Grand Rounds

What is this?

Grand Rounds is a weekly summary of the best posts in the medical blogosphere. Pre-Rounds is an article series about the hosts of Grand Rounds on Medscape.com. Nick Genes of Blogborygmi, who writes the Medscape column, is the founder of Grand Rounds and he maintains the archive. If you would like to know more about the author of Clinical Cases and Images - Blog, see the Pre-Rounds interview here.


This week's Grand Rounds

I work in a large tertiary care center which is probably one of the biggest and busiest hospitals in the world. There are doctors from all sorts of subspecialties, nurses, supportive personnel and, of course, thousands of patients who make this whole endeavor worthwhile.

This organization is glued together by the continuous effort of all these thousands of people (30,000) who come to work and make a difference in somebody's life because it is part of what they do everyday.

The medical blog community reminds me of the hospital structure. It is very interesting to see that the medical blogosphere has spread well beyond the limits of doctors and nurses as authors (click on the diagram to see this week's authors according to job/topic description). Grand Rounds is a snapshot of the best posts and shows the wide variety of medical blogs. It takes all of us to make the miracle of healing happen everyday.


DOCTORS


How to treat hyperkalemia (high potassium)? The new 2005 CPR Guidelines are reviewed by a nephrologist

Treatments for hyperkalemia vary widely and and given the lack of standardization, it is not surprising that different doctors treat hyperkalemia in different ways. The new 2005 CPR guidelines from the American Heart Association provide recommendations for the treatment of hyperkalemia. KidneyNotes offers some criticisms to make a better use of the guidelines in the real world. KidneyNotes.com is a blog maintained by a nephrologist (a kidney doctor).


Should we do PSA screening? A urologist's opinion

Dr. Savatta of Robotic Surgery Blog reviews the pros and cons of PSA testing for prostate cancer. He critiques both the official guidelines and fellow bloggers.


Clinical judgment is the essence of medicine

DB’s Medical Rants writes that clinical judgment remains (and will remain) difficult to define and therefore even more difficult to measure. He discusses three clinical cases as examples.


The “Can-do” spirit of the American health system

No doubt the "can-do" attitude sometimes saves lives, helping some patients with impossible odds survive. Unfortunately, while such an attitude may work well for movie heroes, it does not always lead to victory in patient care. Ad Libitum blog discusses the pros and cons of “do something, don’t just stand there” versus “masterful inaction.” (part one and two)


On Ariel Sharon’s cerebral hemorrhage

Medical blogs follow the news of the day and often provide an explanation to the general public when a famous person is affected by an illness. Recently, Kevin, M.D. reviewed Tedy Bruschi's stroke and the President and the Vice-Presidents annual physicals exams. This week DB’s Medical Rants discusses the two strokes that the Israeli prime minister had - ischemic 2 weeks ago and hemorrhagic later. The first stroke was embolic and similar to the one that affected Tedy Bruschi . The second stroke was probably due to anticoagulation given to prevent the recurrence of the first. Dr. Bob (DB) writes that we must always remember that our treatments have both risks and benefits. Shrinkette reminds us that only about 17% of strokes are hemorrhagic but they account for 30% of stroke deaths.

Sharon had three brain surgeries to evacuate blood in less than 24 hours although there is no sufficient evidence that this approach is clearly beneficial. Medviews comments that taking care of politicians (and kings) is not easy. Frequently, because of their importance and prominence, they may paradoxically get poor care. Bioethics Discussion Blog also asks "Does Standards of Medical Practice Change for a King?" (part one and two).

We do not know all the details of Ariel Sharon's case and the above comments are just an expression of concern rather than a statement of fact.


Suicide bombers' damage lasts beyond the blast

Doc Around the Clock links to a BBC article about a suicide bomber with hepatitis who blew himself up and his body particles infected a survivor of the blast. "As a result of that case, all survivors of these attacks in Israel are now vaccinated for hepatitis B." (BBC)


Sago mine tragedy due to carbon monoxide poisoning

Miners' notes reveal their final moments: "It wasn't bad. I just went to sleep." The miners chose not to tell of their headaches, nausea, and dizziness, which are symptoms of carbon monoxide poisoning, as reported by Shrinkette.


The answer to the question "Why are you overweight?”

NHS Blog Doctor says that "the correct answer, the one that scores points, is straightforward: “Because I eat too much doctor.” We can work on that. The incorrect answer is “I don’t know, doctor, I don’t eat a thing.” Well, I am not sure about the situation on this side of the pond though. Just recently, a U.S. doctor was sued for telling a patient that she was too fat (KevinMD has a summary of the the blogosphere responses).


Minute Clinic opening up at a CVS Pharmacy near you

Bruce of Carolina Healthcare blog is worried that the new Minute Clinic is not only down the street from their office but it also competes directly with their urgent care: "This will impact our business! How should we respond?" "You're Sick. We're Quick" is the Minute Clinic's trademark motto, their discount health care locations are staffed only by nurse practitioners. RangelMD has more on this MiniDoc-in-Box concept which The Health Care Blog calls the Walmartization of health care.


ER Interruptions

GruntDoc shares his frustration with one of the most annoying things in the ER: interruptions while speaking to patients. "I don't expect anyone to wait through the Gettysburg address, but there are natural pauses in conversations when questions aren't completely disruptive, can we all try to wait for that?" Apparently, studies show that the average ER doctor gets interrupted 20 times an hour. Comments say it best: "Nice rant."


Selective abortion of 10 million female babies in Asia

PickledPolitics blog comments on a Lancet study which estimates that 500,000 female fetuses are aborted every year in parts of India, for no other reason than their gender.


Screening during the first trimester of pregnancy

The ObGyn doctor who runs the Red State Moron blog sorts out some inaccuracies in the lay press about the prenatal screening. For starters, first trimester screening (combination of nuchal translucency and serum) is a screening test, not a diagnostic test.


The Hidden Lives of Doctors: Weekend Rounds

Despite the entreaties of some anxious patients, in most cases their doctor is not available 365 days a year. Some other doctor (often unknown to the patient) has to "cover" the weekend for their regular physician. The Cheerful Oncologist has a three part commentary on The Hidden Lives of Doctors, this week's post reveals the mystery of weekend rounds in the hospital. Check out part one (The Art of Signing Out) and part two (The Tergiversator).


Fun with Medical Students

Maria of Intueri teaches medical students how to empathize with pshychotic patients. And she is pretty successful as you will see.


Do antidepressants increase suicide risk or not?

TreatmentOnline blog asks if the FDA warning about antidepressants was wrong.


Don’t be Shocked - Poor Outcomes for Inpatient Cardiac Arrests

LubbDub (a cardiology blog, what else) writes about what we can do to improve the dismal survival after a dreaded "code blue" in the hospital: "Codes have always amazed me in hospitals. As an intern, I felt the intense fear and sinking feeling of having to “perform” using what little knowledge I had to save a patient. I often saw interns running in the opposite direction rather than taking ownership of a dying patient. I quickly realized that the doctors role in a code was to be a calming force in an often chaotic situation."


Medical Consulting for Surgical Patients

The Internal Medicine Doctor writes about Medical Consulting requested by surgical services. The Doctor (formerly: Mad House Madman) has moved to a new domain (internalmedicinedoctor.blogspot.com), so please update your bookmarks and RSS reader. So, now the Madman is a regular internal medicine doctor? Nothings is lost: WebMD just launched a blog called Mad About Medicine.


How to dictate a radiology report?

Hint: use less "cannot be excluded" and "clinical correlation recommended." Sumer's Radiology Site links to the UCSF Radiology Department guidelines on dictating CXR, CT, and other reports.


Somebody sign the death certificate, already!

Respectful Insolence shares a personal story about his uncle who died of a heart attack but the death certificate was not signed for almost 3 days: "The lesson of this incident is that little things we doctors do, without even thinking about it, can, without our knowing it or necessarily appreciating it, cause enormous distress in patients or their families."


NURSES


When A Patient Gets A "Two-For-One" Deal

Emergiblog describes what we sometimes call "an interesting patient." You never, ever want to be an interesting patient. Happily, for this particular gentleman, the outcome was good.


Final Year Nerves

A 3rd year nursing student (Unimum209, whatever that name means) shares her anxiety about starting her first job: "Two semesters of hard work and I will actually be a RN... Is it normal for panic to set in after 3 years of hard work??... I really enjoy reading other nurses, graduates and students blogs' as it is inspiring and comforting to know I am not alone."

There is a community of nursing blogs on mediblogopathy.blogspot.com.


PATIENTS


Appendectomy in Japan

CrozierVision "puts himself at the mercy of the health services" in Japan and explains what it is to have an appendectomy in Tokyo.


A diabetic's take on some timely news

Amy of DiabetesMine comments on news, including the story that the CEO of Amylin Pharmaceuticals, Inc. (formerly of Eli Lilly) pricks her finger daily for a blood glucose test. The CEO is not a diabetic but she wants to know how the patients who buy their products feel every day. Oculir's glucose readings from the whites of the eyes may soon put an end to finger testing.


Did you know you can call?

Joan of Oasis of Sanity is a patient who gives advice who to call when you do not have health insurance but you do need medical advice.


Talking to a friend about his depression

Healthy Concerns blog writes about a friend's relapse into depression and alcohol abuse: "Talking to even a close friend about their alcohol consumption is a sensitive thing..." She did not how to say it. May be the psychiatrists bloggers will have a suggestion.


Medicare Part D - Killing two birds with one stone

AARP claims that the new Medicare Part D Drug Benefit will be cheaper than reimporting drugs from Canada but Healthy Policy blog has doubts.


INFORMATION TECHNOLOGY


Virtual Patient Care Via Internet

Nurses check on patients via Internet, reports the Healthcare IT guy. He is worried if the health IT will be able to correctly track all that information submitted by devices in patient homes. Well, that is why we have a medical connectologist blog.

eHealth blog writes that patients with minor ailments, like cold, get virtual eVisits at Palo Alto Medical Foundation.


The First Medical Blog Network Was Born

Some of you may be aware of the blogging networks like Weblogs, Inc. (bought by AOL for $ 30 million last month) and Gawker Media. Until recently medical blogs had just a RSS aggregator - Medlogs.com (a great aggregator by the way) but not a network. This has changed now. HealthVoice.com started the first medical blog network last week. They have 5 topical blogs in the Featured Columns section, and anyone can start a free blog on their site.

Subscribe to Medlogs RSS feed to get the updates from all medical blogs compiled into one feed.


SCIENTISTS


MRSA kills 90,000 Americans a year

Ruminating Dude lists a few things we can do the limit the spread of the deadly Methicillin-Resistant Staphylococus Aureus (MRSA).


Two potential rotavirus vaccines tested

Rotavirus-related diarrhea causes 70,000 hospitalizations per year in the U.S. The first vaccine against the virus called RotaShield was withdrawn from the market due to reports of an intestinal blockage (intussusception) associated with its use. Aetiology blog informs us about two new vaccines that may be able to take RotaShield’s place.


Individual Response to COX-2 Inhibitors Affected by Genes

Genetics and Health blog writes that genes may explain as much as 30 percent of the variation in individual responses to COX-2 pain killers. People have different adverse effects and to a different extent (for example, blood pressure increase) according to their genetic makeup. Pharmacogenomics is the science of investigating the genetic variations in response to medications.


HEALTH INSURANCE and ADMINISTRATION


Hospital Wars

The nation's hospitals posted record profit margins this year but yet some for-profit hospitals are closing. "Efficiency is doing something right and effectiveness is doing the right thing. Sort of hard to sort them out sometime", writes Fixin' Healthcare.


2006 Forecast for Hospitals: The year of Consumer-Driven Healthcare

Hospital Impact blog lists a few predictions for 2006: patient volume will drop and become more erratic, more phone calls from hospital comparison shoppers, blurring between banks and health plans will continue, just to name a few.


Health Spending In Different Countries

EzraKlein argues that Americans pay more for health insurance and receive less than residents of other countries: "The fiction that we pay more but receive proportionately greater amounts of care is just that: a fiction."


Another Ethical Question

InsureBlog asks if we should pay for an operation for an Americal citizen who is about to permanently leave the country. Check his comments section.


LITERARY and OTHER BLOG POSTS (interesting posts not classified in the groups above)


Baby Boy

"For in that moment I saw my own birth and my own death, lived hundreds of years spanned by the lifetimes of my kin who came before me, and relinquished my bittersweet hope of being forever young." Who else but Dr. Charles?


What's a Rich Doctor To Do?

A medical student in Iran is asking this provocative question. Check out the answer on The Differential blog and if you do not agree, write your opinion in the comments section. Getting instant feedback right there on the web page is part of what makes blogging such a rewarding experience.


After years of shift ER work

Dr. Tony tells us a story which blends past, present and future and ends in a dream.


What I've Learned By Reading Blogs

Rita of MSSP Nexus Blog thinks that reading (and writing) medical blogs is an eye-opening experience. I could not agree more.


Check out Grand Rounds next week

The host of next week's Grand Rounds is GruntDoc, an ER physician in Texas. His blog was voted the Best Medical Weblog of 2004. The voting for 2005 Medical Weblog Awards is open now.