Happy New Year 2007!

Orange dots on the map represent the readers of ClinicalCases.org and CasesBlog.

Map via Google Analytics. Idea from GigaOM.

One Million Page Views

ClinicalCases.org and Casesblog have reached the milestone of one million page views since their launch in 2005 (see the SiteMeter screenshot on the right). We stand at 1,007,723 page views and 348,425 visits as of today. Most of the visitors came from Google, links from other medical websites and blogs, and from BMJ and Medscape. Just as a short explanation, ClinicalCases.org is an attempt to build an online case-based curriculum of medicine; Casesblog is the blog I use to collect ideas, interesting stories and to post relevant news about the Clinical Cases and Images project.

I, and my colleagues who write for ClinicalCases.org, would like to express our deep appreciation to all our readers. We hope you continue to find our sites interesting, educational and worth-visiting in the future.

In the past year, Joshua Schwimmer and I tried to spread the word about the perceived usefulness of blogs in medical education. Our abstracts about different uses of a medical blog platform were accepted to the Annual Perioperative Summit of the Cleveland Clinic, the Annual Renal Week of the American Society of Nephrology, and the Annual Session of the American College of Cardiology.

Although a significant milestone, one million page views is less than the one million visits that Robert Centor's blog has recently reached. Listen to his interesting reflection of what this number means to him and his readers (mp3 file).

Happy New Year!

References:
American Society of Nephrology (ASN) Renal Week 2006
Cleveland Clinic Perioperative Medicine Summit
British Medical Journal Features Clinical Cases and Images - Blog, Again
1 Million hits - a podcast. DB’s Medical Rants.

My 'Best' Blog Posts of 2006

I am not sure if these are really the "best" posts on this blog for 2006 but I sometimes find them useful for my "Web 2.0 in Medicine" presentations and decided to collect them in one place:

Do We Need a Free Medical Encyclopedia?

How Can a Doctor Use Google Page Creator?

Residency Program Blogs

MDCalc is a Useful Online Clinical Calculator

Cocaine FOR Chest Pain

Medical Blog Closed Down by Request of Employer

Six Tips for Happiness by a Harvard Teacher

Another blogger quits due to "blog fatigue"

Digg for Medicine: Nature Publishing Group Launches Dissect Medicine

Physician Bloggers Talk to a Medical Librarian

Microsoft Blogger Has as Much PR Power as CEO. What Does That Mean for Your Hospital?

How Can Academic Physicians Benefit From "Google Office"?

Make Your Own "Medical Journal" with Google Personalized Page

What I Learned from Making the Website of the Cleveland Clinic Hospitalists

What's New in General Internal Medicine?

Top 5 Medical Podcasts I Listen To

Complete List of Medical Abbreviatons and Acronyms

American Society of Nephrology (ASN) Renal Week 2006

UK Medical School Interview Technique on YouTube

YouTube video: Victoria Wood - University Interview -- A nervous schoolgirl is interviewed as a potential student at a UK medical school. Link via NewMediaMedicine.



Admission committee:
Do you think the National Health Service (NHS) is crumbling or doing very well?

Applicant (with a politically correct answer):
I think part of it is crumbling and part of it is doing very well. You have to look at both sides really...

Translate Your Medical Website Automatically with Google Translate

Casesblog and ClinicalCases.org have had automatic translation via Google Translate for a while now (see the form in the lower right corner of any page). I have noticed through SiteMeter statistics that some international visitors are using the form to translate the blog and ClinicalCases.org into their native language.

Google released a translation algorithm from English to Russian a few weeks ago and I just added this function to the form. The automatic translation is far from perfect grammatically but in most cases it can convey the sense of what is written. The translation works seamlessly from technical point of view though -- if somebody closes the top frame, he/she can browse any English website, translated into his/her native language, without even knowing that the website is originally written in English -- try it with CNN. If you hover the mouse over any text in Firefox, you can see a callout with the English translation. This is neat. It works only in Russian, Arabic and Chinese, as far as I tested it.

Using Google Translate makes your website accessible to medical students and residents from around the world who may not know English well. Callouts could help them learn the language better and faster.

I have included the HTML code of the translation form here (click to open a new page). Feel free to use it for your own website, just replace "casesblog.blogspot.com" with the URL of your site.

References:
Google Russian Translator. Google Operating System.
Embed Google Translate widget in your blog template: Translation Widgets for Your Site. Google Operating System, 11/2007.

Related:
Read Googlified in Multiple Languages. Googlified.
Useful Google Translate Addresses. Google Operating System.
Google Translate Becomes the Best Free Online Translator. Google Operating System, 05/2008.

Updated: 05/09/2008

Interesting Medical Links

Top Five (5) Free Meta-Search Tools in Medicine. UBC Academic Search - Google Scholar Blog.

Converting to an Electronic Medical Record: Advice (and Cookies) From a Doc Who's Been There. The Blog That Ate Manhattan.

Graham's Guide to Boards Prep

Physician Salary Survey

10 ways to guarantee a lawsuit. Medical Economics.
Link via The Patient's Doctor.

Long Hours Up High Blood Pressure Risk. More Time at Work Might Earn You 29% Greater Chance of High BP. WebMD.

2 Out of 3 Americans Don't Wash Hands. Survey Finds Germany Is the Worst at Hand Washing. WebMD.

British Medical Journal Features Clinical Cases and Images - Blog, Again

Dean Giustini was kind to include this blog in his landmark BMJ editorial How Web 2.0 is changing medicine:

One of the best blogs in medicine is Ves Dimov's Clinical Cases and Images - Blog. It contains a rich collection of "presurfed" material for busy clinicians and features interactivity and timely discussion. Dimov is also a supporter of medical librarian bloggers. Why waste time fumbling with search engines when you can consult this blog for timely updates? As well as case discussions, Ves provides links to today's medical headlines from Reuters and clinical images via a dynamic, free photo sharing tool called Flickr. One of his slide presentations "Web 2.0 in medicine" is available on Slideshare (itself a fantastic new 2.0 tool). Clinical Cases and Images is a virtual laboratory for doctors and medical librarians interested in Web 2.0.

Since its launch in 2005, ClinicalCases.org and this blog were featured 3 times in the BMJ and twice in Medscape.

BMJ:
How Web 2.0 is changing medicine. Dean Giustini. BMJ 2006;333:1283-1284 (23 December)
How Google is changing medicine. Dean Giustini. BMJ 2005;331:1487-1488 (24 December)
Reviews, Netlines. Harry Brown. BMJ 2005;331:1345 (3 December)

Medscape:
Popular Case-Based Resource Models Online Medical Training. 2006;8(2), 2006 Medscape.
Clinical Cases Make Blog a Popular Resource. 2006;8(1), 2006 Medscape.

MD Net Guide:
Why they blog: Healthcare providers are embracing blogs; Should you join them?. Fard Johnmar.

As I have commented before, I am happy to think that may be this blog is one of the many good medical blogs out there... It is important to keep the online conversation going and this is probably the most significant thing, not the individual blog of any of us.

ClinicalCases.org and the blog will have one million page views by the end of the year. Currently, we are just 4,000 pages short of a million but with 2,000-3000 page views daily, this number will certainly be reached by the end on 2006. It feels as if you have written a book and somebody reads 3000 pages of it... every day. It is funny to realize that this blog likely has a larger readership than many journals. KevinMD, Medgadget, and DB's Medical Rants (by the current president of the Society of General Internal Medicine) have even larger audiences. It is time to assess the effect of medical blogs on the way doctors receive and share medical information.

Further reading:
1 Million hits - a podcast. DB’s Medical Rants.
Redesign of Clinical Cases and Images - A Case-Based Curriculum of Clinical 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.

James Brown, 'the Godfather of Soul', Died Early Today

From Wikipedia:

"James Joseph (May 3, 1933 – December 25, 2006), also known as The Godfather of Soul, was an African American entertainer who was recognized as one of the most influential figures in 20th century music.

Brown was admitted to the Emory Crawford Long Hospital in Atlanta, Georgia on December 24, 2006 after a dentist visit where he was found to have severe pneumonia. Brown died the next day on December 25, 2006, around 1:45 a.m. at the age of 73.

Frank Copsidas of Intrigue Music said the cause of death was uncertain. "We really don't know at this point what he died of," he said."

According to eMedicine: "Pneumonia is the 6th leading cause of death in the U.S. and is the most common infectious cause of death. The mortality rate is reported to be 1% in the outpatient setting but may increase to up to 25% in those requiring hospital admission."

James Brown "was renowned for his shouting vocals, feverish dancing and unique rhythmic style." (Wkipedia). Many videos showing memorable James Brown's performances during the years are uploaded to YouTube. There are also several hundreds photos on Flickr. Motocchio described what it felt to be at a James Brown concert:

"Tonight turned to be one of the most special nights in my life.... Marco and i went to JB's concert tonight!

he's 73 years old. but he's still damn good, and the concert was one perfect entertainment show. and, his charisma... when he appeared on the stage, everybody got crazy and screamed.... including us. when he was singing "it's a man's man's man's world," i understood very very well why bruce brothers got enlightened by a church minister played by him... his music really touches people's soul. he's truly the king of soul.


James Brown & Pavarotti

References:
James Brown, from Wikipedia, the free encyclopedia
Pneumonia, Bacterial. eMedicine.
James Brown, the 'Godfather of Soul,' dies at 73. CNN.
James Brown RIP: Jump Back, Jack, See You Later, Alligator. Steve Anderson.
Image source: James Brown performs at the Yunfeng Theater in Shanghai. Licensed under Creative Commons.

Updated: 12/01/2007

There is a Santa Claus

Dr. Charles links to a wonderful editorial response to the letter of a 8-year old girl who doubted that Santa Claus existed. It was published in the New York Sun in 1897. Not much has changed since then.

Dear Editor--

I am 8 years old. Some of my little friends say there is no Santa Claus. Papa says, "If you see it in The Sun, it's so." Please tell me the truth, is there a Santa Claus?
~VIRGINIA O'HANLON

References:
Yes Virginia, There is a Santa Claus. Dr. Charles, 2006.
Yes, Virginia, there is a Santa Claus, from Wikipedia, the free encyclopedia.
Image source: Wikipedia, public domain.

Are Bloggers the Person Or the Fool of the Year?

It depends on what you read. According to the Time magazine, people posting user-created content online are its "Person of the Year." Surprisingly (or not), a Wall Street Journal editorial calls the same people "fools": "The Blog Mob. "Written by fools to be read by imbeciles."

Who is right? I write a blog, so I am biased... Although I cannot speak of my own intelligence, many bloggers I read daily are some of the smartest people you can find. I think the Wall Street Journal got this one wrong. Happy new blogging year 2007!

Do not forget to nominate the Best Medical Blogs of 2006.

References:
Time's Person of the Year: You. Time.
The Blog Mob. WSJ, 2006.
WSJ Bodyslams Bloggers. Micro Persuasion, Steve Rubel, 2006.
Time Magazine's Person of the Year - is You. Dr. Charles.

The 2007 WeblogCartoons.com Calendar

Dave Walker, the author of free (and really funny) cartoons which I have used before, has released a 2007 Cartoon Calendar:

"The 2007 WeblogCartoons.com Calendar

This calendar (pdf file) features 12 of my non-church-themed cartoons, mostly from WeBlogCartoons.com but also some from the Cartoon Blog that I plan to add to We Blog Cartoons when I get around to it. The cartoons in this calendar are:

• This gadget
• Heat
• Save the environment
• Your car
• Waiting for something to blog
• If I had more money
• Depression / elation
• Customer service
• In through one ear and out the other
• How to tie a tie
• Telephone calls
• The spectrum of cartoon quality

These calendars are entirely free and you are welcome to print them off, print copies for other people, print one off for your church office, give them to your friends as Christmas presents etc etc.

The calendars are pdf files of about 1mb and a bit. My advice would be to right click on the link and select ‘ Save Target As…’ or ‘Save link as…’. Choose where you want to store the file on your computer, then click ‘Save’. Each calendar is 14 pages: One title page, twelve individual monthly pages and then one infomational page at the back. You’ll need to staple or clip the pages together in some way and then find a way to hang the calendar if that is what you want to do."

References:
Blog Cartoon: Too Many RSS Feeds to Read
Keep on Blogging...

Radiology Picture of the Day

Radiology Picture of the Day features a new medical image daily, with a brief description. The website is edited and maintained by Dr. Laughlin Dawes who is a Radiology Registrar at Prince of Wales Hospital, Randwick. He lives in Sydney "with his wife Daniella, his sons Max and Alex, and Oscar the dog."

The website was started in 11/2006 and the Category Archives include:
Brain (10)
Cardiovascular (1)
Gastrointestinal (11)
Genitourinary (2)
Head & Neck (5)
Musculoskeletal (3)
Obstetrics (3)
Paediatrics (8)
Spine (2)
Thoracic (7)

There are more and more competitors to the famous NEJM Images in Clinical Medicine series...

References:
Link via Kevin, M.D.
NEJM RSS Feed for Image of the Week
Image source: Radiology Picture of the Day

Related:
More Consequences of IT: The Disappearance of Radiology Rounds. Wachter's World, 01/2008.

Updated: 01/31/2008

Nominate Best Medical Blogs of 2006

The nominations for the Best Medical Blogs of 2006 are currently underway on Medgadget.com.

There is a new voting system this year:

"Please meet the judges: Medgadget editorial staff is joined by Sumer from Sumer's Radiology Site, Josh from Kidney Notes, Enoch from Tech Medicine, Maria from Intueri, Orac from Respectful Insolence, Steven from docinthemachine, Bard from A Chance to Cut is a Chance to Cure, Amy from Diabetes Mine and Allen from GruntDoc. Judges will conduct a review of each blog submitted and will vote to sort out those blogs that don't belong to a particular category, or simply splogs (spam blogs.) Furthermore, judges will vote for blogs. Your votes and judges' votes are counted as 50% to 50%. Such a voting system was held at a recent TV show Dancing with the Stars, and details on how the counting was done can be found here."

Related:
The Best Medical Blogs of 2005 on Medgadget.com
Image sources: Medgadget

Flickr: Spirit of the Tree

Spirit of the Tree by Venticello (?) on Flickr:

"There have been made many sculptures from cut down trees. The trunks are left standing there and an artist comes and scarves on the tree. It always makes my day to see a new one on our walks in the city's parks.

This is in Kaivopuisto, Finland."

Creative Commons License

Edit Wars in Medical Wikipedia

Background

Wikipedia uses the "wisdom of crowds" concept which postulates that scores of non experts do a better job writing an article than a single expert. It is probably true. Most experts are busy people and do not have time to write, edit and protect from vandals more than one million articles.

Any social media website (and Wikipedia is one of them) has a relatively small number of devoted users who keep the project going and do the bulk of contributions. For Wikipedia, these users are about 500 and they are called administrators. They are in charge of keeping the encyclopedia what is supposed to be -- an encyclopedia -- and not a self-promotion tool.

What happens when administrators disagree with regular contributors? Edit war. There are revisions and versions changed back and forth until sometimes users are even locked-out of "Wikipedia land."

How is this related to medicine?

According to a recent Medscape editorial, "Wikipedia is the future of medicine, and it's good." There is a Clinical Medicine project on Wikipedia which one day may become the most comprehensive medical textbook. Dean Guistini of UBC Academic Search - Google Scholar Blog also started a wiki at University of British Columbia.

I was reading the Wikipedia article about Polycythemia and since I had an illustrative typical case of secondary polycythemia on ClinicalCases.org, I decided to add it in the "External Links" section at the bottom of the page. That was a well-intentioned and innocent addition, I thought. One of the administrators, JFW, disagreed, called my little effort "advertisement" and deleted the link. We discussed it at the talk page and since I tremendously respect people who take care of the world's largest encyclopedia (for free), I just moved on.

Some people are tougher to deal with though. One hair-transplant surgeon is having fierce fights on his talk page regarding his contributions to Wikipedia which are dubbed by some administrators "commercial" and "promotional." If you have 4-5 minutes, I would recommend reading the whole page to get a feel of what an edit war looks like:

Administrator:

Welcome to Wikipedia. We invite everyone to contribute constructively to our encyclopedia. Take a look at the welcome page if you would like to learn more about contributing. However, unconstructive edits, such as your changes to the Raymond V. Damadian page, are considered vandalism, and if you continue in this manner you may be blocked from editing without further warning. Please stop, and consider improving rather than damaging the hard work of others. Thank you. Talk: Administrator.

Plastic surgeon:

Unconstructive edits, vandalism? nonsense. The page on Raymon V Damadian contains numerous factual errors and much evident confusion about the technology which I was just attempting to correct. I'm and MD PhD who was there when all this stuff was going on. Even published papers in the field and know many of the princopals. See my comments at. Talk:Raymond V. Damadian.

There is (was?) also a Wikipedia page about one of the medical bloggers, Summer Sethi, which was labeled for deletion as a "vanity page":

Strong delete: Wikipedia is not a resume or publication list. There are perhaps thousands of other medical researchers with similar publications, nothing shows why this person is any more notable than them. --Ragib 23:59, 2 September 2006 (UTC)

The Full-body scan article is another example of a disagreement between contributors and administrators.

A fine line

Administrators like JFW and Samir are the backbone of the Clinical Medicine project in Wikipedia. Their job is to keep the vandals and self-promotion types out of the encyclopedia. If you make contributing too difficult though, "regular guys" may just go somewhere else.


Wikis in Plain English

References:
Who Edits Wikipedia? Philipp Lenssen.
Raw Thought: Who Writes Wikipedia? Aaron Swartz.
Wikipedia:Lamest edit wars, via Yahoo picks.
Make the Largest Encyclopedia in the World Better. I already did (I hope)

Related:
Why Slate is Wrong About “the myth of Web 2.0 democracy” DavidRothman. net, 02/2008.
Wikipedia: A Key Tool for Global Public Health Promotion (review article)

Rule of 3 for Wilderness Survival

Many people followed closely James Kim tragedy. James was a San Francisco man who sought help for his stranded family, got lost in the snowy Oregon wilderness and died of hypothermia.

According to CNN:

You can survive for 3 hours without shelter
You can survive for 3 days without water
You can survive for 3 weeks without food

References:
Wilderness survival: The rule of threes. Anderson Cooper 360 degrees blog.
A Winter Tragedy. Paul Auerbach, MD. Medicine for the Outdoors.
Kim died close to food, shelter, officials say. CNN.com.

A Typical Home Dialysis Day on YouTube

Gustine, a YouTube user who has been on dialysis since 1978, posted a video of his typical home hemodialysis day:

"Each time I do dialysis at home my two small dogs always are on the alert and tend to keep any intruders from getting near. If I fall asleep they'll bark in front my face!! What can I say, I guess having such critters alongside really helps get through the day!"

Gus also uploaded a video of buttonhole cannulation which is definitely not for the faint-hearted:

"For some of you it may all look gruesome, but in reality its not. I'ts a way of life for many of us who lost our kidneys, but now we have the freedom to do it at home self-care without living your whole life in-center."

Gus writes a blog about dialysis.

More videos:

Bill Peckham does self-dialysis & cannulation via buttonhole method. Billpeckham.com.
Bill Peckham answers Travel on dialysis FAQ and describes his own trips around the world while on dialysis.

Living Donor Kidney Transplant. OR-Live.com.

Link via KidneyNotes.com.

Related:
YouTube Feeds. Google Operating System, 01/2008.

Updated: 01/10/2008

Gordon Brown's Son is Diagnosed with Cystic Fibrosis

Gordon Brown is the Chancellor of the Exchequer of the United Kingdom (the British cabinet minister responsible for all economic and financial matters) and is expected to succeed Tony Blair as Prime Minister.

Mr. Brown' four-month old son Fraser was diagnosed with cystic fibrosis (CF) during routine screening test soon after his birth. According to The Times, "Fraser Brown was born on July 17 at the Royal Infirmary, in Edinburgh. He weighed a healthy 7lb 14oz (3.6kg). The condition was picked up in routine blood tests that all babies in Scotland (but not in England) undergo."

I have worked with children and young adults with cystic fibrosis in the past and I have always been impressed by how tough and mentally grown up those little guys are. Currently, they are fighting a loosing battle since there is no treatment for CF and the average life expectancy is 30-35 years. I cannot help but to share my utmost respect for all patients with cystic fibrosis and their families and my hope that one day a cure for this genetic condition will be found.

Cystic fibrosis is the most common autosomal recessive disease among people of European heritage. In the United States, approximately 30,000 individuals have CF. Approximately 1 in every 25 people of European descent is a carrier of a cystic fibrosis mutation. Approximately 1 in every 46 Hispanics, 1 in every 65 Africans and 1 in every 90 Asians carry at least one abnormal CFTR gene (source: Wikipedia, verified).

Newborn screening for cystic fibrosis (CF) has been mandated for the state of Ohio, beginning August 30, 2006.

References:
Brown family faces a new challenge as baby Fraser has cystic fibrosis. The Times.
'Each winter survived is another victory'. The Guardian.
Rainbow Babies & Children's Hospital Prepared for Newborn Screening for Cystic Fibrosis. UHHS.com.
Image source: Cystic fibrosis from Wikipedia, the free encyclopedia.

Pfizer Discontinues Drug Which Increases HDL Due to Higher Death Rate

Torcetrapib, a new medication developed by Pfizer, is very effective in increasing HDL levels ("good" cholesterol). There is a huge marketing niche for such medications since currently we lack a very efective pharmacological therapy for low HDL, apart from Niacin. The first hint of trouble for torcetrapib was the preliminary report that the drug increases blood pressure. The latest results from a trial of about 15000 patients show significantly increased mortality in the group treated with torcetrapib (7500 patients). According to a Pfizer spokesman, 82 patients taking the combination of torcetrapib and Lipitor died, compared to 51 deaths in the arm of the study where patients were taking Lipitor alone.

Pfizer announced today that it will stop future development of the new drug. The company spent around $800 million to develop torcetrapib and the share prices will certainly take a big hit tomorrow. Ultimately though, there is no doubt that Pfizer did the right thing by reporting the disappointing results early.

We are back to square one -- there is no highly effective pharmacological treatment for low HDL apart from Niacin which usefulness is limited by unpleasant side effects (flushing) and poor glucose control in diabetic patients. Fibrates can also be used to raise HDL levels.

Further reading: A 33-year-old man has a low HDL level. Should you treat him?

References:
Pfizer cuts off cholesterol drug trials. USA Today.
Pfizer's Torcetrapib: Rest In Peace. Dr. Wes.
Deaths Halt Development Of Pfizer Cholesterol Drug. WSJ.
Effects of Torcetrapib in Patients at High Risk for Coronary Events. NEJM, Volume 357:2109-2122, November 22, 2007.

Monounsaturated fats found in vegetable oils, nuts and avocados increase "good" HDL cholesterol levels by 12% http://goo.gl/GBQa5
Image source: Cholesterol. Wikipedia (public domain).