Archive for 2015

Home Archive for 2015

Google Glass 2.0 to launch. 74 articles in PubMed on Glass 1.0, some of them rather curious - have a look

Google Glass 1.0 (the first version available to consumers) was a failure in terms of social acceptance and commercial appeal. Yes, there are more than 70 articles in PubMed about Google Glass as of December 2015 but the device never got traction and most of publicity around it was decidedly negative. The second version aims to change that. Here is more information about Google Glass 2.0 from the WSJ:

Here is something not to try:

Texting while driving using Google Glass™: Promising but not distraction-free.
He J, Choi W, McCarley JS, Chaparro BS, Wang C.
Accid Anal Prev. 2015 Aug;81:218-29. doi: 10.1016/j.aap.2015.03.033. Epub 2015 May 26.

And of course, there is this:

Google Glass liability risks.
Frankel J.
Bull Am Coll Surg. 2015 Feb;100(2):39. No abstract available.

There are potential benefits, of course:

Do you see what I see? Insights from using google glass for disaster telemedicine triage.
Cicero MX, Walsh B, Solad Y, Whitfill T, Paesano G, Kim K, Baum CR, Cone DC.
Prehosp Disaster Med. 2015 Feb;30(1):4-8. doi: 10.1017/S1049023X1400140X. Epub 2015 Jan 9.

Whatever the future application of Google Glass is, there will always be allergies:

GlassAllergy: a Google Glass-based solution to empower patients with skin allergies.
Wiesner M, Pobiruchin M, Hetterich C, Pfeifer D.
Stud Health Technol Inform. 2014;205:548-52.

If you think people did not like to wear the digital glasses, how about a digital wig?

New Wearable Computers Move Ahead: Google Glass and Smart Wigs.
Klonoff DC.
J Diabetes Sci Technol. 2014 Jan 1;8(1):3-5. [Epub ahead of print] No abstract available.
PMID: 24876529

The question is still open:

Google Glass: a new dimension in surgical education or just another gimmick?
Waxman BP.
ANZ J Surg. 2014 Nov;84(11):810. Review. No abstract available.

References:

PubMed search on Google Glass

Lead Contamination of Tea - how much tea is safe to drink per day?

There is a good explanation in the video below, by Dr. Greger:

Regarding lead contamination of tea from China, his recommendation is to drink no more than 3 cups of black tea per day.

Malaria - NHS video

NHS Choices: Malaria is a parasitic infection spread by mosquitoes. This video explains how malaria is treated and what can be done to help prevent contracting the disease.

Genes are not really our genes. It is we who belong to them for a few decades

From OHCM and Thomas Browne, Religio Medici, 1642: "We all labor against our own cure; for death is the cure of all diseases."

Most patients are told less than they want. Yet nothing you can say to your patient can ever be relied upon to tame death's mystery.

Death is nature's master stroke, albeit a cruel one, because it allows genotypes space to try on new phenotypes. Our bodies and minds are these perishable phenotypes.

The genes are not really our genes. It is we who belong to them for a few decades.

These are excerpts from the Oxford Handbook of Clinical Medicine. Read more on page 6-7:

The OHCM mentions JS Bach's cantata in contemplation of death Ich habe genug (I've had enough):

Carbon monoxide - NHSChoices video

NHSChoices: Carbon monoxide poisoning kills around 50 people a year in the UK. An expert explains how the gas affects the body, the symptoms it causes and how to treat it.

http://www.youtube.com/watch?v=Wh8tqEV9E2A

Deep Purple are 2016 Rock Hall of Fame Inductees

From Rock Hall in Cleveland, Ohio:

If there were a “Mount Rushmore Of Hard Rock” it would only have three heads: Led Zeppelin, Black Sabbath and Deep Purple.

Deep Purple combined outstanding musicianship with dozens of FM radio smashes. Three separate incarnations of the band have made spectacular albums culminating with Deep Purple In Rock, which along with Led Zeppelin II and Black Sabbath’s Paranoid created the genre of hard rock music. Deep Purple have sold over 100 million albums and their flagship track “Smoke On The Water” eclipses “Satisfaction,” “Born To Run” and “Smells Like Teen Spirit” as the Number One Greatest Guitar Riff Of All Time. It is the riff that inspired tens of millions of guitarists to pick up the instrument and only Beethoven’s Fifth Symphony gives it a run for the money as far as recognizability and badassed-ness.

The wait is over! Meet the #RockHall2016 Inductees: @cheaptrick, @chicagotheband, @_DeepPurple, @SMBofficial + #NWA! pic.twitter.com/50Lg8xnpKt
— Rock Hall (@rock_hall) December 17, 2015

Genius guitarist Ritchie Blackmore fused countless powerhouse riffs with a deep knowledge and appreciation of classical music. Keyboardist Jon Lord kept pace on the classical and rock fronts and cemented the guitar/keyboard axis that defined the band’s sound, and along with Zeppelin and Sabbath gave birth to an entire genre. Ian Gillian’s vocal range was unparalleled and the boiler room rhythm section of Roger Glover and Ian Paice cemented the classic lineup. Original vocalist Rod Evans and the David Coverdale/Glen Hughes lineups also created masterpieces of their own. Deep Purple are and were a band of supremely talented musicians and songwriters. Their groundbreaking albums and ear drum breaking live shows are the stuff of legend.

See more at: https://rockhall.com/inductees/nominees/2016-deep-purple/#sthash.h2T84QQO.dpuf

Congratulations to all fans and band members! I would like to think that Deep Purple being featured by University of Chicago helped at least a little bit with the Rock Hall of Fame induction... :)

Rock Star Doctors: What Physicians Can Learn from Musicians « Science Life Blog « University of Chicago Medicine

Thank you, Matt Wood @woodtang

Related reading:

Deep Purple's Ian Paice on Rock and Roll Hall of Fame Induction: 'At Last!'. Rolling Stone, 2015.
Read Lars Ulrich's Passionate Deep Purple Rock Hall Induction, 2016 http://buff.ly/1YzuBkc

Good communication makes our work interesting, richer and deeper

Good communication makes our work interesting, richer and deeper. But empathy may dry up over time, hence the need to refresh/recharge periodically.

The most open question is "How are you?" The direction a patient chooses offers valuable information during this first "golden" minute in which you are silent.

Share management plans: "What can we do about this"? Unless you become patient-centered, your patient may never be satisfied with you, or fully cooperative.

Every hospital has a department of reflection. It exists in your mind, don't forget to visit there from time to time.

These are excerpts from the Oxford Handbook of Clinical Medicine. Read more on page 4, Asking questions:

Here is the famous Cleveland Clinic video "Empathy: The Human Connection to Patient Care: Patient care is more than just healing -- it's building a connection that encompasses mind, body and soul. If you could stand in someone else's shoes . . . hear what they hear. See what they see. Feel what they feel. Would you treat them differently?"

App uses a network of smartphones to help research cancer: your phone crunches numbers while your sleep

The company DreamLab says will allow users to "donate" their smartphone's processing power while their owners are sleeping:

"Cancer affects so many of the people we love. But what if you could help by speeding up cancer research, simply by going to bed. Researchers are hindered by limited access to supercomputers. So that’s where you and the DreamLab app come in. It’s a free to purchase app* that uses the processing power of your idle phone to solve a piece of the cancer research puzzle. If just 1,000 people used the app, cancer puzzles would be solved 30 times faster."

http://www.vodafone.com.au/aboutvodafone/vodafoneaustraliafoundation/dreamlab

"When a phone is plugged in and fully charged, it is sent a tiny genetic sequencing task by Australia's Garvan Institute of Medical Research to solve. When it is completed, the data is sent back to the Garvan Institute, which can use it as part of their research.

Users can select what project they want to contribute to, whether it is breast cancer, ovarian cancer, pancreatic cancer and prostate cancer. According to Vodafone, 1,000 smartphones using the app can speed up research by 30 times.

While the service can use a significant amount of data, users can choose limits of 250MB, 500MB and 1GB to send, with the data free for Vodafone Australia customers, or available to send over WiFi."

References:

Vodafone app turns your smartphone into a powerful cancer research machine - Telegraph http://buff.ly/1iNFvnr
App creates 'smartphone supercomputer' to cure cancer http://buff.ly/1NZgbpD
DreamLab - Android Apps on Google Play http://buff.ly/1kkrhfm

How to avoid doctor dependency

How to avoid doctor dependency:

Buy stuff over the counter
Take advice from grandma
Use self-made remedies, e.g. lemon and honey or sensible complementary therapies
Team up with people with the same condition for mutual support
Augment your own mental health and resilience
Rest or exercise
Eat a sensible diet

These are excerpts from the Oxford Handbook of Clinical Medicine:

Reply to comment below:

Yes, the OHCM is great. It's probably one of the most valuable medical textbooks I have ever encountered, It pays off to re-read it from time, at least with every new edition. I have recommended it to residents and students here in the US but Pocket Medicine and other handbooks are more popular here.

"Don't go so fast: we're in a hurry!"

"Don't go so fast: we're in a hurry!" -- Talleyrand to his coachman. Charles Maurice de Talleyrand-Périgord (1754–1838) was a French bishop, politician and diplomat. Due to a lame leg, he was not able to pursue the military career that had originally been foreseen for him by his family. Instead he studied theology. Unique in his own age and a phenomenon in any, Charles-Maurice, Prince de Talleyrand, was a statesman of outstanding ability and extraordinary contradictions. He was a world-class rogue who held high office in five successive regimes.

---

From OHCM: "We aim to encourage the doctor to enjoy his patients: in doing so we believe he will prosper in the practice of medicine."

Aim to:

- reassure
- treat
- refer
- palliate

These are excerpts from the Oxford Handbook of Clinical Medicine:

References:

Charles Maurice de Talleyrand-Périgord - Wikipedia, the free encyclopedia http://buff.ly/1LfmuUV
Amazon.com: Talleyrand (9780802137678): Duff Cooper: Books http://buff.ly/1Lfmvs5

AA: 2015 Nobel Prize in Physiology/Medicine goes to discoverers of antimicrobials Artemisinin and Avermectin

From DW:

Youyou Tu, the chief professor at the China Academy of Traditional Chinese Medicine, began her work with traditional herbal remedies in the 1960s.

Focussing on plant Artemisia annua, Tu extracted the active Artemisin ingredient found in plants, then purified it. Tests conducted by the now 84-year-old showed her trials had “unprecedented potency” in treating Malaria, which infects close to 200 million people every year. The infection leaves more than 450,000 people dead globally annually, with most of the victims being children.

The other 2015 Nobel prize was for another antimicrobial therapy with an "A", Avermectin.

Nobel Medicine Prize 2015 - Announcement And Explanation:

Read more here:
http://buff.ly/1VALadf
Nobel Prize for anti-parasite drug discoveries - BBC News http://buff.ly/1M6DTkL

Full video is below (42 minutes):

70,000 Ways to Get Sick or Die - the switch to ICD-10 in US

From the WSJ: Under a new system, the number of diagnostic codes doctors must use to get paid is expanding from 14,000 to 70,000, including codes for ailments such as "underdosing of caffeine" (video):

Here are some of the new codes:

- Z63.1: “Problems in relationship with in-laws”
- V91.07XA: “Burn due to water skis on fire.”

At the end of the day, this code probably applies to the majority of healthcare administrators in the US today:

F43.22: “Adjustment disorder with anxiety.”

References:

There Are Now Officially 70,000 Ways to Get Sick or Die. Bloomberg, 2015.
http://goo.gl/NMJsab

Extroverts and neurotics tend to use Facebook and WhatsApp more

From a recent study:

20% of smartphone behavior can be accounted for by WhatsApp usage, and females use it 13 minutes longer than males.

Extroversion is of high importance in understanding WhatsApp usage, extroverts use it longer vs introverts.

High neurotics tend to use Facebook more as it facilitates communication without face-to-face interaction.

On the other hand, conscientiousness is inversely correlated with WhatsApp usage. Conscientious humans handle their digital consumption better and are less prone to Internet addiction.

Are you conscientious? Conscientious humans can be described as punctual, and diligently follow their daily routines.

Status updates. Image source: WeBlogCartoons, Creative Commons license.

In related research, there was no good news for science uses of social media:

I Like, I Cite? Do Facebook Likes Predict the Impact of Scientific Work? http://buff.ly/1LPj4Io - Not really.

Impact of Social Media on Dissemination and Implementation of Clinical Practice Guidelines: Zero http://buff.ly/1LPj5fH

References:

Smartphone usage in the 21st century: who is active on WhatsApp? Christian Montag et al. BMC Res Notes. 2015; 8: 331.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522968/

Healthcare social media #HCSM - top articles

Here are my suggestions for some of the top articles related to healthcare social media (#HCSM) in the past 4-8 weeks:

Integration of Social Media in Emergency Medicine Residency Curriculum - Annals of Emergency Medicine http://buff.ly/1CcfgM9

Collaborative Economy Honeycomb http://bit.ly/1zoBreN - Not many companies in healthcare/wellness...

Risks in Using Social Media to Spot Signs of Mental Distress - NYTimes http://nyti.ms/1xYFumq -- NIH committed $11 million to support studies into using Twitter and Facebook to better understand substance abuse. Classification algorithm predicts whether a person was vulnerable to depression, from their Twitter posts, 70% accurate. “We could compute the unhappiest places in the United States,” Dr. Horvitz said. Social media analysis might also eventually be used to identify patterns of post-traumatic stress disorder immediately after events like tsunamis or terrorist attacks. “You can see the prospect of watching a news story break and using these tools to map the pulse of society.”
ike Twitter and Facebook to better understand, prevent and treat substance abuse.

20 Blogging Tips for Writing a Successful Blog http://buff.ly/16Xsu5q

Facebook can leave you with FOMO (fear of missing out) or even MOMO (mystery of missing out)? http://bit.ly/13Pj0aj

The selfie trend has increased plastic surgery in the US. Almost all the smartphones launched in 2014 have special functions to take selfies. The #selfie trend spins money for businesses - all new phones have selfie-friendly front cameras and apps. Selfie stick, a must have gadget http://buff.ly/13JzPDm

An evidence-based review: Distracted driver http://buff.ly/1xCGg5U

Learn to Embrace the Digital Detox - WSJ guide. Digital Detox: Participants trade smartphones for smarter life choices: exercise, art and face-to-face conversation. People don’t think they are addicted to technology because it’s so ingrained in our everyday life. “People don’t often recognize the effect their behavior has on them and those around them" http://buff.ly/1BqNc6D

Good to know for all us here: No increased stress from heavier social media use: survey | Reuters http://buff.ly/1Busk21

Student class standing, Facebook use, and academic performance = "it's complicated" relationship status http://buff.ly/15ujBiH

Establishing an International Consensus on Quality of Emergency Medicine and Critical Care Blogs and Podcasts http://buff.ly/1NCDSHn

Emergency Medicine Journal Club on Twitter: free, asynchronous way to engage a worldwide audience http://buff.ly/1aOsUfX

"A personal reflection on social media in medicine: I stand, no wiser than before" http://buff.ly/1IMgpNg -- “On your death bed, what do you think your biggest regret will be? … that you didn’t TWEET ENOUGH?”

The articles were selected from Twitter @DrVes and RSS subscriptions. Please feel free to send suggestions for articles to clinicalcases at gmail.com and you will receive an acknowledgement in the next edition of this publication.

Cycle of Online Information and Physician Education (click here to enlarge the image).

"Bio-detection" dogs in trial to be used for prostate cancer sniffing

Many urologists agree that the PSA test for detecting prostate cancer is often unreliable, but it remains widely used because there are no other relatively inexpensive tests. Researchers in Britain say this method may soon be replaced with dogs trained to sniff out the type of cancer that, according to the American Cancer Society, affects one in every 7 men. VOA’s George Putic reports:

It takes 6 months to train a dog to detect prostate cancer. According to the report, trained dogs can detect prostate tumors in urine in 93 percent of cases.

"These dogs have the ability to screen hundreds of samples in a day; it's something they find very easy, they enjoy their work. To them it's a hunt game - they find the cancer."

The alternative, "electronic nose" sensitivity is well below the one of a dog. A dog can find 1 part per trillion. An electronic nose is unable to find anything below 1 per million.

References:

Cancer sniffing dogs to aid British doctors. Reuters. http://buff.ly/1PWNrOL

All about hair loss (alopecia) - Deutsche Welle expert interview

Dr. Andreas Finner (Trichomed Praxis Berlin) talks about what everyone can do to keep a full head of hair and about the best methods for treating hair loss:

Today's Hair-Loss Treatments: Drugs

Minoxidil shampoo

Patients can buy an OTC shampoo with an ingredient called minoxidil. Minoxidil (Rogaine) fights androgenic alopecia in both men and women. It's still not entirely clear how minoxidil works. Used properly -- twice a day, massaged deep into the scalp -- it slows new hair loss. Two-thirds of men do get acceptable hair growth. "It is not something a bald person would use, but someone starting to go bald would use it. The goal is to maintain the hair you have."

An example from Amazon:

Propecia pill

Propecia (finasteride) works only for men. It keeps the male sex hormone testosterone from forming its DHT by-product. Many men use both minoxidil shampoo and Propecia pill for maximum effect.

Today's Hair-Loss Treatments: Surgery

Surgeons can transplant hair follicles from the sides and back of the head to the top of the head.

Future Hair-Loss Treatments

- "Hair cloning" although a more accurate name is hair duplication. Follicular stem cells are packaged into follicle-inducing implants.

- Gene therapy. A gene called sonic hedgehog can convert resting hair into growing hair.

Sonic the Hedgehog animation character from Amazon:

References:

Future Hair-Loss Treatments Promise What's not Hair Today will Be Hair Tomorrow. WebMD.

Hidradenitis Suppurativa

Hidradenitis suppurativa, also known as acne inversa, is a chronic skin disease characterized by recurrent boil-like lumps (nodules) under the skin. Hidradenitis suppurativa was once thought to be a rare condition because only the most severe cases were reported. However, recent studies have shown that the condition affects at least 1 in 100 people when milder cases are also considered.

There are three levels in the management of hidradenitis suppurativa:

- topical options
- systemic options
- surgical methods including laser therapy

Dr. Christian Baum, a Mayo Clinic dermatologist, takes a look at a chronic skin condition called hidradenitis suppurativa: overview of the condition and treatment possibilities.

References:

Hidradenitis suppurativa: a review of cause and treatment. Curr Opin Infect Dis. 2011 Apr;24(2):118-23. doi: 10.1097/QCO.0b013e3283428d07.
http://www.ncbi.nlm.nih.gov/pubmed/21192260

Hidradenitis suppurativa. NIH http://buff.ly/1Jiligz

Carpal tunnel syndrome animation

NHSChoices: Carpal tunnel syndrome (CTS) is a condition that causes pain, numbness and a burning or tingling sensation in the hand and fingers. Watch this animation and find out what the carpal tunnel is and what causes CTS.

http://youtu.be/F3VryalTK14

"Gluten sensitivity" may be caused by FODMAPs in everyday foods: Fructose in fruit, Lactose in milk, Galactans in beans, Polyols in chewing gum

FODMAPs is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. FODMAPs are sugars that draw water into the intestinal tract. They may be poorly digested or absorbed, and become fodder for colonic bacteria that produce gas and can cause abdominal distress.

FODMAPs are FLF-GP:

- Fructose: A sugar found in many fruits (hence the name), for example, apples, pears, watermelon, mangoes, grapes, blueberries, tomatoes and tomato concentrate, and all dried fruits; vegetables like sugar-snap peas, sweet peppers and pickles; honey; agave; and jams, dressings and drinks made with high-fructose corn syrup.

- Lactose: Sugar in milk from cows, goats and sheep, present in ice cream, soft cheeses, sour cream and custard.

- Fructans: Soluble fiber found in bananas, garlic, onions, leeks, artichokes, asparagus, beets, wheat and rye.

- Galactans: Complex sugars prominent in dried peas and beans, soybeans, soy milk, broccoli, cabbage and brussels sprouts.

- Polyols: Sugar alcohols (sweeteners) isomalt, mannitol, sorbitol and xylitol, present in stone fruits like avocado, cherries, peaches, plums and apricots.

People with irritable bowel syndrome (IBS) or gluten sensitivity often find that their symptoms lessen or disappear when avoiding foods rich in FODMAPs; however, it can take 6-8 weeks on a low-FODMAPs diet to see a significant improvement.

References:

When Gluten Sensitivity Isn't Celiac Disease - NYTimes.com http://nyti.ms/1EmXFDl
Celiac disease and nonceliac gluten sensitivity - 2017 review in Annals of Allergy, Asthma & Immunology http://buff.ly/2pI2x61

Ankylosing spondylitis (AS) - NHSChoices video

NHSChoices: Ankylosing spondylitis is a type of arthritis that affects parts of the spine. In this video, an expert describes the long-term effects of the condition, its most common symptoms and the different treatments available.

http://www.youtube.com/watch?v=1cYuwDkykoA

What happens when someone gets heat stroke? TED-Ed video

Have you ever suffered from exertional heat stroke? This condition is caused by intense activity in the heat and is one of the top three killers of athletes and soldiers in training. Douglas J. Casa explains heat stroke's tremendous effects on the human body and details an action plan in case it ever happens to someone you know.

Lesson by Douglas J. Casa, animation by Cinematic.

Bedbugs - National Geographic video

An army of these can attack a person 500 times in one night:

How To Get Rid of Bed Bugs - The Home Depot video:

Healthcare social media #HCSM - top articles

Here are my suggestions for some of the top articles related to healthcare social media (#HCSM) in the past 2-4 weeks:

Impact of Social Media on Dissemination of Research: close correlation between when I tweet the paper and downloads. Prior to me blogging and tweeting about the paper, it was downloaded twice. After, it immediately got 140 downloads http://buff.ly/1yf4ylW

Is It Okay to Choose a Children's Hospital Based on Social Media Presence? http://buff.ly/10mSLae - Apparently, yes, it works.

Self-organization on social media: endo-exo bursts and baseline fluctuations. http://buff.ly/10mTMzc - Twitter is an excitable medium

Naturally Occurring Peer Support through Social Media - Study of Individuals with Mental Illness Using YouTube http://buff.ly/10n1U2t

Online Mate-Retention Tactics on Facebook Are Associated With Relationship Aggression (study) http://buff.ly/1oC0Anl

Wikipedia Emerges as Trusted Internet Source for Ebola Information http://buff.ly/1DterO5

Reputation only: US News & World Report will use Doximity as sole source for physician surveys for "Best Hospitals" http://buff.ly/1ycubDy

The Web Is Dying; Apps Are Killing It - mobile users spend 86% of their time on apps and only 14% on the Web - WSJ http://buff.ly/1xx4QHM

Blogging References for ACR 2014 Social Media Bootcamp http://buff.ly/1EUOnhs

A quick list to Social Media Guidelines for Medics: take your pick http://buff.ly/1qd7y2S

Improving your account security - advice from Google engineer Matt Cutts http://buff.ly/1pcewEs

How to active Find my iPad/iPhone http://buff.ly/1pcfjp4 -- Find my Android device http://buff.ly/1tdoiTo

We found a way how not to use social media, if you run a medical journal http://buff.ly/1xU6iEf

Make social media promotion a "standard of care." Here's how you prove it: Create social media posts for a study and include shortened links. Count the clicks on those links. If that number is greater than zero, the post increased article readership. http://buff.ly/1zRQgZh

The articles were selected from Twitter @DrVes and RSS subscriptions. Please feel free to send suggestions for articles to clinicalcases at gmail.com and you will receive an acknowledgement in the next edition of this publication.

Cycle of Online Information and Physician Education (click here to enlarge the image).

Duty calls. Image source: Xkcd.com, Creative Commons license.

Neurological center at Cleveland Clinic Florida: Egil and Pauline Braathen Center

A look inside the Egil and Pauline Braathen Center -- the brand new 144,000 square foot Braathen Center houses world-class neurological services and comprehensive cancer program (video):

"Born in London, Mrs. Braathen was a fashion model and buyer and subsequently developed her own fashion business. She married Egil Braathen, a Norwegian businessman, who became one of the country’s wealthiest men, owning and developing property throughout Norway and in other parts of the world, including the United States. He died in 2009, after suffering the debilitating effects of Alzheimer’s disease for more than a decade. Today Mrs. Braathen is a resident on the private apartment ship “The World,” traveling all over the globe but always returning to Cleveland Clinic Florida for her medical care.

“Through this donation, I want to celebrate my husband’s genius and success, in the certain belief that it will improve many lives for years to come,” Mrs. Braathen said."

It all started with a love story and Mrs. Braathen had written a book about it:

http://memoirsofamarriage.com/Memoirs_of_A_Marriage/Memoirs_of_a_Marriage.html

Related:

Cleveland Clinic Braathen Center Opening
https://www.youtube.com/watch?v=L7wWuo1g0Ww

$30 Million Gift Will Transform Neurology
http://floridacampaign.clevelandclinic.org/news/30-million-gift-will-transform-neurology/

Braathen Center Opens in Florida
http://giving.clevelandclinic.org/articles/braathen-center-opens-florida

Disclaimer: I am an Allergist/Immunologist, Cleveland Clinic Florida and a Clinical Associate Professor, FAU Charles E. Schmidt College of Medicine.

How to combine exercise and diet in one acivity: Should hospitals teach patients how to grow vegetables?

Google has a vegetable garden

Google was doing it in 2007: In Growing our connection to food, Google explained they launched a mini-farm on campus with 300 self-watering containers. The correct name for the containers is sub-irrigated planters (SIPs) and they can be purchased commercially ($30) or made from plastic totes.

Sports team has a mini-farm

San Francisco Giants have a mini-farm on their stadium growing kale, Swiss chard, lemon grass, sage and more. The garden—one of the first of its kind at an American sports stadium—comes as a bizarre sight to some fans who associate stadiums with more traditional fare. But the Giants say that the Garden, as they call it, promotes healthy eating. In a city with no shortage of fussy foodies, it has attracted its share of devotees.

Hospitals could be next

The Giants garden may be an almost utopian oasis of tranquility, with its rows of lushly packed planter beds and water-conserving, vertical garden towers. But it is also a popular vantage point—complete with tables and seating. Fans who want to stay planted inside the garden can still watch the game action through a series of cutouts in the center-field wall or follow it on one of TVs.

Quoting the late author Lewis Grizzard, it reads: “It’s difficult to think anything but pleasant thoughts while eating a homegrown tomato.”

It is possible that hospitals that focus on wellness initiatives may be interested in launching their SIP-powered gardens as an educational initiative for patients and staff.

Related videos:

Google Garden Planting. Executive Sous-Chef Jennifer Johnston leads a team of volunteers to plant a Growing Connection garden on Google campus.

Google Garden Harvest. Rebecca Jepsen from Santa Clara County Master Gardeners helps Jennifer maintain and harvest the garden.

The Growing Connection Gardens at Google. Google Chief Internet Evangelist and Co-Chair of the Global Advisory Board of The Growing Connection Vint Cerf stopped in and helped unveil The Growing Connection's Gardens at the Googleplex on May 1, 2007.

References:

Official Google Blog: Growing our connection to food http://buff.ly/1oC2lkr

For San Francisco Giants, the Star of This World Series Is a Vegetable Garden - WSJ http://buff.ly/1sY8qpM

"Food gardening is the most intelligent adult endeavor on earth and ought to be understood by anyone who eats. You eat healthier, fresher, tastier food, enjoy gentle exercise, and make new friends." Source: http://amzn.to/RpbdJx

Gardening helps you burn calories - 160 calories for 30 minutes of gardening http://buff.ly/1ekjB7L

Why Gardening is Good for Your Health (infographic) http://bit.ly/10JAhzU

He who plants a garden plants happiness. — Chinese proverb

Medical jokes portray an unflattering picture of doctors in general

From this French study:

Sociological studies have shown the link between humor and unconscious ideas that we have of the society in which we evolve. Researchers conducted a survey to answer the question: "What were the stereotypes of our medical profession that emerge from a transcript of jokes collected in a medical population?"

Recruitment of the source population (doctors and medical students) was done through different personal and professional mailing lists, Twitter, Facebook, and medical press. The inclusion period was 6 weeks (from June 6 to July 14, 2013). Each physician recruited received the link to the study authors' blog: http://humourmedical.overblog.com which contained a link to the questionnaire.

Physicians responded to the following simple proposition: "tell the joke involving doctors you laugh the most".

Analysis of jokes was made by 3 investigators. First, two investigators pooled of results to generate a stereotype for each joke. Then a triangulation was made with a third investigator, to determine the final stereotype.

512 jokes were collected on the site and 448 were included in the analysis. The gender of respondents was 284 men (63%) and 164 women (37%).

156 different stereotypes were classified into 6 themes:

- Anesthesiologists were represented as lazy, inveterate coffee drinkers and less awakened than their sleeping patients.

- Surgeons were seen as megalomaniac, tyrannical with other professions, operating without thinking, as their "brain down to a neuron."

- Medical students appeared docile and absurd.

- Psychiatrists were as "crazy as their patients, sometimes passing them to the consultation and looking only at their past relationship."

Researchers claim that the stereotypes contained in the medical jokes were quite caricatured and portrayed an unflattering picture of doctors in general.

Video: "You can never Trust Doctors" (embedded above).

I'm sure some patients and doctors will not find this Eurosport commercial funny, and they probably have a point. Humor may be difficult to explain and interpret. Some social media "experts" even advise doctors not to use humor on Twitter, Facebook and blogs for fear of misinterpretation and legal repercussions.

However, humor is what makes us human. It can also help with the healing process and provide some relief at a time when you need it the most. The commercial above may not provide the best example for that particular purpose but I think you get the point.

Comments from Twitter: @scanman: Ha!! I do this ALL THE TIME!!!

References:

[The jokes are vectors of stereotypes. Example of the medical profession from 220 jokes.] [Article in French] Presse Med. 2014 Oct 2. pii: S0755-4982(14)00419-9. doi: 10.1016/j.lpm.2014.05.013. [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/25284735

Offer new treatments only as part of post-market trials until data on meaningful outcomes are available, says Ben Goldacre to BMJ

Watch the video from the BMJ channel below:

High-fructose sweeteners are a principal driver of type 2 diabetes

High-fructose sweeteners are a principal driver of type 2 Diabetes Mellitus and its consequences, according to a recent report in the journal Mayo Clinic Proceedings. Conversely, whole foods that contain fructose (eg, fruits and vegetables) pose no problem for health and are likely protective against diabetes and adverse CV outcomes. Read more here: http://www.mayoclinicproceedings.org/article/S0025-6196(15)00040-3/abstract

Our own Dr Hyman discusses How to Avoid the Hidden Dangers of High Fructose Corn Syrup in this video from the official Cleveland Clinic YouTube channel: "Dr. Mark Hyman, explores the many ill effects of high fructose corn syrup and offers strategies to avoid it. He says this sweetener can only be processed by the liver, causing what he calls a "fat production factory" in your body."

Disclaimer: I am an Allergist/Immunologist, Cleveland Clinic Florida and a Clinical Associate Professor, FAU Charles E. Schmidt College of Medicine.

This is what happens when social media sites go too far

From Ray Ray, gardener and YouTube star: "This is what happens when social media sites go too far. Mr Zuckerberg, there are certain things you (Facebook) can NOT have from me."

Facebook Launches Suicide Prevention Initiative - WSJ video

Facebook is partnering with suicide prevention organizations on a new tool to identify people in distress. Forefront research scientist Ursula Whiteside discusses the project with Sara Murray.

"A life is like a garden. Perfect moments can be had, but not preserved, except in memory"

A life is like a garden. Perfect moments can be had, but not preserved, except in memory. LLAP
— Leonard Nimoy (@TheRealNimoy) February 23, 2015

Don't smoke. I did. Wish I never had. LLAP
— Leonard Nimoy (@TheRealNimoy) January 11, 2015

Most cancers caused by "bad luck" in cell division and "poor repair" of the defect

Researchers at Johns Hopkins University studied 31 different cancers. Of those, just 9 were found to be linked to bad genetics or unhealthy lifestyle choices. However, researchers excluded two of the most common cancers from their study, breast cancer and prostate cancer (published in the journal Science).

The most common cause of the production of most cancerous cells occurs when one chemical letter in DNA is incorrectly swapped for another during stem cell division. Scientists found that cancer rates were higher in parts of the body where cells are quickest to regenerate, thereby creating more random mutations.

Genetic mutations that randomly crop up as our stem cells divide are “the major contributors to cancer overall, often more important than either hereditary or external environmental factors.”

BBC: New research suggests most types of cancer are the result of bad luck, rather than unhealthy lifestyles, diet or even inherited genes.

References:

Study concludes that many cancers caused by bad luck in cell division | Fox News http://buff.ly/1xebIsy
Besides Lifestyle and Inherited Genes, Cancer Risk Also Tied to Bad Luck - WSJ http://buff.ly/1xebVMw

Ironstrength, the Doctor's Total-Body Exercise Routine - New York Times video

Dr. Jordan Metzl is a sports medicine physician who developed an extreme total-body workout routine called Ironstrength. He now teaches free exercise classes all around New York City. Produced by: Colin Archdeacon.

Myelodysplastic Syndromes / Myeloproliferative Disorders

What are myelodysplastic syndromes?

Myelodysplastic syndromes are clonal marrow stem-cell disorders, characterized by ineffective hemopoiesis leading to blood cytopenias, and by progression to acute myeloid leukemia in a third of patients.

Who is affected?

15% of cases occur after chemotherapy or radiotherapy for a previous cancer. The syndromes are most common in elderly people.

What is the cause?

The pathophysiology involves cytogenetic changes with or without gene mutations and widespread gene hypermethylation at advanced stages.

What are the symptoms?

Clinical manifestations result from cytopenias (anemia, infection, and bleeding).

How to make the diagnosis?

Diagnosis is based on examination of blood and bone marrow showing blood cytopenias and hypercellular marrow with dysplasia, with or without excess of blasts. Prognosis depends largely on the marrow blast percentage, number and extent of cytopenias, and cytogenetic abnormalities.

What is the treatment?

Treatment of patients with lower-risk myelodysplastic syndromes, especially for anaemia, includes growth factors, lenalidomide, and transfusions.

Treatment of higher-risk patients is with hypomethylating agents and, whenever possible, allogeneic stem-cell transplantation.

In this first video in the series, Myeloproliferative Neoplasms 2015 - Mayo Clinic, Ruben Mesa, M.D., professor and hematologist at Mayo Clinic in Arizona, discusses the treatment and management of myeloproliferative neoplasms as well as shares highlights from the 56th Annual American Society of Hematology (ASH) meeting in San Francisco, December 2014.

Here is the complete playlist:

https://www.youtube.com/playlist?list=PLSWR1ylG_6JZKr0ChD4N_8MJ3g3FnF08S

References:

Myelodysplastic syndromes : The Lancet http://buff.ly/VwiRor

Keratitis and Contact Lens Use - CDC video

Misuse of contact lenses (wearing them too long, not cleaning them properly) causes 1 million eye infections/yr in US. "Contact lenses offer many benefits, but they are not risk-free. Keratitis can be a scary infection, but it is preventable if people follow healthy habits and take care of their eyes and their lenses". Some bad habits, such as sleeping with contact lenses, failing to clean and replace lens solution frequently, and letting contact lenses get wet while swimming or in the shower, greatly raises the risk for keratitis. People who wear their contact lenses overnight are more than 20 times more likely to get keratitis. http://buff.ly/1xw4iSn

A few basic 'contact lens hygiene' measures can keep patients free of keratitis -- Keratitis and Contact Lens Use - CDC, YouTube:

Tracking Sleep With Wearables Literally Changed My Life - The Medical Futurist

From Bertalan Mesko: "I use wearable gadgets to measure the quality of my sleep and as some of the subscribers asked me how I do that in details step by step, I thought I would share the whole process and my methods in one video. I hope you will find it useful."

Wearing a Weapon: The Football Helmet's Dangerous Evolution

The history of how helmets arrived on the football field, from TIME:

Don't trust celebrities for health advice -- How did the anti-vaccination movement begin? (CNN video)

How did the anti-vaccination movement begin? CNN's Deborah Feyerick takes a look at the origins behind the anti-vaccination movement and how is has impact the measles outbreak.

How to Treat Dandruff - video by American Academy of Dermatology

Dandruff is a common scalp condition in which small pieces of dry skin flake off of the scalp. The most effective way to treat and control dandruff is to use dandruff shampoo and scalp treatments. Some patients may need to use several different shampoos in succession. Follow these tips from dermatologists to get the best results.

Social epidemic of "diabesity" and community-driven solutions - Mark Hyman at TEDMED 2012

Unhealthy lifestyles have brought on a social epidemic of "diabesity," says author Mark Hyman, and community-driven solutions may be the only way out.

Sparring Injuries

Martial arts instructor Jake Mace tells the story behind his scar and arm fracture:

How to Engage Doctors in the Healthcare Reform - Practical Advice from Cleveland Clinic CEO

CEO & President, Dr. Toby Cosgrove reflects on Engaging Doctors in the Healthcare Revolution:

From the article in Harvard Business Review (http://bit.ly/1y1iyOI): "Fixing health care will require a radical transformation, moving from a system organized around individual physicians to a team-based approach focused on patients. Doctors, of course, must be central players in the transformation: Any ambitious strategy that they do not embrace is doomed.

And yet, many physicians are deeply anxious about the changes under way and are mourning real or anticipated losses of autonomy, respect, and income. They are being told that they must accept new organizational structures, ways of working, payment models, and performance goals. They struggle to care for the endless stream of patients who want to be seen, but they constantly hear that much of what they do is waste. They’re moving at various rates through the stages of grief: A few are still in denial, but many are in the second stage—anger. Bursts of rage over relatively small issues are common."

How to move forward?

The authors suggest a framework based on the writings of the economist and sociologist Max Weber, who described 4 motivations that drive social action (that is, action in response to others’ behavior). Adapted for health care professionals, these are:

- shared purpose
- self-interest
- respect
- tradition

"Leaders can use these levers to earn doctors’ buy-in and bring about the change the system so urgently needs.

Sometimes the story of a single patient is enough to galvanize doctors’ buy-in. In 2008, for example, a patient called the Cleveland Clinic’s urology department seeking an appointment because he was having trouble urinating. He was given the next available slot—two weeks away. A few hours later he arrived in the emergency department with acute urinary retention. Doctors quickly solved the problem, but the patient suffered greatly in the hours before treatment.

As a result, the clinic instituted a same-day appointment policy whereby all patients who call are asked whether they want to be seen immediately. About one million of the 5.5 million visits a year now occur on the same day the patient calls. This policy occasionally disrupts physicians’ schedules, but the new system is comforting to patients, and clinic doctors have come to embrace it."

A longer video overview of the topic: Engaging Doctors in the Healthcare Revolution:

References:

Engaging Doctors in the Health Care Revolution - HBR http://bit.ly/1y1iyOI

Disclosure: I am an Allergist/Immunologist at Cleveland Clinic.

"Walk the walk to talk the talk" - Cleveland Clinic video

CCF leaders are running two innovative "walk in my shoes" programs to take Cleveland Clinic to the next level. This involves learning how to do everyone's job, hands-on.

Exam preparation: NEJM Knowledge+ Adaptive Learning Explained

"At the heart of NEJM Knowledge+ is a smart, adaptive engine that will transform your learning experience. This adaptive learning platform quickly assesses the subjects you know well, and identifies the areas where you need reinforcement. It then delivers more of what you need and less of what you already know, continually adjusting based on your performance. Adaptive learning ensures that you’ll spend your time efficiently, focusing on what you need to learn and review.

Take a look at how adaptive learning helps you tackle the challenges of lifelong learning and board preparation. Learn more about NEJM Knowledge+ http://knowledgeplus.nejm.org"

Adult acne: how to treat it?

A Mayo Clinic dermatologist gives tips on how adults can prevent and treat acne. Treatment options include over the counter medications as well as prescription medications.

Acne has 3 stages that can be remembered by the mnemonic "CIN":

Comedonal - black/whitehead, open/closed
Inflammatory - pimples/zits
Nodulocystic

Use Topical Treatment such as Differin gel as on CCC-F: Cheek, Chin, Cheek, Forehead

Drinking Water: What's the Science?

Who should drink how much water? Bottled or tap? Medscape Expert Commentator, Dr. Jeffrey Berns, and Dr. Stanley Goldfarb discuss the evidence and what you should tell patients. For more from Dr. Berns, visit Medscape: medscape.com/index/list_3468_0

How do vaccines work? TED-Ed video

The first ever vaccine was created when Edward Jenner, an English physician and scientist, successfully injected small amounts of a cowpox virus into a young boy to protect him from the related (and deadly) smallpox virus. But how does this seemingly counterintuitive process work? Kelwalin Dhanasarnsombut details the science behind vaccines.

Lesson by Kelwalin Dhanasarnsombut, animation by Cinematic.

There are a few inaccuracies, but overall this is a good video.

Conversational translation in real time via Google app

"If you're traveling abroad, or facing a language barrier, the Google Translate app can help. WSJ's Nathan Olivarez-Giles takes a look." This is bound to have some use in medicine too.

Blurred Boundaries: The Therapeutics & Politics of Medicinal Marijuana (Mayo Clinic video)

J. Michael Bostwick, M.D., Professor of Psychiatry, Mayo Clinic Rochester, discusses the issue of medical marijuana. In 1970, the Federal Government declared cannabis to be a dangerous drug of abuse without any medical benefit and made it illegal. Over the past two decades, however, more than 20 states have taken matters into their own hands in defiance of federal law and legalized marijuana for medical purposes, recreational use, or both. The result is chaos for physicians and patients alike because there is no uniform law of the land.

Comments from Twitter:

Pat Rich @cmaer: Good Mayo clinic overview of "chaotic" medical marijuana situation facing US physicians

Health risks in extreme cold - and what to do about them

Mayo Clinic emergency medicine specialist Dr. David Nestler talks about how cold weather affects our bodies and what we need to know about frostbite:

“It’s a shame whenever anyone gets a frostbite injury,” says Lawrence Gottlieb, MD, professor of surgery at the University of Chicago and director of the Burn and Complex Wound Center. “People need to be aware of it and take precautions when the temperature drops, like it has this week. Be especially cautious when temps fall below zero, especially when there is a strong wind. Obviously, wear warm clothes. If you are driving a long way, especially at night, make sure you have enough extra clothes to cover up effectively if you get stuck somewhere. And don’t get stuck. Put enough gas in the car.”

Tips for people who go out in the cold

- If the temperature is below zero you could sustain a cold injury in less than 15 minutes.
- Mittens are warmer than gloves.
- Insulate the affected body part to prevent additional heat loss and damage.
- Immobilize and protect the frostbitten tissues from further injury.
- Prevent thaw-refreeze cycles. Do not begin rewarming until there is no risk of further exposure.
- Once in the hospital, physicians recommend rapid rewarming in a water bath at 104°-107.6°F (40°- 42°C) for 15-30 minutes until thawing is complete.

References:

Chicago midwinter – a user’s guide for preventing frostbite | Science Life buff.ly/1xHErpy

"Half-baked research": MD degree does not teach doctors how to tweet scientific meetings

MD degree does not teach doctors how to tweet scientific meetings, reported Reuters (http://buff.ly/1xAOPkO): A study assessed the accuracy of tweets posted by physicians at a medical conference and concluded "it is very easy to misunderstand tone and brevity, so there are dangers here."

First the study authors asked speakers at the meeting to identify key messages for their presentations. Then, they asked the speakers to review tweets posted during their talks to see how accurately these points were communicated.

Duty calls. Image source: Xkcd.com, Creative Commons license.

14 speakers participated in the experiment, and 13 had at least one tweet posted about their presentations. There were only 37 tweets altogether! Editor's note: This seems incredibly low. Allergy/Immunology conferences such as AAAAI and ACAAI generate thousands of tweets, sometimes more than 30-50 for each talk.

The speakers found 16 of the tweets accurately reflected their findings, while an additional 16 posts were partially accurate. In 3 instances, the tweets misrepresented key points. In 2 cases, the speakers were uncertain about the accuracy.

It's possible that the inaccurate tweets indicate that the speakers didn't do a good job of explaining their research. And it's also possible that the doctors listening to presentations didn't use the best language to tweet results.

To be sure, the sample size was quite small. This is the biggest limitation of the study and it qualifies it as what we sometimes call "half-baked research."

This statement also looked inaccurate in the Reuters report: "Asked about the impact of social media on medical education, 82 percent of survey participants said they didn't access websites for medical journals, research articles or major gastroenterology professional organizations." And indeed, it was inaccurate: 82% of GI's didn’t access social media sites of professional organizations, not their main websites.

We all agree on this though: Many physicians prefer to limit use of social media to their personal lives.

Here is an example how to use Twitter when attending a scientific conference:
http://allergynotes.blogspot.com/search/label/Twitter

Here is an approach I suggested a few years ago:

Cycle of Patient Education (click here to enlarge the image):

Cycle of Online Information and Physician Education (click here to enlarge the image):

"And it’s free."

References:

MD degree may not teach doctors how to tweet | Reuters http://buff.ly/1xAOPkO
Are you a SCEPTIC? SoCial mEdia Precision & uTility In Conferences - Emergency Medicine Journal http://buff.ly/1vQCq6j, and bit.ly/1tii1pz Digestive and Liver Disease

Comments from Twitter:

re: SCEPTIC? SoCial mEdia Precision & uTility In Conferences -- Skeptical Scalpel @Skepticscalpel: I've seen some forced acronyms in my time, but that one wins the prize.

@DrVes re: acronym, agree. the whole research endeavor left more to be desired...

Skeptical Scalpel @Skepticscalpel: I liked it because it supported my bias, but really--37 tweets?

Michael Katz @MGKatz036: Pls remember this as I tweet from @Boston_AF! MT @DrVes: MD does not teach doctors how to tweet scientific meetings buff.ly/1xzpiXF

Cytisine is better than nicotine-replacement therapy in helping smokers quit (NEJM video)

Cytisine, also known as baptitoxine and sophorine, is an alkaloid that occurs naturally in several plant genera. In this trial in New Zealand, cytisine was superior to nicotine-replacement therapy in helping smokers quit. The findings are summarized in the NEJM video. Cytisine was first marketed in Bulgaria in 1964 (called Tabex) and then became widely available in other European countries.

Read the full NEJM Original Article: http://www.nejm.org/doi/full/10.1056/NEJMoa1407764

Related reading:

Quitting smoking: Still a challenge, but newer tools show promise - CCJM http://buff.ly/1xCK2fP

Wash your hands for 20 seconds, as long as it takes to sing "Happy Birthday" twice - Mayo Clinic video

From Mayo Clinic: Running your hands under the faucet with some soap for a few seconds isn't enough to kill germs.

To help avoid catching the flu and other illnesses, wash your hands thoroughly and frequently with soap and warm water or alcohol-based hand sanitizer, particularly before leaving a restroom, eating or touching your face.

Wash your hands for about 20 seconds, about as long as it takes to sing "Happy Birthday" twice. When visiting a public restroom, use a paper towel to turn off the faucet and open the door when leaving.

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