June 11th, 2007 by Dr. Val Jones in Medblogger Shout Outs
2 Comments »
Welcome to the latest round up of the best of the healthcare
blogosphere. Today it is my pleasure to offer you your weekly dose of Grand
Rounds, optimized for your state of mind.
I believe that there are two basic types of blog readers, and so you’re
getting Grand Rounds 2 ways (with a dash of cartoons thrown in for extra “feel
good” measure):
- Just
the Facts: Distractible, hurried, currently in between seeing patients –
or perhaps your kids, cats, dogs, llamas are begging for attention… or
maybe you’re an ER nurse or surgeon who has no patience for long winded
stories? You’re category one and
should proceed directly to Grand Rounds IR (immediate release – below).
- All
the Details: Calm, peaceful, you enjoy good prose and a cup of chai
latte. You like reading all the
juicy details of a grand rounds line up and will spend hours picking
through the references – or maybe you’re an Internist or Psychologist who
knows that the best medicine is found in the details? You’re category two and should proceed
directly to Grand Rounds XR (extended release – next post).
Many thanks to Nick Genes, father of Grand Rounds (who acts
behind the scenes to ensure the success of each host), and please check out
next week’s Grand Rounds at Code Blog: Tales of a Nurse.
Grand Rounds IR (asterisk
= honorable mention for great writing)
Happy Posts
*Starbucks Caters to Diabetics
Woman Saved by Bush Pilot in Frozen Tundra
*CEO Says He’s Sorry
Prayer Can Reduce Arthritis Risk?
*Disaster Unpreparedness [Cartoon]
Med School Graduation Ceremony [Cartoon]
Nurse uses Star Trek Mentor to Set Course for Kindness
Galaxy
Shrink Rap Podcast: Prank Call with Dr. Phil McGraw &
More [Cartoon]
*Cape Cod Vacation Derailed by Flood, Stroke, Famine & Infection
The Evils of Hand Washing
Sad Posts
Triage in the ED [Cartoon]
*Sad Cases in ED
Elderly at Risk of Death From Tranquilizers [Cartoon]
Life as a Nurse Assistant in Vermont
Hot Topics
Infanticide
Hucksterism
Healthcare Outsourcing (podcast) [Cartoon]
Blog Censorship A
Blog Censorship B
Arrogant Docs [Cartoon]
Should Kim See Sicko?
Helpful Tips
To Fend off Bears
To Get the most out of Medicine, Web 2.0 style
To Get into Medical
School
To Avoid Kidney Damage from Contrast Agents
To Perform A Pyloromyotomy [Cartoon]
To Diet Successfully – Gluten Free [Cartoon]
Case Reports
Wii-itis
Rare pancreatic tumor
Uncategorized
Cost-benefit analysis of genetic testing
Commencement Speech for Harvard Medical
School Graduation
New Alzheimer’s Research [Cartoon]
New Genetic Research
Book Recommendation for Type 2 Diabetes
For the full text version complete with cheerful commentary, please go to Grand Rounds XR
(next post)
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 11th, 2007 by Dr. Val Jones in Medblogger Shout Outs
5 Comments »
…continued from Grand Rounds 3.38…
GRAND ROUNDS XR
(asterisk = honorable mention for great writing)
Happy Posts
*Kerri from Six Until Me tells the heart-warming story of a
Starbucks Barista who understood her diabetic needs and treated her with
special care.
Traveling Doc from Borneo Breezes Blog, submits a post about
the bush pilots of the Canadian north.
Even though it’s summer time you’ll shudder at this arctic tale of a
native woman whose life was saved by a bush pilot and an Australian surgeon.
Tony Chen of Hospital Impact submits a post by Nick Jacobs, the CEO of Winder Medical Center.
In it Christopher apologizes for being ill tempered and snapping at a
woman who posted a paper sign on the wall.
Dr. Jolie Bookspan of the Fitness Fixer Blog offers a
fascinating look at the physical healing power of prayer. Jolie reports that the movements involved in
Muslim prayer (including standing, bowing, kneeling, and sitting) can promote
flexibility, increase quad strength, and burn up to 80 calories/day. She explains that similar prayer posturing
(found in Russian Orthodox prayer and some forms of yoga meditation) may be
equally useful.
Rita Schwab at MSSP Nexus Blog writes a really funny post
about disaster preparedness. She muses
about how she had been taught to hide under her school desk in case of a
bombing, and even then (at the tender age of 8) wondered how the desk vs. bomb
equation would really pan out for her.
But the real amusement comes when you click on her link to the CDC’s
recommended communication releases on such plagues as tularemia. Yes, the bacterium found in rabbits and
rodents (that perhaps 125 hunters succumb to each year in this country) is not
contagious from human to human and causes flu-like symptoms. I’d give this a fear factor of 1 out of 10. [Cartoon]
Dr. Bruce Campbell of Reflections Blog describes the medical
school graduation ceremony – the first time “doctor” is officially tied to the
graduate’s name. [Cartoon]
Mother Jones, RN from Nurse Ratched’s Place, confesses to
being a trekkie. She did find a good
role model in nurse Chapel, though. Now
here’s my confession: I’ve been known to utter a few “Damn it, Jim-s!” when
asked to do non-medical related work at my current job.
Roy
at Shrink Rap pulls a “Jerky Boys” style practical joke on Dinah. He uses prerecorded audio clips of Dr. Phil
McGraw to simulate a live Skype conversation with her, and gets Dr. Phil to ask
Dinah outrageous questions and give her bizarre advice such as, “I want you to
live as a gay woman.” Poor Dinah falls
for it for a short time… and it’s rather funny, especially if you enjoyed the
Jerky Boys prank call to Hooters with Arnold Schwarzennegger clips. [Cartoon]
Laurie at a Chronic Dose tells a hilarious story of 3 chronically ill family members who experience a comedy of errors during a vacation in Cape Cod. Somewhere between the brain aneurysm, flood, sunburn turned staph cellulitis, and cell phone lost in the ocean, there’s humor in the midst of tragedy.
Susan Palwick from Rickety Contrivances of Doing Good describes the evolution of hand washing requirements for all staff (including chaplans) at her hospital.
Sad Posts
ERnursey from ERnursey: Stories from an Emergency Room Nurse
gives us an eye-rolling perspective on exactly how emergency departments are
abused by drug-seekers and non-emergent cases of ridiculousness. Triage ain’t easy. [Cartoon]
*Type B Pre-med from the blog by the same name, offers a
tear jerking slice of life from the ED.
A woman with breast cancer finds out that it has metastasized to her
brain while a 9 year old sexual assault victim waits for the doctor to see him
next.
Christian Bachmann from Med Journal Watch reminds us that
tranquilizing medications are associated with shorter lifespans in the demented
elderly population. [Cartoon]
Matthew at Path Lab tells the sad story of a bariatric patient’s woes in the hospital, and what daily life is like for nurse assistants.
Hot Buttons
Dr. Tara Smith at Aetiology, discusses the tragedy of
infanticide, and the events that led up to the recent murder of a newborn in Iowa. She asks whether designated “safe havens”
(where mothers can drop off unwanted babies, no questions asked) are not
promoted enough by the media or if the state of mind of a woman who has just
given birth to an unwanted baby wouldn’t be receptive to that messaging.
Dr. Hsien-Hsien Lei interviews the CIO of Suracell Personal
Genetic Health to try to get to the bottom of whether or not nutrigenomic
testing is a form of hucksterism. This
quote followed an objection about nutrigenomic supplements costing more
than similar products in health food stores: “Well, our clients like paying
more for what they believe is something better than the cheaper versions.” Orac should take a look at this.
David Williams of Health Business Blog submits a
thought-provoking podcast of a recent interview he conducted with the founder
(founded in 2002) and creator of Planet
Hospital, Rudy
Rupak. Rudy starts the podcast
explaining that his company arranges surgical treatment for travelers who need
emergent care in foreign countries, but later on explains that the primary
income stream for Planet
Hospital involves
healthcare outsourcing for American women who are “too wealthy for Medicaid and
too young for Medicare” and want cosmetic procedures or IVF done at a lower
price. Rudy then explains that he has a
program called “the best of both worlds” where plastic surgeons travel overseas
to perform their procedures for cash – outside of malpractice laws and with
lower overhead. [Cartoon]
Henry Stern, at InsureBlog comments on the recent loss of
Flea and other medical bloggers. He says
that “There’s a creeping reticence in the blogosphere… and maybe that’s a good
thing.”
Amanda from It’s All About the Walls marries her frustration
with her own health issues with some frustration at the apparent censorship of
certain bloggers.
N=1 from Universal Health offers this challenge – doctors
should try to get outside of their egocentric shells and get to know (and learn
from) all of the knowledgeable, competent allied
health professionals around them, especially nurses. [Cartoon]
Kim at Emergiblog expresses deep inner conflict about going to see Michael Moore’s new movie, Sicko. If she goes, she donates $10 to his cause, if she doesn’t go she’ll be left out of a hot topic of conversation. This is a tough call, fair sister.
Helpful Tips
Dr. Auerbach from Healthline describes how to handle
encounters with bears. I didn’t realize
that humans should respond differently, depending on the kind of bear. Check out what to do if you run into a
Grizzly versus a Black Bear.
Bertalan Meskó from Science Roll lists some “Web 2.0”
activities for patients and physicians alike.
But Bertalan forgot about Revolution Health!
Sarah (a bubbly Aggie from Texas A&M) has some
practical tips on how to get into medical school.
Dr. Joshua Schwimmer from Healthline explains that
Gadolinium used to be the contrast agent of choice for patients with kidney
disease (since the regular iodine-based agents can cause “contrast
neuropathy”) but now new cases of a scleroderma-like condition (called
“nephrogentic systemic sclerosis”) have been associated with Gadolinium. Bottom line: if you have kidney disease, any
sort of contrast dye is risky!
Dr. Lisa Marcucci from Inside Surgery offers up the
technical how-to’s for an open pyloromyotomy to repair baby stomachs. Some little ones are born with a narrow,
thickened area in the junction between the stomach and the intestine so food
can’t pass through. But thank goodness
for surgeons like Lisa who can fix them in a jiff! [Cartoon]
Chronic Babe describes her impulsive eating habits and what
she’s going to do to try to avoid chocolatey, salty days in the future. [Cartoon]
Case Reports
Dr. Ves Dimov of Clinical Cases and Images – Blog –
discusses the New England Journal’s recent case report of Acute Wiiitis
(contracted as an overuse injury from the Nintendo video game Wii remote
control). He rightly points out that as
far as medical nomenclature is concerned, “itis” is more appropriately appended
to the name of the affected body part (e.g. tendon-itis). As far as we know, a Wii remote is not part
of the human body – though one can see how the NEJM editors couldn’t resist
accepting the resident physician’s title selection.
Dr. Iñarrito-Castro from Unbounded Medicine presents a
fascinating case report of an exceedingly rare pancreatic tumor. Beautiful imaging and photos.
Uncategorized
Dr. Keith Robison of Omics! Omics! Blog describes his
thought process of what it might take to determine the underlying genetic cause
for one little girl’s unknown syndrome.
In the end he suggests that it might cost $1 million (to map her entire
genome) and result in no clinically useful benefit. In this cost-benefit analysis, it looks as if
mom got it right – love the child as she is, and spend your money on mobility
enhancing equipment.
Dr. Joe Wright submits his commencement speech (for
Harvard’s graduating class of MDs and DDSs) for your consideration.
Girlvet from Madness: Tales of an Emergency Room Nurse
describes some promising research in Alzheimer’s Disease and how her own mom died in a nursing home from complications of the disease. [Cartoon]
Nurse JC Jones from Healthline, highlights the recent
Wellcome Trust announcement of significant advances in the genetic
underpinnings of several major diseases. She includes a recent photograph of
James Watson (of Watson and Crick fame), who is now 79 years old.
Rachel from Tales of My Thirties highly recommends a book
about Type 2 Diabetes.
SPECIAL BONUS POSTS
Now, because Dr. Val has a keen eye and is very meticulous, she has rounded up some savory morsels that she found on her own – these posts were not formally submitted to Grand Rounds 3.38, but will be included because she’s sure their authors wouldn’t object:
Dr. Richard Reece from MedInnovationBlog summarizes Regina Herzlinger’s arguments for consumer driven healthcare.
PandaBearMD explains why he believes that Chiropractors are quacks – and other controversial issues.
Kevin, MD points out that while websites designed to allow patients to rate doctors are gaining acceptance, websites that allow clients to rate lawyers are causing a legal meltdown.
Dr. Stanley Feld (former President of the American Association of Clinical Endocrinologists) takes a very well argued swipe at Dr. Steve Nissen’s recent article about Avandia in the New England Journal of Medicine.
Dr. Charles exposes the quackery of Dr. Heimlich (of the Heimlich maneuver).
Dr. Au from the Underwear Drawer accidentally summarizes the difference between men and women in a conversation with her husband about whether or not to save an old medical school name tag.
Dr. Rob from Musings of a Distractible Mind offers some hilarious genetic explanations for male/female differences.
Hallway Four captures a fascinating disconnect between what a patient thinks a doctor is doing and what a doctor is actually doing.
Dr. Hildreth at the Cheerful Oncologist gives us 8 ways to cope with a malpractice lawsuit.
Dr. Scalpel presents a case of a scratch (plus toenail fungus) sufferer presenting for a work excuse.
#1 Dinosaur argues that obese doctors are more empathic counselors for obese patients who wish to lose weight.
TBTAM recounts a sexual history dialogue in which a patient had condoms delivered at 5am from a local deli.
Ian from ImpactEDnurse continues the condom refrain with an interesting analogy: how practicing “safe nursing” is like practicing safe sex.
FLASHBACK: And for the all time coolest classic blog post… let’s go back to GruntDoc circa 2004 for a look at the scariest menace in the ED: “Some Dude.”
Thanks for reading! Hope you’ll tune in for our regular Wednesday feature of Revolution Rounds – the best of the 27+ person Revolution Medical Blogger team posts, organized and served up friendly by yours truly.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 23rd, 2007 by Dr. Val Jones in News
1 Comment »
I was struck by two different news stories today – one in the New York Times, and the other in the Washington Post. Although the topics were different, the underlying theme was unified: drug companies (particularly Glaxo Smith Kline?) are coming clean with research data and marketing messages. Sure, it might have taken a law suit by Eliot Spitzer to shine a light on the common practice of witholding negative research information from scientists… and it also may have taken a costly failure of an over-hyped diet pill by a competitor drug company to cause GSK to take the honest marketing track with Alli… But I like this new honesty, however we got to it.
Did you know that drug companies spend billions of dollars to research the safety and effectiveness of their drugs, but then are under no obligation to share what they learn with the general scientific community? No, they share what they want to – generally the studies that show the largest effect or the greatest safety profile. But now, physicians have been given access to the raw data collected in all the trials (showing benefit, no benefit, or harm) conducted by GSK. And they’re having a field day! A new study published in the New England Journal of Medicine is based on an analysis of GSK’s research, where they have found that Avandia (a popular diabetes drug) may put people at higher risk for heart attacks and heart related death.
Now here’s the devil in the details (as Dr. Charles rightly points out): the potential harm has been blown way out of proportion – the media has been citing “a 43% increase in heart attacks/myocardial infarctions and a 64%
increase in death from cardiovascular causes” when another way of stating what the authors found is that 86/14,371 patients or 0.598% of the patients taking Avandia had a heart attack, while 72/11,634 or 0.619% of people
not taking Avandia also had a heart attack. Gee… which sound bite seems more scary?
Honestly, I feel worried for the general public who are now (with the new full disclosure of drug company data) sure to be victims of an onslaught of media hype around all sorts of small differences found in research studies. Believe me, it’s important to sift through all this data to look for early signs of potential drug related health risks – but I think we should be careful before we terrify our patients with scary statistics.
Maybe in the midst of all this new honesty – we can have medical bloggers like Dr. Charles and the Revolution Health team help patients get to the bottom of things without having to have a PhD in biostatistics. We need a voice of reason to translate research data for public consumption. I’ll do my part – but since there are ~6000 research studies published per day in this world… I need some back up. Any takers?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 22nd, 2007 by Dr. Val Jones in Opinion
No Comments »
I realize that my last post has probably left you wondering what on earth bulldozers and ballerinas have to do with medicine. Well, let me lead you down my little mental garden path here and explain.
The dancing event took place right next to the National Academy of Sciences, where the Institute of Medicine (IOM) holds its regular meetings. It was all the more humorous to see these bulldozers (with rose petal-filled buckets) participating in this awkward dance – right in front of the hallowed halls of medicine’s most prestigious scientific body. As I thought about what the IOM stands for – the pursuit of truth through objective scientific analysis – and what these ballerinas were up to (reveling in the whimsy of life) it struck me that good medicine might actually combine the two.
Clearly, there are aspects of a healthy life that cannot be well defined by science. Love, peace, and joyfulness are all nourishing to the mind and body – but quantifying them is rather difficult. The things that grandma taught us – get your beauty rest, be kind to others, get lots of fresh air, marry a loving man (or woman) – are great medicine, and should be the foundation for a life in balance.
However, the science of medicine is also critically important. The media thrives on exaggeration and controversy. If there were a mountain of sand in front of us, and we had the choice to move it with a bulldozer or a teaspoon – the media would have us convinced that the spoon was equally effective. And this is why we are constantly misled about treatments – we hear about efficacy, but we don’t hear about the relative effectiveness compared to other therapies. So cinnamon, for example, is touted as a great new treatment for diabetes, when in fact it is only a teaspoon compared to the bulldozer of insulin.
And so I guess I would summarize my musings this way: good health is a dance near the IOM, with bulldozers instead of teaspoons.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
