ideas and focus on education.

Simple guidance for social media use

The suggested guidance for social media use by health professionals is very simple and based on a recent book by a nurse and social media advocate:

1. Remember the basics:

- your professional focus

- the laws around patient privacy (HIPAA in the U.S.)

- the professional standards of regulatory bodies and of your employers

2. After that, explore all the different social media tools that are out there.

Will Google+ have an effect on blogging? Undoubtedly. Will it "kill" blogging, as some have suggested? Of course not.

The Cycle of Online Information

Google+ is just another communication platform that fits nicely in what I called the "The Circle of Online Information" in 2009.

Here is how to facilitate the Rise of the ePhysican who works hand in hand with the ePatient:

1. Inbox for the web, receive information. Receive updates from selected RSS feeds (Google Reader) and Twitter accounts. See the list of suggested RSS feeds and Twitter accounts at the end of this post.

2. Digital outposts, share information on social networks. Share interesting links and ideas on the 3 main social networks, Twitter/Facebook/Google+, curate the inflow of information.

3. Get feedback. Get feedback from your followers on Twitter/Facebook/Google+, see what works.

4. Publish at your homebase, blog. Write a blog post using the ideas, updates and feedback from Twitter/Facebook/Google+. Expand on them. Aim for a blog post on Monday/Wednesday/Friday.

5. Share your expert opinion. Share the link to your blog post via RSS and the 3 main social networks, Twitter/Facebook/Google+. Go back to step 1 to continue the circle.

Different styles/same goal

The two videos below show different communication styles but both are authored by physicians who use social media as extension of their everyday practice - they educate patients and colleagues and address their questions and concern.

The first video is by an orthopedic surgeon and the second by a pediatrician. They are both gifted natural communicators.


Do your patients speak "Doctor"?


Seattle Mama Doc 101 - Teething and Fever

RSS bundles of medical news

You can use the following RSS bundles to subscribe to medical news items. The bundles are exported from my Google Reader account. They update automatically several times per day. When in Google Reader, just select the ones that you find interesting and share them on Twitter. Add your own comments to some of the tweets.

Top Twitter Doctors

This is a list of the Top Twitter Doctors arranged by specialty in alphabetical order - feel free to add your own suggestions. The list is open to anybody to edit:

Comments from Google+:

Sina Neda - Good to see that the medical community is gathering on Google+, I'm still trying to find interesting people to follow in the medical field. Also want to remind everyone that is interested in MED-networking to add your Google+ and Twitter handles on the following list.

Neil Mehta - I for one would be very sad to see blogs go away. I find them to be the best place for "quiet" reflection, where you can think, write, cite, and then present to the society for feedback - a good example for social constructionism.

Art Gross - Every new social platform is always said to kill blogging. So far none of them have. Blogging is where content is created. Twitter, Google+ is where it is shared. Although the feedback on Google+ adds a new dimension and one that should add value to blogs. BLOGGING IS NOT DEAD YET! :)

Ves Dimov - "Blogging is where content is created. Twitter, Google+ is where it is shared." - Example: "The circle of online information"

Arin Basu - To some extent Google plus is essentially a microblogging/lifestreaming platform. As you wrote, it will change blogging but don't see how blogging will go away.

Related reading

Assessing Patients' Interest in Social Media: 83% used it, 56% wanted providers to use social media http://goo.gl/yD63V
The central part of medicine is patients - don't push them out of social media

For doctors: How to be a Twitter superstar in two easy steps

How to deal with the information overload from blogs, RSS and Twitter?

29 Debates About the "Right Way" to Blog

For doctors: How to start using social media

Bloggers: Google+ is coming to annihilate you
What are the Downsides of Social Media for Doctors? Dr. Wes shares insights from 6 years of blogging

Image source: OpenClipArt.org, public domain.

Hepatitis delta virus

From a recent review in The Lancet:

Hepatitis delta virus (HDV) is a small, defective RNA virus that can infect only individuals who have hepatitis B virus (HBV). More than 15 million people are co-infected worldwide.

There are 8 genotypes of HDV. The hepatitis D virion is composed of a coat of HBV envelope proteins surrounding the nucleocapsid.

The nucleocapsid consists of:

- a single-stranded, circular RNA genome
- delta antigen, viral protein

HDV suppresses HBV replication but also causes severe liver disease with rapid progression to cirrhosis and hepatic decompensation (liver failure).

The range of clinical presentation is wide, varying from mild disease to fulminant liver failure.

Treatment of HDV is with pegylated interferon alfa; however, response rates are poor.

Better understanding of the molecular structure of HDV may lead to new therapeutic targets for this most severe form of chronic viral hepatitis.

References:

Hepatitis delta virus. Sarah A Hughes MBBCh, Heiner Wedemeyer MD, Dr Phillip M Harrison MD. The Lancet, Volume 378, Issue 9785, Pages 73 - 85, 2 July 2011.

Post-splenectomy and hyposplenism - Lancet review

The spleen links innate and adaptive immunity.

The impairment of splenic function is defined as hyposplenism. The term asplenia refers to the absence of the spleen, a condition that is rarely congenital and mostly post-surgical.


Spleen. Image source: National Cancer Institute and Wikipedia, public domain.

Complications of hyposplenism and asplenia

Hyposplenism and asplenia might predispose individuals to thromboembolic events. However, infectious complications are the most widely recognised consequences of these states.

Splenectomy and hyposplenism are associated with infections by encapsulated bacteria with high mortality, fulminant course, and refractoriness to common treatment.

Prevention through vaccination and antibiotic prophylaxis is the basis of management.

References:
Post-splenectomy and hyposplenic states. Antonio Di Sabatino MD, Rita Carsetti MD, Prof Gino Roberto Corazza MD. The Lancet, Volume 378, Issue 9785, Pages 86 - 97, 2 July 2011.

Beyond "Good Job": How to Give Effective Feedback to Residents

Although too often used interchangeably, encouragement, evaluation, and feedback are quite distinct:

- Encouragement (eg, "good job!") is supportive but does nothing to improve the learner's skills

- Evaluation is summative and is the final judgment of the learner's performance

- Feedback is designed to improve future performance

References:

Getting Beyond "Good Job": How to Give Effective Feedback. PEDIATRICS Vol. 127 No. 2 February 2011, pp. 205-207 (doi:10.1542/peds.2010-3351).

Image source: OpenClipArt.org, public domain.