Stock market dips linked to heart attack increase

During the period of increased volatility in the stock market in 2006-2009, when stock market values decreased, heart attacks seemed to increase, and then decreased when stock trends improved.

While earlier studies showed a link between traumatic events such Hurricane Katrina in 2005 and an increased risk of "cardiac events," there was limited data on the impact of financial markets.

References:
Stock market dips linked to heart attack surge: study - Yahoo! News.
Image source: Gray's Anatomy, 1918, public domain.

Walnut labeled "Supernut" because of high antioxidant conent



Based on antioxidant content (polyphenols), here is how nuts stack up, from highest to lowest:

- walnuts
- Brazil nuts
- pistachios
- pecans
- almonds
- peanuts
- macadamia nuts

References:

Memorable medical textbooks of the past

Medical textbooks were not always as dreary and as bland as they are now, according to BMJ. Some examples of lively, first person didactic tone come from J L Burton’s Essentials of Dermatology:

"The Lord Privy Seal is neither a lord, nor a privy, nor a seal" and "‘seborrhoeic’ warts have no relationship to seborrhoea."

"The simultaneous occurrence of scabies in a doctor and a nurse may mean that they have shared nothing more exciting than a patient with Norwegian scabies."

Explanation:

The Lord Privy Seal (or, more formally, the Lord Keeper of the Privy Seal) is the fifth of the Great Officers of State in the United Kingdom. Originally, its holder was responsible for the monarch's personal (privy) seal (as opposed to the Great Seal of the Realm). Though one of the oldest offices in government anywhere, it has no particular function today.

Seborrhoeic keratosis (seborrhoeic wart, basal cell papilloma) is a benign overgrowth of the basal cells of the epidermis. The patient is usually elderly and concerned because the lesion is unsightly.

References:
Image source: Seborrheic keratosis, Wikipedia, GNU Free Documentation License, Version 1.2.

A microscopic look at hotel hygiene makes a microbiologist travel with an impervious mattress cover

From CNN:

The microbiologist Philip Tierno doesn't feel comfortable staying in hotels. He knows too much. He travels with an impervious mattress and pillow cover to protect against the unseen debris that guests leave behind. When humans sleep they shed about 1.5 million cells an hour.

While the covers were developed for allergy sufferers, Tierno encourages everyone to use them at home and on the road.

And definitely ditch the bedspread, he advises. Hotel bedspreads became a hot topic when one featuring bodily fluids from several sources was introduced in boxer Mike Tyson's 1992 rape trial.


How hotels clean drinking glasses

An Atlanta TV station used hidden cameras to monitor how the drinking glasses in hotel rooms were cleaned. In one case, a housekeeper appeared to clean a toilet and the glasses wearing the same gloves. In multiple hotels, the glasses were rinsed in the sink and dried for the next guests, in violation of health codes.

The Health Magazine lists the 12 germiest places in America or the so called "dirty dozen":

  1. Kitchen sink
  2. Airplane bathroom
  3. A load of wet laundry
  4. Public drinking fountain
  5. Shopping cart handle
  6. ATM buttons
  7. Playgrounds
  8. Bathtub
  9. Office phone
  10. Hotel-room remote

References:
A microscopic look at hotel hygiene, CNN, 2011.

Sleep Habits Differ by Ethnicity but All Groups Are Sleep Deprived

All ethnic groups said they missed work or family functions because they were too sleepy, with the percentage ranging up to 24%, according to a 2010 "Sleep in America" survey by the National Sleep Foundation (NSF).

Some distinct differences are listed below:

On weekdays or workdays, African Americans reported they slept the least - 6 hours, 14 minutes, compared to 6 hours, 34 minutes for Hispanics, 6 hours, 48 minutes for Asians, and 6 hours, 52 minutes for Caucasians.

10% of African Americans and Hispanics reported having sex every night or nearly every night in the hour before bedtime, compared to 4% of Caucasians and 1% of Asians.

African Americans had different pre-bedtime activities and tended to pray in the hour before bedtime - 71% of them said they prayed but only 18% of Asians did so.

Asians were least likely to drink alcohol an hour before bed - a practice that many mistakenly think will help sleep. Only 1% of Asians had a nightcap every night or nearly every night, compared to 7% of whites, 4% of African Americans and Hispanics.

Caucasians were most likely to sleep with their pets - as well as more likely to sleep with their spouse or significant others: 16% of them say they sleep with a pet, and 72% say they sleep with their partners. In comparison, only 4% of Asians, 4% of Hispanics, and 2% of African Americans let the pet on the bed.

References:
The 2010 Sleep in America poll by the National Sleep Foundation (NSF).
Sleep Habits Vary by Ethnicity. WebMD, 2010.
Sleepiness and sleep-disordered breathing may be found in 19-29% of children with positive allergy test (http://goo.gl/AfCWZ).
Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.

Acyclovir reduces risk of HIV-1 disease progression, if positive for HIV-1 and HSV-2

Most people infected with HIV-1 are dually infected with herpes simplex virus type 2. Daily suppression of this herpes virus reduces plasma HIV-1 concentrations, but whether it delays HIV-1 disease progression is unknown.

In this study, the median CD4 cell count at enrollment was 462 cells per μL and median HIV-1 plasma RNA was 4 log10 copies per μL. Aciclovir reduced risk of HIV-1 disease progression by 16%.

The role of suppression of herpes simplex virus type 2 in reduction of HIV-1 disease progression before initiation of antiretroviral therapy warrants consideration.

References:

Daily aciclovir for HIV-1 disease progression in people dually infected with HIV-1 and herpes simplex virus type 2: a randomised placebo-controlled trial. The Lancet, Volume 375, Issue 9717, Pages 824 - 833, 6 March 2010.
Image source: Diagram of HIV. Image source: Wikipedia.

Video: "You Can Never Trust Doctors"



Video: "You can never Trust Doctors", linked by one of my Facebook friends.

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

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

Comments from Twitter:

@scanman: Ha!! I do this ALL THE TIME!!!

Professor Tracks Clusters of Terrible Sport Injuries in Hope of Prevention

From the NYTimes:

Prof. Mueller almost immediately noticed a previously hidden cluster in, of all things, pole-vaulting. Several high school and college athletes each year were killed or paralyzed simply by missing the pit with the pole, falling on their heads off the landing pad, or sliding down the pole and hitting their heads on hard surfaces. Pits were soon expanded and surrounded with softer padding.

Mueller detected a strange number of paralytic accidents in organized swimming, all from relay-type dives into water that was too shallow — resulting in today’s minimum depths.


Concussion Recovery - Mayo Clinic Video

References:
Professor Tracks Ghastly Injuries in Hope of Prevention - NYTimes.com.

The First Journal Club on Twitter - Then and Now

The first journal club on Twitter in 2008

I think we started the first medical journal club on Twitter at the Allergy and Immunology program of Creighton University back in 2008. Please let me know if you are aware of an earlier journal club focused on medical articles and broadcasted or held exclusively on Twitter prior to that date. We published an abstract at the annual meeting of the The American College of Allergy, Asthma and Immunology (ACAAI) in 2009, with collaborators from Creighton University, Louisiana State University (LSU) in Shreveport and Cleveland Clinic. The abstract and the poster are embedded below:


The Utility of a Real-time Microblogging Service for Journal Club in Allergy and Immunology. Dimov, V.; Randhawa, S.; Auron, M.; Casale, T. American College of Allergy, Asthma & Immunology (ACAAI) 2009 Annual Meeting. Ann Allergy Asthma Immunol., Vol 103:5, Suppl. 3, A126, Nov 2009.

Purpose

Internet-based services are an important source for communication and reference information for fellows in training in allergy and immunology. Our aim was to explore the utility of the free microbloging service Twitter.com to make the journal club educational activity more interactive.

Methods

We used the text message and Internet interfaces of the free microblogging service Twitter (http://twitter.com/) owned by Twitter, Inc. to post updates and summaries from the journal club activities at an Allergy and Immunology fellowship training program at an academic center. The updates were posted on a web site provided free of charge at http://twitter.com/AllergyNotes and simultaneously distributed to the cell phones of subscribers via text messages. The web site was freely available and comment were open to visitors. One fellow in training was assigned to update the microblogging service from his cell phone with the label "#JCAllergy" for easy referral and later retrieval from the Internet search interface.

Results

Five articles were discussed during a 2-hour journal club teaching session and 24 updates with links were posted on Twitter.com. The updates were followed in real time by 2 fellows at an Allergy and Immunology training program in a different state (not physically present at the meeting). Five fellows (out of 7, 71.4%) at two training programs expressed a favorable opinion of the use of the microblogging service to post updates from journal club.

Conclusion

The microblogging service Twitter can be used to share information from journal club in allergy and immunology and thus serves as an easy to implement form of distant learning for trainees and community allergists. The service is free to use and requires minimal equipment limited to an Internet-connected computer or a basic cell phone (not a smartphone) with activated text messaging service. A potential limitation of this approach may be the distractions that the reporting journal club participant may experience while simultaneously sending text messages and listening to the presentations. Twitter allows an immediate feedback from the journal club participants, following the updates from remote locations, which can enhance the educational aspects of this activity.


The concept of a journal club on Twitter has its own limitations inherent to the publishing medium and the enthusiasm of the participants. After a few months, we decided that the concept was interesting but ultimately the discussion of a journal article requires more than 140 characters.



The worldwide journal club on Twitter in 2011

In June 2011, a medical student and a junior doctor in the UK launched the idea of a journal club exclusively on Twitter. The social network and publishing medium of Twitter has grown tremendously from approximately 40 million accounts in 2008 to 150 million in 2011. The networks mass effect and the infectious enthusiasms of the two founders ensured a large participation in this new journal club on Twitter: http://twitjc.wordpress.com

I wish them best of success in this new educational endeavor. I think it is a great effort and it should be strongly encouraged.

My general comment on the 2008 concept, and this new 2011 version of journal club on Twitter, was that “we need to go beyond this 1950s model rather than adapt it to social media”. To be exact, Sir William Osler established the first formalized journal club at McGill University in Montreal in 1875 (http://j.mp/aGEvB0), but the concept itself seemed to get traction after the 1950s.

I think it would be a good idea to ask the participants themselves what they would like to see in a journal club on Twitter, i.e. "crowdsource" the community. This can be done via a Google Forms poll with a free text option for additional suggestions.

Dr. Stuart Flanagan tweeted that this could be an opportunity to develop or even reinvent the Journal Club model, and it could be a very exciting project. I agree, and will try to add a few specific ideas in a future blog post.

If we stay just on Twitter, this may look like another topical Twitter chat. For example, what are the major differences between "Journal Club on Twitter" and a Twitter chat on a topic?

In addition, Twitter may not be the best way for article discussion. It is just the popular tool at this time. Google Buzz is an alternative service that works well for this purpose but the major problem is that very few people use it. Buzz is a better medium than Twitter for a journal club from a technical point of view. It is easier to follow the conversation threads - this is one its main advantages and Facebook has it too. The search function of Buzz works well while Twitter Search traditionally “forgets” tweets older than 7 days.

Please have a look at the transcript of the first edition of #twitjc and you will realize how challenging is to follow a conversation on Twitter: http://www.scribd.com/doc/57191306/TwitJC-Transcript-5-6-2011

Reading a 30-page Twitter chat transcript with all @ handles, hashtags and timestamps included is not for everyone. Some editing of the transcript would make it more readable. We tried this with the original journal club in 2008, on a much smaller scale of course: http://allergynotes.blogspot.com/2008/12/allergy-and-immunology-journal-club-on.html

How about Journal Club on Facebook? I don't think that JC on either Facebook or Twitter (or blog comments) take the concept to a fundamentally new level.

In any case, Cleveland Clinic, ever the innovator, actually has a Journal Club on Facebook. Dr. Neil Mehta wrote a great summary on their model, using Google Reader and Facebook, check it out here: http://goo.gl/rnw2P



In conclusion, from personal experience, I would say that you can only learn when people criticize your project - it is the most helpful kind of feedback that you typically get for free.

Please consider visiting the website and Twitter account of this new Twitter Journal Club (http://twitjc.wordpress.com), follow the hashtag #TwitJC and enjoy the new editions.

Comments from Twitter:

@DrVes: Did you find #TwitJC useful? @EugenieReich is looking for scientists to be interviewed in Nature. I think the second event was very engaging and useful. That said, #TwitJC is more a Twitter chat on a topic/article rather than a Journal Club as we think of it in the U.S. This brings me to the third tweet on the topic: Do we need separate #meded tags for different parts of the world? http://bit.ly/maPEwm

@amcunningham: well, it's a journal club the way we think of it in the UK... A noisy, hectic one!- but gets the job done :) #TwitJC

@DrVes: Right. Different from what we typically do here, e.g. discuss every detail of a recent (very recent) article, focused on one topic.

Related reading:

Twitter Journal Club: yet another ‘revolution’ in scientific communication? BMJ http://t.co/NrB7KAJ - Any plans for Google+ Journal Club now?

Virtual Journal Club for Hospital Medicine by the Washington University in St. Louis

International Urology Journal Club via Twitter: 12-Month Experience http://buff.ly/NErFFk
Surgical Opinion: Keys to a Successful International Journal Club on Twitter http://buff.ly/NErPwl

CPAP for sleep apnea - BMJ video



BMJ: Sleep apnoea (apnea, in its American spelling) is a condition that causes a patient to stop breathing for short periods during their sleep. In this video researchers Joaquín Durán-Cantolla and Jose María Montserrat discuss their work into the use of CPAP (continuous positive airway pressure) to treat the condition.

People with OSA may be twice as likely to develop a stroke.

Did you know that obstructive sleep apnea (OSA) can reduce a child’s IQ by as many as 10 points, while treatment in children with OSA can improve school grades?

Related:

Mavs Fan at the Finals - Photos - SI.com http://goo.gl/tIdL3

Understanding PAP Therapy for your Sleep Apnea - video from Cleveland Clinic (2013):

The central part of medicine is patients - don't push them out of social media

Clinical medicine is disappearing fast as topic for blog posts

Something happened to medical blogs in the past 6-12 months. They now seem a lot less interesting, more industrialized and aggregated. They have also become "too safe", generic and detached for regular reading.

There seems to be a rise of group blogs, guest posts and semi-syndicated contents. Several "clinic-focused" health bloggers have retired due to a variety of professional and HIPAA-related concerns.

It looks like clinical medicine is disappearing fast as a topic for blog posts in the U.S., replaced by posts about social media itself. As a side note, "social media" is actually a plural noun (media vs. medium), but it seems to be used mostly in singular form nowadays.

The central part of medicine is patients - don't push them out of social media

The central part of medicine is patients. Yet, we tell doctors: "never, ever blog about patients". This somewhat misguided advice displaces the most important part of the equation - the patients themselves.

Some health bloggers claim that we have to "aim above HIPAA" to avoid privacy breaches and comply with the highest standard of professionalism required by our occupation as physicians. How high "above HIPAA" is good enough though? In most clinical scenarios, the compliance with omitting the 18 unique HIPAA identifiers strikes the right balance.

Physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content first to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities (Source: AMA Policy: Professionalism in the Use of Social Media, 2011; my edits are in bold in the text above).

Different standards for individual doctors vs. health system conglomerates

There seems to be a discrepancy of the methods employed by doctors and institutions when using social media. We tell doctors: "never answer patient questions on Twitter". Yet, Cleveland Clinic runs regular Twitter chats soliciting patient questions which are then answered by doctors and healthcare personnel. Mayo Clinic and other institutions do the same.

A blog is your notebook for lifelong learning

Don't forget the most important thing: A blog is your notebook for lifelong learning. Doctors learn from their patients every day. Patients learn from their doctors every day too. Both groups must try their best to excel in the joint quest to achieve the best possible outcome.

Comments from Twitter

@scanman (Vijay): 3 doctors, @kmathan @razmohan & I, set up a twitter account @DrTamil to answer medical queries from Tamil tweeters.

@DrVes: You know the comment that you are going to get, right? "It will never happen here."

@DrVes: New trend: Hospitals tell doctors-in-training point-blank during orientation: "Don't blog. Don't tweet." Consequently, interns close blogs and Twitter accounts (confirmed via email from a trainee).

@macobgyn (MacArthur Obgyn) why do you think that is?

@SarahStewart (SarahStewart): I wonder if medical blogs are reacting to fear of litigation etc.

@DrVes: I'm sure they are. The community itself is not making things easier either.

@Skepticscalpel (Skeptical Scalpel): You're reading the wrong blogs. Try mine http://skepticalscalpel.blogspot.com

@CardioNP (Cardio NP): mirroring medicine in general? Agree w you re blogs; miss the early years ~2004-5. Agree skeptic that ur blog is a nice welcome addition

@marciovm (marcio von muhlen): will change as social media permeates society, informed consent will be feasible re: sharing medical info. Difficult to explain now.

@scanman (Vijay) This tweet - http://bit.ly/mpPL0P - by @DrVes, one of the most consistent medical bloggers, was meant for the Social Media Moral Police.

@vincristine (Vincristine): Who is 'we'? I imagine doctors will tweet what, where and how they choose to tweet, no matter what 'we' say

@laikas Laika (Jacqueline): A lot of interesting observations by @DrVes on the evolvement of medical blogs & social media use. I will take up my #FF habit #ff @DrVes

References

“The powers of medicines and the practice of healing - to exercise the quiet art” - Virgil, Aeneid http://goo.gl/5BUb3
The making of a modern physician - The Lancet http://goo.gl/SYfTu
Strictly speaking, “Doctor” is a word incorrectly applied to most medical practitioners http://goo.gl/wjA0S
Despite the dire warnings, use of social media among emergency physicians is unusually strong http://goo.gl/QlqnK
AMA Policy: Professionalism in the Use of Social Media, 2011.
Image source: Wikipedia, GNU Free Documentation License.

Related reading

Why I became an oncologist - by the president of the American Society of Clinical Oncologists - a patient defined his professional life. CNN, 2011.
Patients can teach us so much. We must pay attention. And yet some people want to silence their voice on blogs and Twitter.
Keeping all regulations in mind, a medical student soon finds there is nothing to blog about: http://goo.gl/541pj
HIPAA found in Hippocratic Oath: Keep the patients’ secrets a secret. Also: My colleagues will be my brothers and sisters http://bit.ly/pGObLI

Disclaimer

I am the Editor-in-Chief of several case-based curricula of medicine and related specialties. This is the information regarding patient data: There is no real life patient data on this website. Please note: we do not write or “blog” about patients. All case descriptions are fictional, similar to the descriptions you can find in a multiple choice questions textbook for board exam preparation. Case courses and descriptions do not follow real cases.

Promoting women in science and medicine to become a priority

The University of Tromsø in Norway - the world's northernmost university - has adopted new recommendations designed to increase the number of female full professors from the current 23% to 30% by 2014.

Women spend longer as Associate Professors than men, partly because “men apply as soon as they think they have a chance of promotion, while women tend to wait until they are very confident”.

The panel developed 13 recommendations, among them:

- re-advertising positions if there are no women in the applicant pool
- ensuring that women receive training in salary negotiation
- assessing research quality rather than quantity
- improving the visibility of women within institutions
- encouraging diversity in leadership style

References:
Promoting women in science and medicine. The Lancet, Volume 376, Issue 9754, Page 1712, 20 November 2010.
Image source: OpenClipArt.org, public domain.