Chest compressions-only CPR works as well as standard technique in adults

The not-so-old 2005 AHA CPR guidelines put much more emphasis on chest compressions as opposed to rescue breaths. For the first time, the AHA advised CPR performers to give 30 compressions for every two rescue breaths, i.e. 30:2 (the old ratio was 15:2).

It's not ABC anymore, DocAroundTheClock half-jokingly wrote, it's ACB (airway, compressions, breathing).

Well, it looks like it will be just AC (airway, compressions) from now on. Click here for the official AHA advisory on Hands-Only (Compression-Only) Cardiopulmonary Resuscitation published in Circulation (PDF file).

According to the CNN report from the 2008 AHA meeting, chest compressions-only CPR works as well as the standard technique in adults:

"Bystanders will now be more willing to jump in and help if they see someone suddenly collapse. Hands-only CPR is simpler and easier to remember and removes a big barrier for people skittish about the mouth-to-mouth breathing.

"You only have to do two things. Call 911 and push hard and fast on the middle of the person's chest."

Hands-only CPR calls for uninterrupted chest presses -- 100 a minute -- until paramedics take over or an automated external defibrillator is available to restore a normal heart rhythm.

This action should be taken only for adults. A child who collapses is more likely to primarily have breathing problems -- and in that case, mouth-to-mouth breathing should be used."


It's not Rocket Science, it's Hand-Only CPR!

See the CNN video: Heart Association: Hands-only CPR works.

Mr. Bean did not feel very comfortable performing mouth-to-mouth breathing either, as you can see from this YouTube video (not to be taken seriously).



References:

Heart Association: Hands-only CPR works. CNN.
Hands-Only (Compression-Only) Cardiopulmonary Resuscitation: A Call to Action for Bystander Response to Adults Who Experience Out-of-Hospital Sudden Cardiac Arrest. A Science Advisory for the Public From the American Heart Association Emergency Cardiovascular Care Committee. Circulation.
Image source: Gray's Anatomy, 1918, public domain.

Related:

Dangers of unrecognized heart disease: Husband dies while giving wife CPR (both found dead, age 60, 59) http://goo.gl/LZ39U
British Heart Foundation is urging people to forget "mouth-to-mouth" during CPR: 'no kissing, just hard CPR'. BBC, 2011.

Google Maps Street View Comes to Cleveland -- See Cleveland Clinic, UH, Metro, SVCH, etc.

Last week, Google Maps Street View expanded to more metropolitan areas in the U.S. and now includes Cleveland.

The Cleveland hospitals have become the "crown jewels" of the city. Some of the top health institutions in the country, and indeed, in the world, are located in Cleveland and now you can see them as if you there, from street level:


View Larger Map
This view from Euclid Avenue shows "the past and the future" of Cleveland Clinic. The original Clinic building is shown on the right and the new all-glass building of the Heart Institute is shown on the left.


View Larger Map
My office is in one of the buildings in the middle, called H. There are buildings from "A to Z" at Cleveland Clinic, and in fact, building A is shown below:


View Larger Map
The Crile building of Cleveland Clinic (building A)


View Larger Map
University Hospitals (UH)


View Larger Map
St. Vincent Hospital (SVCH)

Street View images like the ones above can easily be embedded in websites and blogs, so go ahead and share your favorites.


Video: How to use Street View of Google Maps

References:
Street View: expanding our horizons. Google Maps Blog.

Google puts its eye on Cleveland. The Plain Dealer.

Disclaimer: Dr. Dimov is a Clinical Assistant Professor of Medicine at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, and a Staff Physician at the Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio. All opinions expressed here are those of their authors and not of their employer.

Enterprise Wiki - Why and How to Start One

Mike Cannon-Brookes has a good presentation on Organisational Wiki Adoption on SlideShare (link via DavidRothman.net). This may convince your department or hospital to start a wiki, if you do not already have one.

He also lists the top 4 wiki enemies:
1. Share drives
2. Email
3. Knowledge management
4. Intranets

Steve Ballmer's Videos and Human Psychology

Steve Ballmer is a CEO of Microsoft and a very intense personality, as you can see from the videos below. In 2008, Mr. Ballmer was ranked the 43rd richest person in the world, with an estimated wealth of $15 billion.


Steve Ballmer shows his excitement at Microsoft 25th Anniversary by performing what became known as "Monkey Boy dance."


"Developers, Developers, Developers!" Steve Ballmer shows how important the applications developers are to Microsoft.

Wikipedia describes those "viral videos":

"Footage featuring Ballmer's flamboyant stage appearances at Microsoft events have been widely circulated on the Internet, becoming what are known as "viral videos". The most famous of these is commonly titled "Dance Monkeyboy", it features Ballmer dancing and hopping around while verbally screeching and screaming erratically on a stage for about 45 seconds after being introduced at a Microsoft employee convention. Another video, captured at a developers' conference just days later, featured a visibly sweat-drenched Ballmer chanting and shouting the word "developers" fourteen times in front of a gathering of Microsoft associates."

For a more balanced view of Mr. Ballmer, you can watch his interview with Guy Kawasaki.

The Fascinating Story of "Stingray Jim"

The CNN recently published the unfortunate story of a woman who died after a stingray leaped from the water off the Florida Keys and struck her. The force of the blow pushed the woman backward, she hit her head on the boat deck and died.

The article mentioned a guy who was considerably more lucky and become a member of the exclusive club of few who have survived after being hit in the chest by a stingray barb.

Read the story of "Stingray Jim" below.

The famous TV personality Steve Irwin ("Crocodile Hunter") was killed when a ray's barb pierced his heart in September 2006.

The 81-year-old James Bertakis is the founder a successful home manufacturing company (started 1972). Just a month after Steve Irwin was killed, the retired Michigan businessman was fishing on his boat near Lighthouse Point, Florida, when a stingray leaped out of the water and landed in his lap. The fish lashed out with its tail and the barb penetrated his chest.

This is where the story ends for most people but Mr. Bertakis is no ordinary man. His son, James, told CNN that his father is a "tough customer": "He is extremely active; he puts a lot of people to shame. He never admits he's over 69 years old. He's quite a character."

Mr. Bertakis managed to drive the boat back to shore, bleeding and light-headed, laid down on the dock and had his granddaughter call 911. He was taken to North Broward Hospital, where a chest X-ray showed the barb in his chest. He was taken to surgery, but as doctors worked, the barb was pulled through his heart as it pumped. Without cardiac bypass equipment available, the surgeons closed the heart with the barb still inside, and airlifted him to Broward General Hospital where the barb was removed.

He spent 5 weeks on a ventilator and his recovery took several months but was fit enough to appear on The Today Show "feeling wonderful," surrounded by his family and ready to fish again.

Feeling that he was spared by a miracle, Bertakis has started The Stingray Jim Charity (stingrayjim.com) to raise money for charities that help children and the elderly.

And that is the story of Stingray Jim. If interested, you can even buy branded t-shirts, coffee mugs and other memorabilia from Cafe Press.

But wait a minute -- what happened to the stingray that attacked Stingray Jim? This is the only answer in the FAQ section of his web site: "Stingray Jim bears no ill-will toward the stingray that stung him. Sadly, the stingray expired in the commotion surrounding the attack. Stingray Jim asked his family to have it preserved and mounted as a reminder of how unexpected and precious life is. You can see Jim holding it on the front page of this website."

References:
Woman dies after ray strikes her. CNN.
Man who survived stingray attack ready to fish again. The Today Show.
Irwin might have survived: surgeon. Sydney Morning Herald.
Florida Stingray Victim 'Holding His Own.' CBS News.
Stingray attacks Fla. boater, lodges barb into his heart. The Detroit News.
Man stabbed in chest, heart by stingray barb. St. Petersburg Times.
How do stingrays kill? How Stuff Works.
Images source: Wikipedia, Creative Commons Attribution ShareAlike 1.0 license, by Dr. Tony Ayling, and GNU Free License.

March is Colon Cancer Awareness Month: Get a Screening Colonoscopy if Appropriate for Your Age and History

Video: See What to Expect During a Colonoscopy.

The CBS news anchor Katie Couric (formerly of the NBC Today show) lost her husband to colon cancer ten years ago. According to the press release, "since then colon cancer awareness and prevention has been a cause near to her heart. March is Colon Cancer Awareness Month and Katie Couric put together a video for her YouTube channel with recognizable faces who have loaned their talent for Public Service Announcements about the disease."


Colon Cancer Awareness

Related:

Cleveland Clinic Colorectal Cancer Risk Assessment Tool. Get your score in 2 minutes (free).
Remembering Dad on Father’s Day. Paging Dr. Gupta, 06/2008.

Fear was the No. 1 reason people gave to explain why they hadn’t gone in for a colonoscopy to screen for colon cancer. NYTimes.

Topics Discussed During the Medicine Consult Service Rotation at Cleveland Clinic in March/April 2008

This is a list of the topics discussed during the Medicine Consult Service rotation with residents and medical students at Cleveland Clinic:

Which blood pressure medications to take on the morning of surgery?
Use of blogs in medicine
How to start a medical blog in 2 minutes
Use of RSS feeds in Medicine
Best Web Feeds Reader for Medical and General Information
What is the risk for developing ARF after surgery?
Something you have never seen before -- a rare central line complication in NEJM
Self-plagiarism of a Case Report in NEJM
What to do if you loose a guide wire during central line placement?
Guidelines for treatment of DVT/PE. See the presentation from Google Docs.
Preoperative Care of Patients with Kidney Disease, mnemonics PAST and HIP
New perioperative guidelines for noncardiac surgery (ACC, Medscape)
Podcasts in Medicine:
- Top 5 Medical Podcasts I Listen To
- Annals of Internal Medicine Launches Podcast and Audio Summaries
- Podcasts from Conferences of University of Tennessee IM Residency Program
Text-to-Speech Programs and Continuous Medical Education
Case 2: Does this patient need a beta-blocker? and 4CD mnemonic to remember the risk factors in RCRI
How to Score Well on the Boards?
Chest compressions-only CPR works as well as standard technique in adults
Hyponatremia and Hypernatremia:
Hyponatremia - Na 118 - What is the cause?
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) due to SSRIs
SIADH due to Lung Cancer and Aspiration Pneumonia
Hypernatremia due to Dehydration in Dementia
Wellbeing practices correlated with the feeling of happiness: MOTORS
Keep residents happy -- it is better for patients
Inventor of Cardiac Bypass (CABG)
A doctor asks which portable computer/PDA/smartphone to choose
Electrocardiogram (ECG, EKG) Learning Tools
A Systematic Approach to Electrocardiogram (EKG) Interpretation by Using 2 Mnemonics: A RARE PQRST/DR III EEE by Dr. Dimov
Atrial fibrillation (AFib) with rapid ventricular response (RVR) due to triple lumen catheter (TLC) placement
Complications of Central Line Placement: Pneumothorax, Arrhythmia, Hematoma
Drum circles at a major Cleveland hospital relieve employee stress
Will "Dr. Nurses" Take Over Primary Care?
Case 3: When to correct hyperkalemia before surgery?
Case 4: When to do hemodialysis before surgery in patients with ESRD?

To be discussed in the future

Acid-base Balance Cases and Calculators by Dr. Dimov
5 Tips to Stay Up-to-Date with Medical Literature
Web 2.0 in Medicine (from Google Presentations) by Dr. Dimov
Aortic Stenosis and Preoperative Evaluation for Noncardiac Surgery
New guidelines for prevention of bacterial endocarditis

Topics from previous rotations

Different IV catheters and related complications
Atelectasis as source of fever by Dr. Dimov
Rates of medication errors among depressed and burnt out residents by Dr. Dimov
How do you define prolonged immobilization?
Hydralazine use in HTN by Dr. Dimov
How many "organ"-renal syndromes are recognized? by Dr. Dimov
GLP-1 receptor agonist (Byetta) and DPP-4 Inhibitors for Treatment of Diabetes by Dr. Batal/Dr. Dimov
Difficult to control asthma - what to do after ICS/LABA/LTRA have failed by Dr. Dimov
When to Use Xolair (Omalizumab) in Asthma? by Dr. Dimov
Mind maps for asthma treatment by Dr. Dimov

The list will be updated periodically as new topics are added by the end of the month. As you can see from the links above, a blog can be used as an educational portfolio for both personal learning and teaching.

Further reading:
Topics Discussed During the Internal Medicine Rotation at Cleveland Clinic in October/November 2007. CasesBlog, 10/2007.
Topics Discussed During the Internal Medicine Rotation at Cleveland Clinic in September 2007
Using a Blog to Build an Educational Portfolio. CasesBlog, 1/2007.
DB’s thoughts on being a clinical educator. DB’s Medical Rants, 11/2007.
Attending Rounds. DB’s Medical Rants, 02/2008.
Happiness. DB’s Medical Rants, 03/2008.

Updated: 04/04/2008

Remembering the ACGME 6 Core Competencies by a SIMPLE mnemonic

The Accreditation Council for Graduate Medical Education (ACGME) is responsible for the accreditation of post-MD medical training programs within the United States. The ACGME developed the so-called 6 "core competencies" that all residents should achieve during their training. When I was a chief resident, the concept was still new and not easy to remember so I made up a SIMPLE mnemonic for the 6 competencies:

SIMPLE

Systems-Based Practice
Interpersonal Skills and Communication
Medical Knowledge
Patient Care
Learning - Practice-Based and Improvement
Etiquette ~ professionalism

References:
General Competencies. The Accreditation Council for Graduate Medical Education (ACGME).
Medical Mnemonics
Image source: OpenClipArt, public domain.

Video: Brain Researcher at Harvard Talks About Her Stroke and More

Jill Bolte Taylor: My stroke of insight. The brain she is holding in the video is a real one.

Read the transcript. From the TED Conference:

"Neuroanatomist Jill Bolte Taylor had an opportunity few brain scientists would wish for: One morning, she realized she was having a massive stroke. As it happened -- as she felt her brain functions slip away one by one, speech, movement, understanding -- she studied and remembered every moment. This is a powerful story about how our brains define us and connect us to the world and to one another."

TED stands for Technology, Entertainment, Design. "It started out in 1984 as a conference bringing together people from those three worlds. Since then its scope has become ever broader."

The byline of TED is "ideas worth spreading." Not surprisingly, Dr. Taylor's talk is about more than her own stroke:

"So who are we? We are the life force power of the universe, with manual dexterity and two cognitive minds. And we have the power to choose, moment by moment, who and how we want to be in the world. Right here right now, I can step into the consciousness of my right hemisphere where we are -- I am -- the life force power of the universe, and the life force power of the 50 trillion beautiful molecular geniuses that make up my form. At one with all that is. Or I can choose to step into the consciousness of my left hemisphere. where I become a single individual, a solid, separate from the flow, separate from you. I am Dr. Jill Bolte Taylor, intellectual, neuroanatomist. These are the "we" inside of me.

Which would you choose? Which do you choose? And when? I believe that the more time we spend choosing to run the deep inner peace circuitry of our right hemispheres, the more peace we will project into the world and the more peaceful our planet will be. And I thought that was an idea worth spreading."

Link via O'Reilly and Scobleizer.
YouTube link to the video.

How to backup your medical blog?

Writing a medical blog takes time and effort. A blog is also a personal archive which should be protected against deletion by an accident or a malicious hacker. The first step is to choose a good password. The second it to backup your blog regularly, probably weekly or monthly.

There are 2 relatively easy options to backup your blog:

1. HTTrack Website Copier

This free program allows you to save entire web sites (including your blog) on your hard drive so that you can browse them offline. I use HTTrack to backup several of my websites and have not had any problems with it. It downloads all the text, links, images, audio and video files to the hard drive in a directory called "MySites." An incremental backup is done after the first run of the program.

2. Blogger Backup at CodePlex.com

Blogger Backup goes one step further than HTTrack by allowing you to restore your posts back online in case you accidentally delete your blog or some of the posts. I have not tried the program yet but the credible Digitial Inspiration blog has a positive review of Blogger Backup.

References:
Download All Your Blogs with Blogger Backup, Easy Restoration. Digital Inspiration.
Image source: Wikipedia

Related:
New: Export Your Blogger Blogs or Merge Multiple Blogs into One. Digital Inspiration, 06/2008.
How do I import and export blogs on Blogger? Blogger.com.
Bulletproof Backup Strategies. EfficientMD, 08/2008.
Import and Export for Blogger blogs. Blogger Buzz, 12/2008.

Updated: 12/11/2008

Announcement: Conference on Web 2.0 in Medicine in Toronto, September 2008. What is "Apomediation"?

According to the conference website:

"Medicine 2.0™ is an international conference on Web 2.0 applications in health and medicine, organized and co-sponsored by the Journal of Medical Internet Research, the International Medical Informatics Association, the Centre for Global eHealth Innovation, CHIRAD, and a number of other sponsoring organizations."

Medicine 2.0 is defined as "Web-based services for health care consumers, caregivers, patients, health professionals, and biomedical researchers, that use Web 2.0 technologies as well as semantic web and virtual reality tools, to enable and facilitate specifically social networking, participation, apomediation, collaboration, and openness within and between these user groups."

What is "apomediation"? According to this article, "traditional media intermediaries are replaced by apomediaries -- tools and peers standing by to guide consumers to trustworthy information, or adding credibility to information." The reference is provided in case some of the readers of this blog always wanted to know what apomediation was but were afraid to ask.

The deadline for abstracts is May 2nd, 2008.

The conference is organized by Gunther Eysenbach who is the Editor-in-Chief, publisher of the Journal of Medical Internet Research, and the author of the term apomediation. See his blog Gunther Eysenbach's random research rants.


A low resolution version of Medicine 2.0 map (fair use). Click here to see the full resolution image from Gunther Eysenbach's blog.

An easier on the eye version is the Social Media Starfish created by Darren Barefoot (a Creative Commons license):

The starfish also illustrates some of what I call "6 Axes of Medical Education in Web 2.0 Style":

1. Web feeds (RSS)
2. Podcasts
3. Blogs
4. Wikis
5. Custom search engines
6. Second Life virtual world

Judging by the conference web site, it looks like the term "Medicine 2.0" was registered as a trade mark... Berci Mesko who organizes the Medicine 2.0 carnival may want to look into that. Actually, I never use "Medicine 2.0" in my presentations. They are usually titled simply "Web 2.0 in Medicine" which is an attempt to solve the confusion created by terms such as eHealth, iHealth, Health 2.0, Medicine 2.0, Medicine 3.0, etc. I also hold the dubious distinction of first describing how physicians can use Web 2.0 in medicine on 10/29/2005 but that does not count for much anymore, I guess.


My presentation on Web 2.0 in Medicine, updated in 1/2008.

References:
Web 2.0 in Medicine. CasesBlog, 2005.
Medicine 2.0 Conference in September. eHealth.

Related:
Dangers of Web 2.0: In Medicine. ScienceRoll.com.

AllTop Health: a news aggregator of all top health stories on one page

Alltop is "a news aggregation site that provides “all the top” stories for 40 of the most popular topics on the Web. The headlines and first paragraph of the 5 most recent stories from 40-80 sources for each topic are displayed. Alltop stories are refreshed approximately every 10 minutes."

Click here for Alltop health stories which include news stories and blogs. Overall, it is an interesting and useful concept although not new. The forgotten Findory news aggregator had a similar approach. Alltop does not look very different from iGoogle populated with health-related RSS feeds. Google News service has a similar interface and I especially like the slick image view. In any case, I rarely have time to check more than the subscribed feeds in Google Reader in the condensed "list view." This is usually sufficient to stay up-to-date with most news stories.


Alltop: Guy Kawasaki's Newest Venture in Social Media

Alltop is powered entirely by RSS feeds but it does not provide feeds itself.

References:
Announcing (Formally) Alltop. How to Change the World.
Alltop: Guy Kawasaki's Newest Venture in Social Media. PodTech.
Google News Image View: Allergy. Allergy Notes.

Related:
NewsFlashr Health is a similar aggregator to AllTop.

Updated: 05/17/2008

NPR: Doctor Blogs Raise Concerns About Patient Privacy

A NPR story discusses if Doctor Blogs Raise Concerns About Patient Privacy (4 min 49 sec).

Dr. Debra Peel, a psychiatrist and founder of the group Patient Privacy Rights, is unhappy with doctors "venting" their frustration on personal blogs:

"If you are unhappy with the people that you're supposed to be serving and taking care of, you probably need therapy," she says. "You don't need to be venting your frustrations in a public manner like that. That's very inappropriate and unprofessional."

These are strong words. A few members of the profession have made a "blogging career" out of sharing their frustration with the current status of our health system. This is not limited to the U.S., NHS Blog Doctor, for example, is very critical of the government-sponsored health system in the U.K.

One should take into account not only protecting confidentiality and professional behavior but also freedom of speech.

There are some simple rules to observe when blogging, in addition to using common sense. The top and foremost is not to publish any of the 18 HIPAA identifiers when writing about patients. Some doctor bloggers take this rule to an extreme and do not to write about patients at all.

Tips for medical bloggers

- Write as if your boss and your patients are reading your blog every day
- Comply with HIPAA
- Do not blog anonymously. List your name and contact information.
- If your blog is work-related, it is probably better to let your employer know.
- Inquire if there are any blogging guidelines. If there are, comply with them strictly.
- Use a disclaimer, e.g. " All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."
- Get your blog accredited by the Heath on the Net Foundation

Dr. Wes offers more detailed advice on Keeping Pace With a Blog in EP Lab Digest. Note: GruntDoc disagrees with the advice not to blog anonymously (see his comment here).

References:
Doctor Blogs Raise Concerns About Patient Privacy. NPR.
Simply Fired - How NOT to Blog About Your Job. Especially If You Are a Doctor. Clinical Cases and Images - Blog, 08/2005.
How to write a medical blog and not get fired?
Anonymous Medical Blogger? Not Anymore. Clinical Cases and Images - Blog, 02/2007.
Can You Trust Blogs? 10 Questions for Medical Bloggers
Case Reports and HIPAA Rules
Image source: Wikipedia

What is Included in President's Physical Exam?

WebMD reviews items included in the 2007 annual physical examination of President George H. Bush. The inclusion of both exercise treadmill testing and stress echocardiogram is a bit unusual since he has not reported any symptoms, at least according to the publicly available information.

An annual physical examination of healthy people is not recommended by any national medical society.

References:

What’s in a President’s Physical? WebMD.
President Bush's Physical - A Good Example on How to Have a Healthy Lifestyle. CasesBlog, 2005
Executive Health Physicals. Are They Worth $ 3,000? CasesBlog, 2006.
The Presidents Club | Photos: Oval Office Secrets from Truman to Obama | TIME, 2012.
Image source: Wikipedia, public domain.

The Times with an X-ray gallery of common ski injuries

The winter is almost over but The Times of UK has just published an X-ray gallery of common ski injuries:

"If you are a skier, then the knee is the most likely injury on the slopes. And if you're a boarder? Do take care of your wrists, the most vulnerable to damage.

For skiers, the body parts most likely to be injured are the knee (32% of all ski injuries), head/face (13.7%), shoulder (9.1%), lower leg (7.6%), wrist (5.4%) and thumb (4.9%)"

References:
Ski breaks: the X-ray stories. The Times.
Image source: Bone fracture, from Wikipedia, the free encyclopedia (public domain).

NYC Nephrologist Finds Google Book Search Useful

Dr. Joshua Schwimmer is a New York City nephrologist and an author of several interesting medical blogs: The Efficient MD, KidneyNotes and TechMedicine. I have enjoyed reading Joshua's posts for years and have picked up some very useful ideas from them. In this video post on the official Google Book Search blog, he explains how he used Book Search as a teaching aid while in the emergency department with a group of students and residents.

Dr. Schwimmer's newest blog is called InfoSnack and is here: http://infosnack.net

Related:
Build An Online Version of Your Library and Share It Via Google Books

Updated: 10/06/2010

Antibiotics, anticonvulsants, antidepressants and sex hormones in drinking water of 41 million Americans

According to the Associated Press:

"A vast array of pharmaceuticals — including antibiotics, anti-convulsants, mood stabilizers and sex hormones — have been found in the drinking water supplies of at least 41 million Americans. The concentrations of these pharmaceuticals are tiny, far below the levels of a medical dose but the long-term consequences to human health are unknown."

The pharmaceutical industry points out the amount of medication in the water supply is the equivalent of a single pill in an Olympic-size swimming pool. Still, if you a have glass of water in Philadelphia, you are drinking tiny amounts of at least 56 medications.

CNN has a map of the affected metro areas and a video explanation of how drugs end up in tap water.

The Wikipedia article about drinking water comments on the "Tap Water vs Bottled Water" debate: "Many large corporations and some water companies are now making an effort to promote tap water over bottled water. The mayors of San Francisco, Salt Lake City and Minneapolis signed a pledge to promote tap water over bottled water as part of the “Think Outside the Bottle” campaign."

References:
AP Probe Finds Drugs in Drinking Water. Associated Press.
Drugs in water causing troubling problems to fish, wildlife. CNN.
In U.S., bottled water lacks drug safeguards. CNN.
Faucet image source: OpenClipArt.org (public domain).

Another Milestone: Two Million Page Views for Clinical Cases and Images

ClinicalCases.org and Casesblog have reached the milestone of two million page views since their launch in 2005 (see the SiteMeter screenshot on the right). We stand at 2,015,005 page views and 707,771 visits as of today. Clinical Cases and Images (ClinicalCases.org) has become probably the most popular case-based curriculum of clinical medicine on the web and is ranked number one among 11 million pages.

The project was developed at Cleveland Clinic is hyperlinked in the web sites of 27 medical schools in the U.S., Canada, Europe, South America and Asia. ClinicalCases.org has been featured in 10 peer-reviewed medical journals and other scientific publications including British Medical Journal (3 times), Journal of the American College of Cardiology, Cleveland Clinic Journal of Medicine, Journal of the American Society of Nephrology, BMC Medical Education, Journal of the American Podiatric Medical Association, Nursing Education Perspectives, Baylor College of Medicine Web Digest, Medscape (2 times), Student BMJ, Medical Journal of Australia and Clinical Infectious Diseases. Abstracts and posters about the use of Clinical Cases and Images for medical education in different subspecialties have been presented at multiple scientific meetings including the annual sessions of American College of Cardiology, American Society of Nephrology, International Association of Medical Science Educators, Society of Hospital Medicine, Cleveland Clinic Annual Perioperative Medicine Summit, and Case Western Reserve University Research ShowCase.

Just as a short explanation, ClinicalCases.org is a collaborative attempt to build an online case-based curriculum of medicine. CasesBlog is the blog I started in March 2005 (3 years ago) to collect ideas, interesting stories and post relevant news about the Clinical Cases and Images project.

In my work as a Clinical Assistant Professor at the Cleveland Clinic and Case Western Reserve University medical schools, I was pleasantly surprised to find that a blog can be very useful for both personal education (building a portfolio) and education of others. A wiki seems to be the next logical step for collaborative education and I have recently been exploring this concept with several of my friends and colleagues.

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

See how you can use Web 2.0 services for medical education in the presentation below:



References:
Another Milestone: One and a Half Million Page Views for Clinical Cases and Images. CasesBlog, 06/ 2007.
One Million Page Views. CasesBlog, 2006.
Medical Schools Which Link to Our Project Clinical Cases and Images

Wintertime and Rhino Enrichment, Cleveland Style

Rhino Enrichment, Cleveland Style from CMZooTube

Cleveland Metroparks Zoo is home to more than 3,000 animals representing 600 species, including the largest collection of primate species in North America. Top attractions include The RainForest, Northern Trek, Australian Adventure, African Savanna, Waterfowl Lake and the Primate, Cat & Aquatics Building.

I have posted many photos and videos from Cleveland Zoo on the travel blog. The most recent posts are:


Viktor Schreckengost and Elephant Sculptures at Cleveland Zoo


Bactrian Camels at Cleveland Zoo

A mnemonic for the correct name for each camel species is this: "Bactrian" begins with "B", and "Dromedary" begins with "D" -- and "B" on its side has two humps, whilst "D" on its side has only one hump. Source: Wikipedia.

Electrocardiogram (ECG, EKG) Learning Tools

To provide some background, I am a teaching attending at Cleveland Clinic and have multiple rotations during the year with our residents and medical students. We record all topics discussed during a particular rotation on this blog and I know from the feedback which one the residents and students like the best. This month it was the session about using 2 mnemonics as a systematic approach to interpreting EKGs and web-based tools for EKG training. All senior medical residents at Cleveland Clinic have to take an EKG exam in their second year and they found the EKG learning tools listed below especially helpful:

- ECG Wave-Maven by Harvard Medical School is a fully-fledged ECG-trainer

- EKG World Encyclopedia by McGill University

- Arrhythmia simulator by SkillStat with a play, pause and quiz mode

-ECG Palm Brain is a useful online and PDA reference

- Systematic Approach to Reading Electrocardiograms by Using 2 Mnemonics

- EKGs with Dr. Koch: It's Not Only Educational It's Also Fun -- a Cleveland Clinic cardiologist will guide you through the interpretations of several EKGs

Audio

Audio lecture: Basics of EKG. Dr. Dwight Dishmon. Podcasting Project for the UT Internal Medicine Residency Program, 2006.

Video



ECG Video: For Med Students studying the basics of reading an electrocardiogram, from the University of Wisconsin.

References:
Topics Discussed During the Internal Medicine Rotation at Cleveland Clinic in February/March 2008
Image source: Atrial fibrillation (AFib) with rapid ventricular response (RVR) due to triple lumen catheter (TLC) placement

Updated: 03/04/2009

Blogger Advice: Communicate with Your Readers Via Free Phone Calls and Chat

Google released 2 new features which allow any blogger with access to the HTML template of their site to embed 2 badges = communication channels for direct contact with readers:

- Free phone calls via Grand Central VOIP service (WebCall Button). The button also allows you to post voice mail to your blog which replaces the now defunct AudioBlogger feature.

- Chat via Google chat (Chatback badge)


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:
Google Talk chatback. Google Talk Blog.
Chatback: Let people comment using Google Talk. Garett Rogers.
Add Google Talk Badge To Your Blog and Chat with Readers Live. Digital Inspiration.
GrandCentral: receive calls and post voicemail with your blog. Blogger Buzz.

Attending rounds: What is SAPHO syndrome?

SAPHO syndrome includes a variety of inflammatory bone disorders that may be associated with skin changes. SAPHO stands for Synovitis-Acne-Pustulosis-Hyperostosis Osteomyelitis.

An entity initially known as Chronic Recurrent Multifocal Osteomyelitis (CRMO) was first described in 1972. The term SAPHO was coined in 1987.

Treatment is with NSAIDs, steroids, methotrexate or Enbrel.

References:
Round 7: Synovitis-Acne-Pustulosis-Hyperostosis osteomyelitis syndrome (SAPHO). Johns Hopkins University School of Medicine.
SAPHO syndrome, from Wikipedia, the free encyclopedia.

How to Use Web 2.0 Services for Research

According to Wikipedia, "Web 2.0 is a trend in World Wide Web technology, and web design, a second generation of web-based communities and hosted services such as social-networking sites, wikis, blogs, and folksonomies, which aim to facilitate creativity, collaboration, and sharing among users. "

GooMedic.com has a summary on using Web 2.0 services for research which includes:

Social Writing (Documents) and Research Papers
Social Bookmarking
Sharing Resources
Social Networking
Groupware
Social Online File Storage
Social Calendars
Social ToDo Lists
Social Statistics

References:
Web 2.0 as Research Tools 02-1- : Collaborative software. GooMedic.com, 02/2008.
Image source: ScienceRoll, a Creative Commons License.

Related:
Research Tip: Create Surveys and Databases with Online Forms via Google Spreadsheets
Google Docs & Spreadsheets Could Replace Word & Excel for the Average User. Clinical Cases and Images - Blog, 10/2006.
Video presentations: Novel concepts and easy-to-use web tools for researchers. European Molecular Biology Laboratory, 2006.

Diabulimia (Skipping Insulin to Slim Down) Increases Morbidity and Mortality

CNN first mentioned “diabulimia” last June:

"Like many teenage girls, Lee Ann Thill was obsessed with her appearance. Then one day at a camp for diabetic teens, she heard counselors chew out two girls for practicing “diabulimia” — not taking their insulin so they could lose weight, one of the consequences of uncontrolled diabetes..."

Not surprisingly, a study published in Diabetes Care shows that women who restrict insulin face higher mortality and morbidity. The study authors also proposed a screening question for diabulimia asking patients to answer true or false to the statement, “I take less insulin than I should.”

In the world of medical journals, Web 2.0 is here to stay -- Diabetes Care prominently features several social bookmarking tools with each articles. A comment section is still missing however.

References:
Morbidity and Mortality in Women with Type 1 Diabetes. Ann E. Goebel-Fabbri et al. Diabetes Care.
Diabulimia: Skipping Insulin to Slim Down. Clinical Cases and Images - Blog.
Women who restrict insulin face higher mortality, morbidity. ACP Internist Weekly.
Image source: Wikipedia, public domain.

Interesting Articles: A Weekly Review of the "Big Five" Medical Journals

This is a collection of articles I have found interesting in the weekly editions of the "big five" medical journals: NEJM, JAMA, Annals, Lancet and BMJ (a few more journals are included occasionally). The review is a weekly feature of Clinical Cases and Images - Blog. Please see the end of the post for a suggested time-efficient way to stay up-to-date with the medical literature.

Venous Thromboembolism and Mortality Associated With Recombinant Erythropoietin and Darbepoetin Administration for the Treatment of Cancer-Associated Anemia. Charles L. Bennett at al. JAMA. 2008;299(8):914-924.

Erythropoiesis-stimulating agents (ESA) raise the risk of death among cancer patients by about 10%. The study also found a 57% increase in the risk of venous thromboembolism, a known side effect of ESAs. The findings raise concern about the safety of ESA administration to patients with cancer in addition to the concerns we already have about ESA use in CKD and ESRD patients.

Salivating for Knowledge: Potential Pharmacological Agents in Tick Saliva. Hovius JWR, Levi M, Fikrig E PLoS Medicine Vol. 5, No. 2, e43.

Tick saliva is a potential source for novel pharmacological agents that could be useful for clinical practice.

Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure. van Baal PHM, Polder JJ, de Wit GA, Hoogenveen RT, Feenstra TL, et al. PLoS Medicine Vol. 5, No. 2, e29.
Obesity prevention leads to a decrease in costs of obesity-related diseases but this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures. Bottom line: people living longer cost more to health insurers.

Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock. NEJM, 02/2008.

Low-dose vasopressin did not reduce mortality rates as compared with norepinephrine among patients with septic shock.

Cumulative Association of Five Genetic Variants with Prostate Cancer. NEJM, 02/2008.

Five Single-nucleotide polymorphisms (SNPs) in this study and family history accounted for 46% of the cases of prostate cancer in the Swedish men studied. In conclusion, SNPs in 5 chromosomal regions plus a family history of prostate cancer have a cumulative and significant association with prostate cancer.

Survival after bilateral versus single lung transplantation for patients with chronic obstructive pulmonary disease: a retrospective analysis of registry data. The Lancet 2008; 371:744-751.

Bilateral lung transplantation leads to longer survival than single lung transplantation in patients with COPD.

Russia's next president needs to tackle health reforms. The Lancet 2008; 371:711-714.

Perspectives, Profile: Viktor Schultz: physician in a Russian municipal hospital. The Lancet 2008; 371:717.

A time efficient way to stay up-to-date with medical literature

"How do you eat in elephant? In small bites." The same rule probably applies to staying current with the ever expanding avalanche of medical literature. One can try the following approach:

1. Subscribe the to the RSS feeds of the 5 major medical journals (NEJM, JAMA, BMJ, Lancet and Annals) plus 2-3 subpecialty journals in your field of interest.


Medical Journals tab: A screenshot of iGoogle with RSS feeds from the major medical journals.

2. Read the journal on the day it is published online, for example, NEJM on Wednesdays.

3. Use text-to-speech to listen to articles you do not have time to read.

4. Listen to journal podcasts. Click here to subscribe the podcasts of the 4 major journals in iGoogle.

Related:
Make Your Own "Medical Journal" with iGoogle Personalized Page
Share iGoogle Tabs with Medical Journals, Podcasts and Gadgets
Annals of Internal Medicine Launches Podcast and Audio Summaries
Text-to-Speech Programs and Continuous Medical Education
Image source: OpenClipArt, public domain.

BBC: Different Stages of Life

Listen to BBC programs about different stages of life:

Life as a Teenager

Life as an Adult

Life in Middle Age

Life in Old Age

Life after 80

BBC 4 has a streaming Listen Again page and a podcast directory. Subscribing is YouTube-style easy -- you can copy the URL directly, or subscribe via Google Reader/iGoogle or iTunes.

Related:
BBC Podcasts Are Worth Listening To
Four Stages Of Life by The Happy Hospitalist.
Image source: OpenClipArt.org, public domain.

Updated: 07/19/2008