Redesign of Clinical Cases and Images - A Case-Based Curriculum of Clinical Medicine

ClinicalCases.org was redesigned to give credit to the authors and to streamline the front page of the website, so that it reflects the natural flow of a clinical encounter:

- History Taking and Physical Examination

- Imaging and Labs

- Procedure Skills

- Best Clinical Evidence

- Questions & Answers

Suggestions are welcome. The website has already had more than 500,000 page views and we are hopefully going for one million this year.

Feel free to submit typical clinical cases or rare case reports. Both have a place in expanding this online case-based curriculum of clinical medicine which was reviewed favorably by the British Medical Journal. With more than 800 daily visitors (and growing) from all over the world, this is our humble contribution to medical education.

ClinicalCases.org is integrated within the Cleveland Clinic intranet with links on the home pages of clinical education and the internal medicine residency program.

Nobody Owns "Web 2.0" Because It's Yours

There is no dispute that Tim O'Reilly coined the term "Web 2.0", the same way Robert Wachter first used "hospitalist" in his landmark 1996 NEJM article.

Timo O'Reilly also organized the first Web 2.0 conference but does he really own the term "Web 2.0"?

According to IHT:

"On Wednesday, a lawyer from O'Reilly Media sent a cease-and-desist letter to it@cork, a nonprofit industry group in Ireland that is holding its own Web 2.0 conference next month."

The people at it@cork thought that the O'Reilly's request was somewhat unfair since Web 2.0 is in large created by the web users themselves and does not really belong to anybody. They posted the cease-and-desist letter on their website and in no-time the post was the top story on Digg.com.

It looks like the blogosphere backlash soon made O'Reilly media changed their mind.

According to the organizer of it@cork:

"Because of Web 2.0 and blogging, I was able to put up a post and have this large multimedia organization apologize and turn around and say, 'You can use our trademark terms.'

"That's only possible because of the power blogging confers."

I should be OK to use Web 2.0 in my presentations too... :-)

Update 1/19/2007:
The new version of my presentation Web 2.0 in Medicine is available.

References:
Blogging liberates "Web 2.0". IHT.
How to Use Web 2.0 in Medicine?
Image source: OpenClipArt.org, public domain

Further reading:
Collaborative Presentation on Web 2.0. Link via Go2Web2.

Updated: 10/02/2007

Interesting Blog Posts

The questioning of career, life, family, love follows grief (taking a week off of blogging). Scobleizer. Related: Celebrating seven years of blogging. Scobleizer, 12/2007.

Vint Cerf says he’s a weird old fart... :-) Scobleizer.

The Six Habits Of Highly Effective Healthcare Bloggers. HealthcareVox.

Why can't a tattoo be a legal advanced directive? RangelMD.

Updated: 12/23/2007

No Work Blogging Allowed

Scoble, Microsoft's most famous blogger, comments on a NYTimes article about companies taking a stance against employees-bloggers:

"There's lots of companies that don't allow blogging, the New York Times reports today.

That's cool. I hope none of my competitors allow their employees to blog. Why? You'd be amazed at the number of job seekers we get simply because we blog openly...

In many companies blogging ANYTHING is a fireable offense. I’ve talked with many HR and PR teams and they can’t believe that we’re allowed to do what we’re doing at Microsoft."


Michigan University recently launched 12 blogs by medical students in effort to increase recruitement.

Work blogging, if done right, can offer a competitive advantage to many companies. It gives a human face to a corporation and it also brings a lot of Google traffic that you otherwise have to pay for through AdWords.

In today's world, Microsoft's "chief blogger" has almost as much power as the CEO. Banning blogging is a disadvantage, to say the least.

Fortunately, at the Cleveland Clinic, we do not stop any employee from writing his/her own blog. Of course, you must have the usual disclaimer: "All opinions expressed here are those of their authors and not of their employer" (see the sidebar of this blog). Protecting patient confidentiality, as described in HIPAA, is also extremely important.

All hospitals should have blogging guidelines.

References:
Interns? No Bloggers Need Apply. NYTimes.
No work blogging allowed at many co’s, NYT says. Scobleizer.
Medical Students Blogging on a "Massive Scale" at the University of Michigan
Microsoft Blogger Has as Much PR Power as CEO. What Does That Mean for Your Hospital?
Case Reports and HIPAA Rules
Simply Fired - How NOT to Blog About Your Job. Especially If You Are a Doctor
Image source: Openclipart.org

First Man with HIV Contracted the Virus from a Cameroon Chimpanzee

According to a study, published in the journal Science, it looks like the first people with HIV caught the virus from Cameroon chimpanzees that harbor a simian immunodeficiency virus (SIV).

SIV antibodies were found in up to 35% of fecal samples from wild-living P. t. troglodytes apes (chimpanzees).

The HIV epidemic started in a different place though -- in Kinshasa, the Democratic Republic of Congo. Studies have traced HIV to a man who gave a blood sample in 1959 in Kinshasa. The primate-to-human transmission likely ocurred much earlier, in the 1930s.

How did people contract HIV from chimpanzees?

The chimpanzees in that area of Cameroon are hunted for meat. One of the researchers explains:

"We know that you don't get it from petting a chimp, just like you can't get HIV from a toilet seat. It requires exposure to infected blood and infected body fluids. So if you get bitten by an angry chimp while you are hunting it, that could do it."

References:

Research suggests HIV originated in Cameroon chimps. CNN.
Chimpanzee Reservoirs of Pandemic and Nonpandemic HIV-1. Science DOI: 10.1126/science.1126531.
Tracking the Epicenter of AIDS: Africa, 1930. NPR.
Origins of HIV. Listen to an interview with one of the study authors. Time Global Health Update.
HIV's Ancestry Traced To Wild Chimps in Cameroon. WSJ (subscription required).
Retroviruses and herpesviruses found in illegally imported wildlife products (bushmeat) seized at US airports. JAMA, 2012.
Image source: Wikipedia

3C = Cleveland Clinic Canada

The Cleveland Clinic "will be opening a spectacular facility in downtown Toronto" this September called Cleveland Clinic Canada's Health and Wellness Centre.

Also in the news, Medgadget reports that the gigantic Dubai Healthcare City will be powered by Harvard Medical International (HMI), the international division of Harvard Medical School.

NEJM Video: Arthrocentesis of the Knee

Knee arthrocentesis is the latest of the NEJM Videos in Clinical Medicine. This procedure series by NEJM is an excellent learning tool. Videos are free to watch and download.

There are several articles on Joint Aspirations and Injections in AFP.

You can also review the Procedure Skills section of ClinicalCases.org.

Image source: NEJM

Cleveland Zoo in the Spring

See the Tabblo

Clinical Case: A Toddler Swallows a 40-cm Piece of Dental Floss

A 3-year-old boy had his teeth cleaned by his mother and wanted to play with the dental floss afterwards. Half an hour later, the mother could not find the dental floss.

What would you do?

Continue reading on ClinicalCases.org.

Image source: OpenClipart.org, public domain

Clinical Cases and Images is "Blog of Note" on the Front Page of Blogger.com

Blogger.com/Blogspot is the # 18 most trafficked website in the world, according to Alexa.com. Yahoo is # 1, Google is # 2.

Clinical Cases and Images - Blog is featured on the front page of Blogger.com this week as a part of the Blogs of Note series.

Thanks to Googlers/Bloggers for selecting me. I think that Google staff physician, Taraneh Razavi, helped a little bit... :-)

Great medical blogs powered by Blogger.com are KevinMD and KidneyNotes, just to name a few. Feel free to add more in the comments section.

How to Use Web 2.0 in Medicine?

This is the PowerPoint file of my talk about Web 2.0 in Medicine. I presented it to the Section of Hospital Medicine at the Cleveland Clinic on 10/17/05, internal medicine residents and faculty at the Cleveland Clinic on 1/05/06, Grand Rounds of the Department of Internal Medicine at the Cleveland Clinic on 1/25/06, and internal medicine residents and faculty at Case Western Reserve University (St. Vincent/St. Luke) on 5/18/06.

Of course, I had to make modifications for each audience but the general content was the same.

All blue links in the presentation are clickable.

Feel free to use it for your own presentations, if you find something interesting. The usual requirements for a citation and a back link apply and are listed on the last slide.

Update 1/19/2007:

The new version of my presentation Web 2.0 in Medicine is available.


My presentation on Web 2.0 in Medicine from December 2006.

References:
Web 2.0 in Medicine
Wikis, blogs and podcasts: a new generation of web-based tools for virtual collaborative clinical practice and education. Boulos MNK, Maramba I, Wheeler S. BMC Med Educ 2006;6:41.
10 Tips for How to Use Web 2.0 in Medicine. ScienceRoll.com, 2007.
Web 2.0 in Medicine Presentations by a University of Michigan Librarian
Web 2.0 and Medicine: The Slideshow. ScienceRoll, 02/2008.

Related:
Web 3.0 Concepts Explained in Plain English (Presentations). Digital Inspiration, 2009.

Updated: 06/01/2009

Tim O'Reilly Defines Web 2.0

I remember when I gave my first series of talks on Web 2.0 in Medicine at the Cleveland Clinic, people were coming to me after the presentation asking me where they can buy Web 2.0... Obviously, this speaks volumes about my presentation abilities (or lack of abilities) but it also shows how confusing the first definition of Web 2.0 was to users.

Tim O'Reilly, who coined the term Web 2.0, spread the first definition on 5 pages. I am so glad to see that the second attempt to define it is at least more concise:

A true Web 2.0 application is one that gets better the more people use it. Google gets smarter every time someone makes a link on the web. Google gets smarter every time someone makes a search. It gets smarter every time someone clicks on an ad. And it immediately acts on that information to improve the experience for everyone else.

It's for this reason that I argue that the real heart of Web 2.0 is harnessing collective intelligence.

The world of Web 2.0 *can* be one in which we share our knowledge and insights, filter the news for each other, find out obscure facts, and make each other smarter and more responsive. We can instrument the world so it becomes something like a giant, responsive organism.

I still remember calling blogs "living organisms" in my interview with Nick Genes for Medscape, so I was not far off the mark.

Update 1/19/2007:
The new version of my presentation Web 2.0 in Medicine is available.

References:
Tim O'Reilly and defining Web 2.0. Geeking with Greg.
My Commencement Speech at SIMS. Radar.OReilly.com.
Image source: OpenClipArt.org, public domain

Further reading:
Collaborative Presentation on Web 2.0. Link via Go2Web2.

Updated: 10/02/2007

The Happiness Formula

BBC tries to find The Happiness Formula starting with the fundamental question "What is happiness?" Is the answer to "Think yourself happy"? (video link).

Take a 5-question test and discover how happy (or unhappy) you are.

The website is among the Yahoo picks.

References:
Thinking About Medicine - Your Inner Peace
Six Tips for Happiness by a Harvard Teacher
20 Ways to Get and Stay Happy. Time, 2007.

Experienced happiness is largely set by personality, it will temporarily respond to changing circumstances. The Lancet, 2010. http://goo.gl/ot3Kx
Image source: OpenClipArt.org

Medpundit Stops Blogging. She Started in March 2002

Medpundit, one of the veteran medical bloggers, decided to stop blogging:

"I no longer have the time needed to devote to it. The phrase "declining reimbursement and rising overhead," is repeated so often in medicine that it seems a cliche, but it's also a reality. I'm spending longer hours at work and seeing more patients to support my office and my family. The 1-2 hours a day it takes to keep up the blog are no longer there. I don't have any hope of that getting better in the foreseeable future. In fact, I anticipate that in the next 1-2 years, I'll be adding even more office hours until I've reached the limits of my physical and mental capabilities.

I've also come to realize that I've been neglecting my family too long."

This is sad. People have been reading Medpundit for years.

Related:
Medpundit signs off. GruntDoc.com.
Sunday musings on the medical blogosphere. Notes from Dr. RW.
Medpundit calls it quits. GruntDoc.com, 01/2008.
Year's End, Blog's End. Medpundit, 01/2008.
Image source: Openclipart.com

Updated: 01/02/2008

Google Rates High Medical Blogs

Three days ago, I wrote that ACP released MKSAP 14 and now this post is # 2 on Google, second only to the official ACP page.



Similarly, the post about the ABIM results for 2005 is # 2 after the official website of the American Board of Internal Medicine. I feel sorry for the poor Mo-Media.com that pays to be listed in "Sponsored Links" section...



I am writing this not to brag how great my blog is (it is not) but because I would like to encourage more health workers to blog. You can really make a difference by sharing your experience with the world by starting a blog or participating in Google Co-op Health.

For example, I could have never imagined that my website would reach 500,000 page views -- this is almost as if you had written a book and people have read half a million pages of it.

Future medical bloggers usually start just by reading blogs and gradually gathering the courage to start one of their own. Grand Rounds is a good place to check what other medical bloggers write about and to see which one is closer to your style of writing.

Blogging is both an enriching and therapeutic experience. It can even advance your career, or it can get you fired...

You do not have to be "a blogger" to start a website using a blog service. For example, the initial website of the Section of Hospital Medicine at the Cleveland Clinic was powered by Blogger.com but it was not a blog at all.

References:
Simply Fired - How NOT to Blog About Your Job. Especially If You Are a Doctor
Case Reports and HIPAA Rules
Blogs 'essential' to a good career - The Boston Globe

Google Video and Tabblo Photo Sharing

Google Video Update

There is no need to download and install a video uploader now, everything works within the browser. Question for Google: how about fixing the extension install for Google Notebook?

The other improvement is that your video is available for viewing immediately, YouTube-style. Google editors will have to review the video before it can be searchable.

References:
Instant gratification, Google Video style. Google Blog.

Tabblo Photo Sharing

Google needs a photo sharing service badly and the newly-launched Tabblo may be the answer. It even has a Picasa plug-in.

Tabblo is a Flickr competitor and so far I like it better. I wonder what Enoch Choi thinks about it -- he had some Flickr aggravations recently. The servce is free with unlimited uploads and the "tabblos" just look good: see my photos from a recent visit to the Cleveland Botanical Garden.

See my Tabblo

Update 3/22/2007:
HP goes web 2.0, buys Tabblo. GigaOM.

References:
Tabblo Allows Its Users To Design Sleek Montages; Paying $20 for a Poster. WSJ.com.
First Look: Share Photos and Stories With Tabblo. PCWorld.com.

Physician Blogger Writes About Her Stroke

Big Mama Doc writes a funny and deeply-insightful blog about working at her family medicine practice, teaching residents and having not the best of health herself.

According to her blog, she had a stroke not a long time ago but was able to return to work with the help of several medications including Coumadin.

Unfortunately, while at a conference in San Francisco at the beginning of May, she had a series of new strokes and had to be hospitalized for surgical interventions:

5/2/06
Update
"I was admitted Friday night with several new strokes. Turns out my bad mood was nothing but poor perfusion; a few intracranial stents this afternoon should do the trick. Please forgive the brevity of this message. Typing is a challenge with limited use of my left hand."

5/3/06
Saga
By a Friend of Big Mama Doc: "The procedure last night terminated early once they saw how goopy things were in those brain arteries "

5/5/06
One Down One To Go
By "Big Mama's not so talented writer husband": "Bigmama had her procedure yesterday afternoon. It lasted almost eight hours."

5/10/06
Part Two
"Mama Doc had her second procedure."

5/14/06
Home
"Quite frankly, I'm amazed to still be alive, and I am lucky to have limited deficit. Typing is a challenge, but speech is better every day."

5/15/06
What I Remember


She is now discharged home and on the path of recovery surrounded by her loving family. It takes courage to write about you personal problems and to share you deepest fears with the world.

I wish her a speedy recovery.


Follow-up

5/26/06
Occupational Therapy
The road to recovery after a stroke in not an easy one, especially for practicing physicians. There are so many fine motor skills that we take for granted which have to be "re-mastered" after a stroke. FatDoctor has a long list for her occupational therapist...

References:
Anniversary: My Story in Ten Brief Chapters. Fat Doctor.
Blogiversary. Fat Doctor.
Image source: FatDoctor.blogspot.com