I’ve received some emails from nurses who would like to start a blog. Some are a bit nervous about starting, others are not sure how to begin. There are a million sites out there on how to start a blog; in fact, I wrote a post specifically on how to be a “nurse blogtitioner”.
But their emails got me thinking about the blogosphere in general and the most important considerations in starting/maintaining a blog.
1. The blogsosphere can never be saturated.
Think you have nothing to add to the dialog? Think that everything about your topic has been said? Think again. If you aren’t blogging there is still a voice that needs to be heard. What exactly do you bring to the discussion? You! No one has had your experiences or can express your opinions. More importantly, no one else can bring your voice. And unlike a meeting or an email, there are no time limits or physical boundaries to the blogosphere. There is room for everybody, and that means you!
2. The heart of the blogosphere is interactivity.
If you read blogs, you probably leave comments. Comments are the soul of the blogosphere. With them, the blogosphere is a conversation. Without them, the blogosphere is simply a virtual collection of “articles”. By starting a blog, you bring the dialog to your “home turf”, so-to-speak. You are the host/hostess of a virtual “salon”, providing information on your sphere of expertise, initiating the debate and most importantly, learning from those who comment on your posts.
3. The blogosphere is the great equalizer.
There is no hierarchy of blogs. Don’t confuse size with importance. Some blogs may have a million readers a day and some may have ten, but in the blogosphere, no one is “better” than anyone else. Your blog, with that first post, is just as important and just as relevant as anything you see on “Instapundit” or the “Huffington Post”. It’s unique and cannot be replicated, because it is based on your outlook and experiences.
Here are some things to keep in mind as you start your blog:
1. Content is King
Maybe you look at the blogs with the sidebars and the graphics and the ads and the widgets and think, “Man, I don’t know how to do all that!”. You don’t have to do all that! All you have to do is start posting. One post. Later, if you want, you can add a blogroll or a few widgets. But the way to start is to begin writing, and keep writing. People will come for your content. Everything else takes a back seat to that.
2. Promotion, Ur Doin’ it Right
You’ve just put up your first post. A few folks might stumble on your site by accident, but you need to get out the word that you’re on the web. This is where you start promoting your blog. The best way to do this is find a carnival for your niche and submit a post. For those of us in the medblogging community, examples would be Grand Rounds, Change of Shift, Patients for a Moment and The Handover. Make your url part of every email signature and blog comment you send. Write it, and they will come…but they need to know you’re there.
3. Prolific Perfection…Not
Blogging can be addicting, and in a good way. It can be challenging, therapeutic, frustrating, and energizing – all in one post! But…you do not have to be the “perfect” writer. Just find your style and run with it. And while consistent posting makes it easier for readers to find your blog, you control your posting schedule. “Prolific” is what you say it is, be it once a week or once a day. But know this: the more you write, the easier it becomes to write; the more you are interacting with the blogosphere, the more inspiration you will find and the more you will want to write. It’s the blogosphere “circle of life”!
So…if you ask me, should I blog?
I’ll say YES!!!!
Been there, still doing that, and if I can do it, you can do it.
It will clarify your outlook.
It will recharge your batteries.
It will change your life.
Really, the bottom line?
You’ll never know unless you write…
That first post.
*This blog post was originally published at Emergiblog*
A new microfluidic device from the University of Southampton, called single-cell impedance cytometer, is being reported in Lab on a Chip. The technology promises to perform a white blood cell differential count in a tiny package from a puny sample.
According to Dr David Holmes of ECS, lead author of the paper, the microfluidic set-up uses miniaturised electrodes inside a small channel. The electrical properties of each blood cell are measured as the blood flows through the device. From these measurements it is possible to distinguish and count the different types of cell, providing information used in the diagnosis of numerous diseases.
The system, which can identify the three main types of white blood cells – T lymphocytes, monocytes and neutrophils, is faster and cheaper than current methods.
‘At the moment if an individual goes to the doctor complaining of feeling unwell, a blood test will be taken which will need to be sent away to the lab while the patient awaits the results,’ said Professor Morgan. ‘Our new prototype device may allow point-of-care cell analysis which aids the GP in diagnosing acute diseases while the patient is with the GP, so a treatment strategy may be devised immediately. Our method provides more control and accuracy than what is currently on the market for GP testing.
The next step for the team is to integrate the red blood cell and platelet counting into the device. Their ultimate aim is to set up a company to produce a handheld device which would be available for about £1,000 and which could use disposable chips costing just a few pence each.
Last night, President Obama made a pitch for preventive care in his address to a joint session of Congress on health care:
“And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies – because there’s no reason we shouldn’t be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.”
As a doctor who has held the hands of patients dying from totally preventable illnesses, I couldn’t agree more. The largest number of deaths in the United States are caused by two preventable causes – tobacco smoking and high blood pressure – killing an estimated 467,000 and 395,000 people respectively in 2005. The list goes on and on, including obesity, physical inactivity, and poor diet.
When I was working in the emergency room as a medical resident, it was heartbreaking to see a patient with poor routine medical care roll into the emergency room with a devastating stroke that could have easily been averted with regular office visits and blood pressure medication – both relatively inexpensive compared to the cost of caring for the stricken patient.
We’re not preventing enough deaths by the types of cancer screening tests mentioned by President Obama. One reason is the technology is still not good enough. We need to develop better screening tests that pick up problems early but don’t lead to an unacceptable number of unnecessary biopsies, procedures, and further tests. And not enough patients are screened. Only about about 60 percent of women get mammograms and about 50 percent of men and women get routine colonoscopies.
Lack of insurance coverage is certainly a big reason why some patients don’t undergo screening. Another reason is patient fear and misunderstanding. In order to educate the public about the risks of colon cancer and the benefits of screening exams, Katie Couric underwent a colonoscopy on national television in March, 2000. Three years later, researchers at the University of Michigan found that colonoscopy rates jumped by 20 percent across the country following Katie’s procedure, calling the rise the
“Katie Couric Effect.”
It’s almost 10 years later and we’re still not screening enough patients. Although the death rate from colon cancer has dropped in recent years – likely mostly because of screening efforts – colorectal cancer still strikes almost 150,000 Americans every year and kills about 50,000.
As a gastroenterologist, I have seen patients’ lives saved by the removal of polyps and early cancers found by colonoscopy. I have also taken care of patients whose colon cancers were found too late to save them. Over the years, I must have heard every excuse for ducking a colonoscopy. The top four (and my answers):
I have no symptoms (most colon cancers start small and have no symptoms until they grow larger.)
I have no family history of colon cancer (that’s true in about 70 percent of patients with colon cancer.)
I’m afraid it will hurt (that’s why we use sedation and, if needed, anesthesia.)
I can’t do the prep (we’ll figure out a way to clean out your colon that you can tolerate.
And even if you have a tough night, it sure beats chemotherapy.)For this week’s CBS Doc Dot Com, I follow Katie’s lead and undergo a colonoscopy with cameras rolling in an attempt to remind people that a screening colonoscopy can save your life. I had the benefit of a house call the night before by my office nurse, Debbie Fitzpatrick, who held the video camera and offered advice and encouragement as I had a taste of my own medicine: the colon cleanout solution. The colonoscopy was performed expertly by Dr. Mark B. Pochapin, director of The Jay Monahan Center for Gastrointestinal Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
For more information about the Jay Monahan Center,click here.
For more information about screening for colon cancer, click here.To watch my colonoscopy, click below:
This past week I was once again asked about suture allergy. It has prompted me to revisit the issue which I have posted about twice now. (photo credit).
Sutures by their very nature of being foreign material will cause a reaction in the tissue. This tissue reactivity is NOT necessarily a suture allergy.
Many factors may contribute to suture reactivity.
The length of time the sutures remain. The longer the sutures are in, the more reactivity occurs.
The size of the sutures used. The larger the caliber of the suture, the more reactivity. The increase of one suture size results in a 2- to 3-fold increase in tissue reactivity.
The type of suture material used. Synthetic or wire sutures are much less reactive than natural sutures (eg, silk, cotton, catgut). Monofilament suture is less reactive than a braided suture.
The region of the body the suture is used affects tissue reactivity. The chest, back, extremities, and sebaceous areas of the face are more reactive.
In general, accepted time intervals for superficial suture removal vary by body site, 5-7 days for the face and the neck, 7-10 days for the scalp, 7-14 days for the trunk, and 14 days for the extremities and the buttocks. The deeper placed sutures will never be removed.
Sutures meant to dissolve (ie vicryl sutures) placed too high in the dermis (which happens often when the dermis is thin) can “spit” several weeks to several months after surgery. This is a reactive process, NOT a suture allergy. It usually presents as a noninflammatory papule (looks very much like a pimple) and progresses with extrusion of the suture through the skin. The suture material may be trimmed or removed if loose, and it is not needed for maintaining wound strength. Rarely does this affect the scar outcome.
The remaining portion is a “repost” about suture allergies:
Allergic reactions to suture materials are rare and have been specifically associated with chromic gut. However, Johnson and Johnson mention known triclosan allergy as a contraindication for use of certain sutures (see below). Contact allergy to triclosan is uncommon.
Surgical gut suture (Plain and Chromic) is contraindicated in patients with known sensitivities or allergies to collagen or chromium, as gut is a collagen based material, and chromic gut is treated with chromic salt solutions.
PDS Plus Antibacterial suture should not be used in patients with known allergic reactions to Irgacare MP (triclosan).
VICRYL*suture should not be used in patients with known allergic reactions to Irgacare MP (triclosan). [In rechecking facts, I found that only Vicryl Plus has the triclosan, so simple vicryl or coated vicryl should be okay.]
Surgical Stainless Steel Suture may elicit an allergic response in patients with known sensitivities to 316L stainless steel, or constituent metals such as chromium and nickel. Skin staples are surgical steel so should be used with the same precautions.
Dermabond — Tissue glues should not be used in patients with a known hypersensitivity to cyanoacrylate or formaldehyde.
SO WHAT IS LEFT TO USE
So what is left to use in a patient who may have or has a proven allergy to suture or closure material?
Silk, Dexon, Nylon (monofilament or braided), Prolene, INSORB (absorbable staples), and any of the above listed (in the allergy section) to which the patient in question doesn’t react negatively.
The choice of a particular suture material will have to based further on the wound, tissue characteristics, and anatomic location. Understanding the various characteristics of available suture materials will be even more important to make an educated selection.
The amount of suture placed in a wound, particularly with respect to the knot volume, affects inflammation. The suture size contributes more to knot volume than the number of throws. The volume of square knots is less than that of sliding knots, and knots of monofilament sutures are smaller than those of multifilament sutures.
REFERENCES
Allergic Suture Material Contact Dermatitis Induced by Ethylene Oxide: G. Dagregorio, G. Guillet; Allergy Net Article
Materials for Wound Closure by Margaret Terhune, MD; eMedicine Article
Product Allergy Watch: Triclosan; MedScape Article by Lauren Campbell; Matthew J. Zirwas
New References
Surgical Complications; eMedicine Article, May 29, 2009; Natalie L Semchyshyn, MD, Roberta D Sengelmann, MD
Engler RJ, Weber CB, Turnicky R. Hypersensitivity to chromated catgut sutures: a case report and review of the literature. Ann Allergy. Apr 1986;56(4):317-20. [Medline].
Newsweek’s Sharon Begley writes about the phenomenon, which goes a long way why the myth about “death panels” continues to persist in the health reform conversation. She cites the work of sociologist Steve Hoffman, who explains: “Rather than search rationally for information that either confirms or disconfirms a particular belief, people actually seek out information that confirms what they already believe.”
And with a growing majority obtaining their news through pundit-tinged lens, such as from FOX News on the right and MSNBC on the left, there’s always fodder to confirm pre-existing beliefs.
Ms. Begley goes on to suggest that cognitive dissonance is also in play:
This theory holds that when people are presented with information that contradicts preexisting beliefs, they try to relieve the cognitive tension one way or another. They process and respond to information defensively, for instance: their belief challenged by fact, they ignore the latter. They also accept and seek out confirming information but ignore, discredit the source of, or argue against contrary information.
This is seen often in those who believe there is a link between vaccine and autism, despite convincing evidence to the contrary.
And with information freely available on the internet and on the 24-hour cable news cycle, there are endless opportunities to confirm, rather than challenge, one’s beliefs.
*This blog post was originally published at KevinMD.com*
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