50 Ways to Improve Your Life in 2008 According to U.S. News & World Report

The 50 Ways to Improve Your Life in 2008 are divided in 4 groups:

Your Money
Your Mind
Your World
YourPlay

Don't forget to check the related video by the U.S. News staffers:

Rockefeller Greenhouse in Cleveland, Ohio

Rockefeller Greenhouse. Click here for larger photos.

The Rockefeller Greenhouse was part of John D. Rockefeller's estate, and it is now owned by the city of Cleveland and is free to the public. Cleveland Cultural Gardens are just down the road from the greenhouse.

Read more about the greenhouse here.

There are are many online choices for photo and video sharing. I currently use Picasa Web Albums (Google Photos) for photos and YouTube for videos. It looks like Google Video does not update its service for personal users anymore and I had to switch to YouTube in 2007.

There is a Santa Claus

In 2006, Dr. Charles linked to the wonderful editorial response to a 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. Apart from the fact that Dr. Charles' blog is no longer active, of course.

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, from Wikipedia, the free encyclopedia.
Image source: Wikipedia, public domain.

Free Online Atlases: Dermatology, Radiology and Ophthalmology

Links:

Interactive Dermatology Atlas

Case-in-Point by American College of Radiology (ACR)

RedAtlas.org (Ophthalmology)

Video: Eye Trauma according to Dr Root http://goo.gl/KIEC and http://www.rootatlas.com

Related:

Ophthalmology Self-Guided Study Activity - ACP 2011 .
30,000 Medical Images, Tables and Figures from Leading Textbooks are Online. CasesBlog, 8/08/2005.
Free Ophthalmology Atlas. CasesBlog, 5/20/2007.
First 2 links are from MedSkool.
More Consequences of IT: The Disappearance of Radiology Rounds. Wachter's World, 01/2008.

"Diagnosis Wenckebach" YouTube Style

A spoof of Justin Timberlake's song done by the University of Alberta 2010 medicine class. Wenckebach is a cardiac arrhythmia -- type 1 second degree AV block, also known as Mobitz I, as they clearly explain in the clip.

This video seems to be quite a hit I was unaware of until our hospital medicine fellow told us today.


EKG of Second Degree Type 1 AV Block, Mobitz I, Wenckebach.

Second degree AV block is characterized by a failure of one or more atrial impulses to reach the ventricles. Type I second degree AV block, or Wenckebach, requires prolongation of the PR interval prior to the blocked impulse with subsequent shortening of the PR interval with the next conducted impulse. On the ECG, the R-R interval progressively shortens up to the point of the blocked ventricular impulse. This occurs because the largest increment in the PR interval occurs between the first and second cycle. The site of block in Type I second degree AV block is the AV node. This conduction disturbance most often is physiologic and seen with high vagal tone and during sleep. Pacing is rarely indicated. Image source: AskDrWiki, Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License.


Karel Frederik Wenckebach, M.D. Image source: Government of Malta.

The type of AV block described above was named after Karel Frederik Wenckebach, a Dutch-born Austrian internist, (1864- 1940). In 1899 he provided a description of irregular pulses due to partial blockage of AV conduction which created a progressive lengthening of conduction time. This condition was referred to as a "second degree AV block" (Mobitz Type I), and later named the Wenckebach phenomenon. Source: Wikipedia.

Dr. Wenckebach wrote in the Lancet: "I owe my reputation to the fact that I use digitalis in doses the text books say are dangerous and in cases that the text book say are unsuitable." Source: WhoNamedIt.com.

Related:
YouTube as a Source of Health Misinformation. Highlight HEALTH 2.0, 02/2008.
YouTube as a source of information on immunization: a content analysis. Keelan et al. JAMA. 2007 Dec 5;298(21):2482-4.

Updated: 02/06/2008

NEJM Image Challenge and (Lack of) Wisdom of Crowds

The New England Journal of Medicine Image Challenge "provides an opportunity for you to use the clinical images from NEJM to test your diagnostic skills.

A new image and question appears each week, along with several possible answers. Before selecting an answer, you can take a closer look by zooming in and moving the image within the frame. You can also look at the relative distribution of answers chosen by other users." Source: NEJM.

The Image Challenge is a good review tool for USMLE, ABIM or residency in-service exams. When I studied for USMLE, I used to group clinical images from NEJM under system headings, e.g. Cardiology, Pulmonology, etc. but the image quiz/challenge is more fun.

The NEJM Image Challenge is, in a sense, a Web 2.0 tool -- it relies on user-created content in terms of recording readers' responses and comparing them to correct answers. It is surprising to see that for many image challenges the readers ("the crowd") did not get the right answer despite the massive participation of tens of thousands of responders for some queries -- click to enlarge the image above for an example. This may be an indication that for professional fields like medicine the "wisdom of crowds" concept does not work as well as, for example, Digg.com or Wikipedia. I would prefer an expert's opinion over the crowd's opinion most of the time, I think.

It could be an interesting mini-research project to have a look at all the answers in the NEJM Image Challenge and to see how many times the "crowd" got it wrong versus the "expert" (NEJM) who always provided the correct answer. In August 2007, I calculated the percentage of correct answers and the number of responses per question from all the images available on the NEJM website at the time. The results showed that there were on average 8300 responses per question and the "crowd" solved correctly only 69% of the image challenges.

Related reading

JAMA liked NEJM's Image Challenge so much that they launched their own "Clinical Challenge" http://jama.ama-assn.org/site/clinicalchallenge/jcg-index.xhtml
Make the Largest Encyclopedia in the World Better. I already did (I hope), 9/28/2005.

You know NEJM has a clinical "Image Challenge" right? Now The Lancet has "Picture Quiz" http://goo.gl/1NLIq - Where are you, BMJ?
Digg for Medicine: Nature Publishing Group Launches Dissect Medicine, 5/03/2006.
Edit Wars in Medical Wikipedia, 12/09/2006.
Google Finds Correct Diagnosis in 58 % of Cases Published in NEJM, 11/11/2006.
The only way to preserve the wisdom of the crowd is to protect the independence of the individual. WSJ, 2011.
NEJM Image Challenge is one of the most popular features on NEJM.org, and now there is a new way to play - on Facebook http://goo.gl/3VfGf

JAMA Adds More Web 2.0 Features to Its Website

Following the lead of NEJM, JAMA has added more audiovisual and interactive content to its website. The leading journals are becoming much more than a vehicle for printing articles, and medical professionals who are not regular users of their websites are missing out on some useful features. You do not even need to visit the website to get the latest updates -- they follow you via RSS web feeds. The feeds also power journal podcasts which are downloaded automatically to your iPod whenever a new addition is published, again, no website visit required. I have become a regular listener to the editorial podcasts of JAMA, NEJM, Lancet and Annals. Here is the list of the Top 5 Medical Podcasts I Listen To.

Below is the list of some "Web 2.0 features" JAMA has added to its website:

• JAMA Audio Commentary, a podcast by the editor available via iTunes/Google Reader, 15 minutes
• Author in the Room Teleconferences, a podcast, duration: 1 hour
• JAMA Video Reports
• Video Supplements
• JAMA Interactive

Most people subscribe to medical podcasts by using iTunes/iPod/iPhone from Apple. A lesser known fact is that Google Reader can be used as a podcast program as well.

Click here to subscribe to the 4 major journal podcasts in your iGoogle homepage.

References:
Top 5 Medical Podcasts I Listen To
Annals of Internal Medicine Launches Podcast and Audio Summaries
Make Your Own "Medical Journal" with iGoogle Personalized Page
JAMA Podcast: Audio Commentary by the Editor-in-Chief

DVT and PE may double the risk of heart attack or stroke

In a 20-year Danish population-based cohort study of more than 40,000 patients, deep venous thrombosis (DVT) and pulmonary embolism (PE) doubled the risk of myocardial infarction (MI) and stroke.

For patients with DVT, the relative risk was 1·60 for MI, and 2·60 for stroke in the first year after the thrombotic event. For patients with PE, the relative risk was 2·60 for MI, and 2·93 for stroke. The relative risk was also raised, though less, during the subsequent 20 years of follow-up, at 20-40% for arterial cardiovascular events.

There seems to be a link (causative or associative) between the 3 conditions: venous thromboembolism (DVT/PE), MI and stroke.

References:
Venous thromboembolism and subsequent hospitalisation due to acute arterial cardiovascular events: a 20-year cohort study. The Lancet 2007; 370:1773-1779.
Vein clots up risk of heart attack. Reuters.
Image source: Saphenous vein, Gray's Anatomy, 1918 (public domain).

Popular tech blogger Mark Orchant died of heart attack at 50

According to most people who knew him, Marck Orchant was a remarkable human being. Oliver from StarrTrek chronicled what happened:

"At some time between 7:30 and 8:10 AM on Sunday Morning December 2nd, 2007, Marc Orchant, my fellow author on this blog, as well as one of my closest friends sustained a massive heart attack while working in his home office.

According to Sue Orchant, Marc was up early Sunday morning as is his normal custom. Sue told me that he was working in his office from about 7:30 AM until 8:10 when Sue says she heard a strange noise in Marc’s office.

When she went to investigate she saw that Marc was not sitting in front of the computer like he normally does and was slumped over between his desk and a small couch that is in the room. Initially, Sue said, she though he was leaning over doing something to their Golder Retriever but then she realized that he was not conscious.

Fortunately, Sue has basic medical knowledge and after verifying that Marc was not choking and had a clear airway she began to perform CPR while their son, Jason, called paramedics. The ambulance arrived in less than 10 minutes and technicians immediately took over performing CPR and administered treatment with a cardiac defibrillator. Marc was rushed into emergency open heart surgery where an angioplasty was performed to restore circulation in the blocked artery.

Sue went on to tell me that in spite of Marc’s apparent good health, he has severe occlusion in both his other arteries and they too will require treatment soon. The primary concern and the question that cannot be answered until Marc regains consciousness is the nature or extent of any neurological damage as a result of insufficient oxygen reaching Marc’s brain."

Digital Inspiration posted a farewell tribute to Marc Orchant:



In medical school, I made up a mnemonic for some of the risk factors for CAD -- OBESE:

Obesity
Blood pressure (hypertension)
Elevated LDL, low HDL
Smoking
Elevated glucose (diabetes)

At least from the extensive blog coverage, it does not look like Mark Orchant had many of the risk factors listed above.

Related:
AltaVista Founder Dies of a Heart Attack at 42, CasesBlog, 2006.
Honoring the Memory of Marc Orchant. Micro Persuasion.
In Web World of 24/7 Stress, Writers Blog Till They Drop. NYTimes, 04/2008.
Dangers of unrecognized heart disease: Husband dies while giving wife CPR (both found dead, age 60, 59) http://goo.gl/LZ39U

CNN asks "Can Led Zeppelin still rock?" Did you have any doubts?

The surviving 3 members of legendary rock group Led Zeppelin reunited for a one-time gig on December 10.

To ask if the founders of the hard rock can still rock, as CNN just did yesterday, shows a lack of understanding of what the music is all about. If you had any doubts, check the BBC coverage of the concert: Zeppelin wow their fans at gig (video).


WSJ video: Song remains the same

"As soon as the tickets went on sale -- for £125 ($253.50) -- fans rushed to get their hands on one. In total 11 million people signed up for the chance to see the reunion gig but only 18,000 were the lucky ones."

"The concert web site exceeded its bandwidth allowance and crashed almost immediately following the announcement, with the promoter predicting that the gig would cause the "largest demand for one show in history", due to the ticket request site receiving one billion page impressions."

For the record, I like Deep Purple better but Led Zeppelin are truly the epitome of a rock band. Here is the link to an interview with Roger Glover, the bassist of Purple.



If you think that this post is off-topic, think again. One of the best orthopedic surgeons at Cleveland Clinic, Viktor Krebs, seems to be the fan of rock music too:



References:
Can Led Zeppelin still rock? CNN.
Legendary Led Zeppelin feels a whole lotta love. USA Today.
Music Review: Led Zeppelin Finds Its Old Power. NYTimes.
Music in the OR? For Cleveland Clinic Surgeons, It's Not Just Mozart.
Zep lover 'will rule Russia.' The Sun, 12/2007.
A day in the life of a touring musician - Roger Glover from Deep Purple http://goo.gl/69yMx

Red Wine in a Pill?

Resveratrol ("res-vera-trol") is a compound found in red grape skins and seeds. I have written before about several studies on cardiovascular effects of red wine and made up the "R" mnemonic:

Red wine
Res-vera-trol
Reduces stroke area in mice by 40%

The WSJ Health Blog interviews the CEO of a company which is planning to test a pill form of resveratrol in diabetes patients. It has developed new compounds which reportedly mimic the effects of resveratrol and had a beneficial effect on blood glucose and insulin levels. See the video below:



References:
Health Blog Interview: CEO, Red Wine in a Pill, Inc. WSJ Health Blog, 11/2007.
Red Wine Can Prevent Stroke (in Mice). CasesBlog. 10/2006.
A glass of wine daily may prolong life. How you can you predict which patient will have a bottle daily though? CasesBlog, 03/2007.

Doubt on Anti-Aging Molecule as Resveratrol Trial Is Halted http://goo.gl/wpY0i
Image source: Wikipedia.

A Doctor has a Problem with the "Queen of All Googlers"

Dr. Scott Haig, a NYC orthopedic surgeon, wrote about his encounter with a lady he describes as the "queen of all Googlers" and a "brainsucker." Not surprisingly, his TIME article has faced some backlash from health-related online communities and blogs.

What Dr. Haig describes though goes beyond simply using search engines for medical information and one should know that if the article is read in full. On a side note, I do not think that anybody should be calling names to anybody. Most doctors usually remember that no matter how tired or angry they feel, the things are almost always worse on the colder side of the stethoscope where the patient is.

Generally, I encourage patients to research their condition. Here, at Cleveland Clinic, we have patient information handouts authored by us and integrated within the electronic medical record software (Epic). Many people read the handouts in detail and ask excellent informed questions.

By the way, Google discourages the use of its name as a verb, for example, "Googling." The correct description of the activity should be "searching on Google."

References:
When the Patient Is a Googler. Scott Haig, TIME.
A Doctor’s Disdain for Medical “Googlers.” NYTimes health blog.

Related:
Google Finds Correct Diagnosis in 58 % of Cases Published in NEJM
Who's your patients' best friend? Google!
Google, M.D. In Action - Part II
The Patient Who Knew Too Much. California Medicine Man.
Information is stupid. I think. Jay Parkinson.

Clinical Correlations, NYU Internal Medicine Blog, Celebrates One-year Anniversary

Clinical Correlations, an NYU Department of Medicine educational web site, hosted by the Internal Medicine Residency Program, celebrates its one-year anniversary:

"It’s been quite a year in the life of Clinical Correlations. One year ago today we officially announced the creation of Clinical Correlations, the NYU internal medicine blog, to the NYU medical community. Starting from scratch without much of a game plan we developed a website (a word I greatly prefer to blog) that we hoped would simultaneously inspire students, house staff and faculty. I am so proud to say that I think we have accomplished this goal. In this year, I have learned that perseverance clearly pays off and now Clinical Correlations has become part of the very fabric of NYU."

"In the last year we have had 216 posts on various medical topics. Our writers have included medical students, residents, chief residents, former chief residents and faculty from NYU. Our editorship staff has expanded to 11 senior editors and 11 copy editors. Our overall readership has steadily slowly grown through the year without any a single advertisement or strategically placed comment on other blog sites or forums. We have readers in over 110 countries. Our hits are now averaging ~250/day."

I wrote a short piece on Residency Program Blogs in 2006:

The Early Days

I think the first residency program blog was Bedside.org launched by a faculty member at the University of Cincinnati in March 2003. It looks like Dr. Carl Gandola is still the sole contributor to the website.

For the Residents, By the Residents

My former residency program at Case Western Reserve University (St Vincent/St Luke) followed in 2004, and as far as I know, that was the first blog created for the residents by the residents (correct me if I am wrong). Actually, the web site was not a blog in the exact sense of the word but it just used the newly redesigned (at that time) Blogger.com to make a regular web site supported by the residents who contributed clinical cases, EKGs, CXRs and medical procedures info. This web site grew quite popular within the residency program and spun off several projects, including the blog you are currently reading...

References:
Celebrating our one year anniversary!! Clinical Correlations.
Residency Program Blogs. CasesBlog, 03/2006.
Image source: Clinical Correlations.

Web 2.0 Music Video: Here Comes Another Bubble

Web 2.0: Here Comes Another Bubble, version 1.1. Song by Matt Hempey based on Billy Joel’s We Didn’t Start the Fire. Link via Google Blogoscoped.

Will something similar happen to the medical Web 2.0? Will doctors, nurses and patients tire of writing and reading blogs? Will physicians forget the last time they logged in Sermo and the other social networks? Will medical students delete the NEJM and JAMA podcasts and listen to music only? Only time will tell.

Update 12/19/2007:
The version 1.0 of the video was deleted due to a copyright violation. Read more inCopyright Claim Erases Parody Video From YouTube. Wired.com.

Related:
Web 2.0 Company Logos
Social Media Starfish and 6 Axes of Medical Education in Web 2.0

Updated: 01/01/2008

How to Create a Blog Carnival: A Step by Step Guide

Berci Mesko of ScienceRoll.com has a comprehensive how-to guide on creating your own blog carnival. A blog carnival is a blog event similar to a magazine dedicated to a particular topic. Each edition of a blog carnival is in the form of a blog article that contains links to other blog articles on the particular topic (source: Wikipedia).

The most famous medical blog carnival is the venerable Grand Rounds - a weekly summary of the best posts in the medical blogosphere. Pre-Rounds is an article series about the hosts of Grand Rounds on Medscape.com. Nick Genes of Blogborygmi, who writes the Medscape column, is the founder of Grand Rounds and he maintains the 4-year-old archive. I have hosted Grand Rounds twice which is nothing compared to 4-time hosts like GruntDoc and Kevin, M.D.

Berci knows a thing or two about launching blog carnivals for sure -- he started 2 of them:

Medicine 2.0
Gene Genie

He points to the following steps to help you create your own blog carnival:

Find out a proper name
Register it at BlogCarnival.com
Create a blog for your carnival
Write a mission statement and a guideline:
Create a logo
Recruit


This Google video shows it takes about 2 minutes to start a blog on Blogger.com. Creating a web site has never been easier.

References:
How to create a blog carnival: Step by Step. ScienceRoll.com.
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.
Image source: OpenClipArt.org, public domain.

Clinical Case: Chronic Idiopathic Urticaria

A 27-year-old male is referred to the allergy clinic for symptoms of hives for 2 months. Possible triggers have not been identified.


Figure 1. Urticaria appearing on right arm. Image source: Wikipedia, public domain.

What is the next step?


Figure 2. Mind map diagram of chronic urticaria.

Read more in Chronic Idiopathic Urticaria on AllergyCases.org.

Geography Quiz: Is Europe a Country? Hungary as in "Hungry"?

From Gadling travel blog: The American Idol finalist Kellie Pickler "appeared on US television game show "Are You Smarter Than A 5th Grader" and was asked what country Budapest was the capital of. She had never even heard of Hungary, and she thought Europe was a country."

Here is one of the responses to the video on YouTube: "I'm from Budapest, Hungary, yet I don't feel offended by the lady's ignorance. Why on earth should she have known? What I think she should have known, however, is the fact that Europe is a continent rather than a country. A continent that has had separate countries for at least 2,000 years, including 1,100-year-old Hungary. A country where people are not normally hungry."

Ms. Pickler donated the money she won from the competition to charity.

By the way, I was lucky to visit Hungary in the 1980s and I agree with the general opinion that Budapest is of one the most beautiful capital cities in the world. It is actually 2 cities -- Buda and Pest divided by the Danube river.

May be Berci Mesko of ScienceRoll, who is Hungarian, will have something more to add.

Douweosinga.com (whatever the name means) offers an easy way to create a map of the states and countries you have visited -- see an example here.

References:
Gadling.com.
Link on Google Video.

Amazon Kindle One Week Later: iPhone or Zune of Electronic Books?

Kindle eBook reader by Amazon was met with great accolades initially. It sold out in 2 days. After all, you can store 200 (medical?) books on one thin 10.3 oz (292 g) tablet. The euphoria lasted until the users actually got the device in their hands. Kindle, it turns out, is a great concept with poor implementation. It makes it easy to buy books and difficult to -- eh -- read them... Reading books, from technical point at least, is supposed to be easy. Amazon had designed some huge buttons on the sides of the device which users press inadvertently when holding the Kindle and then pages flip back uncontrollably. A reading device which makes reading difficult is unlikely to succeed. I am sure Amazon will have a better luck with the second generation of Kindle but in the meantime Apple may take over the market with their much-rumored "multi-touch" tablet. In summary, Amazon Kindle is an interesting device but I would hold on buying one until its second generation, at least.

See a few funny videos showing pre-Kindle, launch and post-Kindle opinions:


Medieval Helpdesk Solves Problems With a New Technology: The Book


WSJ's Walt Mossberg review: Will the Kindle catch fire?

Robert Scoble: Whoever designed this should be fired and the team should start over


The iPod of E-Book Reader?

References:
Kindle e-book reader by Amazon: you can have 200 (medical) books on one device. CasesBlog.
Medieval Helpdesk Solves Problems With New Technology. CasesBlog.

Related:
Hack Your Kindle: 100+ Tips, Resources, and Tutorials to Get More Out of the Amazon Kindle. CollegeDegrees.com, 06/2008.
The Kindle for Medical Education. Life as a Healthcare CIO, 10/2008.
Turning Page, E-Books Start to Take Hold. NYTimes, 12/2008.

Updated: 12/25/2008

How to make the correct diagnosis?

What helps some doctors make the correct diagnosis after so many have failed before that? Jenny McCarthy shares her experience:

"I didn't know what was going on with my son Evan. Countless doctors and hospitals couldn't get to the bottom of it, and no one could figure out the right diagnosis. Finally, I got an appointment to see the best pediatric neurologist in Los Angeles.

When the door opened and a sweet older man walked in, I immediately felt good. He listened closely but had his eyes on Evan the whole time. I could tell he was evaluating Evan and his bizarre behavior.

He asked me a couple of questions and seemed very peaceful about the whole thing. I was starting to feel more relaxed as he played with Evan, and then he stood up and opened his office door and told his secretary to cancel his next appointment.

He closed the door and pulled his chair up close to mine and put his hand on my hand. He looked at me with sorrowful eyes and said, "I'm sorry, your son has autism."

Read the rest of the story:
Jenny McCarthy: The day I heard my son had autism. CNN, 2007.

Related:
FreeMD: Your virtual doctor. Link via David Rothman.

Updated: 01/29/2008