THIS WEEK in the MEDICAL BLOGOSPHERE: GRAND ROUNDS 2.36

Welcome to Grand Rounds 2.36, this week's best posts of the medical blogosphere.

The medical blogosphere is made up of a growing number of physicians, nurses, students, PAs, patients, scientists, social workers, administrators, engineers, IT professionals, librarians, EMTs, consultants, and many other people involved in health care.

On the right is a graph of the blogs that mention "Grand Rounds." The spikes on the graph represent Tuesdays, when Grand Rounds are traditionally posted.

Grand Rounds shares the same purpose as the annotated table of contents in printed medical journals like the NEJM and the Annals of Internal Medicine: it introduces noteworthy writing and encourages further reading.

It's been six months since I last hosted Grand Rounds. In that time, the blogosphere has doubled to over 41 million blogs.

Grand Rounds has also grown. This week, there were forty submissions. Of the many tools on the web designed to help humans deal with vast quantities of information, I've found del.icio.us to be among the most useful. (Del.icio.us is an online bookmarking service that allows you to easily browse links and share them with others.)

The del.icio.us page summarizing Grand Rounds 2.36 is here. Included are links to all the posts, short excerpts, and tags/keywords of all the topics on the right side of the page.

Del.icio.us is one way of viewing all the entries. I've also organized each by categories and included short quotes from each submission to highlight the variety of voices.

I have the pleasure of hosting Grand Rounds again this week. Here are the blogs:

Editor's Picks

• Eskimo Food and Botulism, Tundra Medicine Dreams
• The Theory of the Fourth Day, Doctor Hébert's Medical Gumbo
• Triage: How Much Is Too Much?, Emergiblog
• The Money Shot, Urostream
• Field Guide to Elevator Passengers, Ad Libitum
  

Doctors / PAs / PhDs Stories

From Doctor Hébert's Medical Gumbo:

This is the quandary I find myself in when I try to convince patients to forego antibiotic treatment for colds. Doing so benefits all of society. But does it benefit the patient in any way? Not very much. It takes real altruism to see the value in that argument, and -- how do I delicately put this ? -- we are not in the habit of raising altruists in this country.

From Dr. Deborah Serani:

I noticed, while visiting your terrific XXXXXXXX, that you have a copy of an actual XXXX. It would be more ethical if the reproduction of this XXXXXX was not posted. Test security is a highly regarded aspect in our field, and having that XXXXXXX posted can compromise validity and reliability in the XXXXXXXXX.

From Healthy Concerns:

Sometimes I am astonished, delighted and even moved by the stories that MedBloggers tell. Today I'd like to point you to just a handful of my favorites from the last couple of weeks.

From Doctor:

This week's issue of JAMA has a commentary essay about the new Electronic Medical Record system. I'd have to say that it's right on the money for how inconvinient sifting through any chart is these days. The essay is available here for free and is written in a format that really drives the point home! (highly recommended)

From Tundra Medicine Dreams:

Living a subsistence lifestyle—i.e., living off the land—requires a constant round of seasonal activities directed at acquiring food, heat, shelter and clothing. Most of the people living in villages, and quite a few living in Bethel, are doing exactly that. It is a constant procession of hard work with very few days off.

From UroStream:

However, this particular patient made his living as a porn star, known for his (ahem) "money shot", and a TURP would have been the end of his career. What to do? He was quite torn about his choices, and we (the residents) became quite involved with this "drama". He was basically deciding between the ability to urinate freely versus the ability to continue with his chosen profession.

From Wandering Visitor:

In taking care of patients, we have the opportunity to run the gamut of emotions. Patients can make us happy, angry, scared, and sometimes, either patients or their medical conditions can make us cry.

From Medical Humanities:

Last night I attended a wake. It was meant to be a party to celebrate 8 years of Medical Humanities at UCL but there was an inevitable air of sadness: UCL's pioneering Centre for Medical Humanities is no longer being funded and has been forced to close. It is understatement to say this is a great shame. The Centre has served as a crucible for the discipline in the UK.

Grand Rounds 2.0 and The Medical Blogosphere

From The Medical Blog Network:

In anticipation of TMBN hosting of the leading medblog carnivals, Health Wonk Review on 6/1 and Grand Rounds on 6/6, we have a major service update. In fact a real trifecta:

• Blog Carnival Management: Automated system for managing entry submissions to blog carnivals.
• Blog Listings & Member Profiles: All-new blog directory to give you improved ways to promote your blog(s).
• Syndication & Revenue Sharing: A way to give back to our members, including bloggers interested in feed syndication.

From The Haversian Canal:

Grand Rounds, and its audience, continues to grow, and there have been several conversations about the conflict between linking to all who submit the products of their labor and providing readers with a relatively clean, concise introduction to the medical blogosphere. Some Rounds have pushed 100 submissions and the average is over 50. Maybe we should link to everybody. Maybe we should link to five. I don't know. As most hosts link to everyone, I am going to take the road less travelled, and I hope you will join me.

I will link to thirty articles from thirty authors. My goal is not to select the most popular bloggers or those I think are the best. I want the thirty best articles written. I don't care when they were written, how many times they've been edited, or what your credentials are.

From GruntDoc:

I've emailed Dr. Reider (who runs Medlogs) several times, and so far there's no inclusion of my feeds. (I'm linked in the sidebar, twice, which is nice but not getting the feeds in).

Is anyone else having problems getting their feeds included, and does anyone have a better / more effective way of contacting them?

From Enoch Choi of Medmusings:

I've volunteered to be the discussion leader of Bloggercon 4 in SF, CA... If we have enough interest, we can have a medblogger track. Who's in? email me at enochchoimd-thoughts AT yahoo DOT com.

We've got two venues committed now, so there will be at least two tracks. We're working on space for another track and I'm starting to put together a grid, and a list of DLs I want. If you've been a DL at a previous BloggerCon and are available to do this one, please let me know. No guarantees, but it would help to get things together more quickly, and given the closeness of the dates, time is of the essence.

Drugs and Technologies

From The Biotech Weblog:

According to a group of Finnish researchers, the carcinogenic damage caused by alcohol and smoking to the mouth, pharynx and esophagus can be accounted for in part, by the exposure of these organs to high concentrations of acetaldehyde... Since it has been known that the amino acid l-cysteine can bind to acetaldehyde and thereby eliminate its toxicity, scientists have developed l-cysteine products that could neutralize acetaldehyde and help prevent digestive tract cancers... The first commercial product, the l-cysteine containing chewing gum, was launched last week at the 11th International Congress of Oral Cancer.

From The Beast:

Big news in the myeloma world on Friday! Thalidomide was approved by the FDA for treatment of multiple myeloma. Thalidomide is an old drug with a dark past.

From Straight from the Doc:

The technology leader in products for reconstructive surgery of the extremities, Nexa Orthopedics, Inc. has recently received 510(k) clearance from the USFDA to market its pyrolytic carbon Carpometacarpal Implant (CMI).

From The Pharm Voice:

According to an animal model study conducted by University of Pittsburgh School of Medicine researchers whose results have been presented at the annual meeting of the American Urological Association, IP 751, a potent synthetic analog of a metabolite of THC (the principal active ingredient of marijuana) effectively suppresses pain in hypersensitive bladder disorders such as interstitial cystitis (IC).

From Diabetes Mine:

Thinking it over, my last post didn't really do justice to those USB flash drives specially designed to let you carry your medical records with you. (In Germany they call them "Sticks," while a cell phone is called a "Handy" ... pragmatic language)

Considering that we PWDs are constantly told to carry our full medical records along with us when we travel, the idea of putting it all on a tiny little stick is actually pretty interesting.

From Health Business Blog:

NEJM Editor Jeffrey Drazen has a letter to the editor of the Wall Street Journal today, responding to an article that demonstrated the New England Journal's laxity in scrutinizing the infamous Vigor trial of Vioxx.

Health Economics

From The Marketplace MD:

There was a disturbing story this week in the New York Times about how insurance companies take a long, long time to make payments to physicians. As Matthew Holt points out, this, by itself, is not news. The news was new data on exactly how long docs actually have to wait to get paid. The very worst insurance companies pay an average of 41.4 days after services are performed while the very best pay 29 days later. 29 days?!! That’s A MONTH!!

From Interested-Participant:

Here's the case of Tom Garrett, an 18-year-old leukemia patient, who must fly from Toronto to Calgary every 16 days to receive photoimmune therapy not available in Ontario. This is so despite the fact that at least one hospital in Ontario has the medical equipment necessary to provide treatment.

From Parallel Universes:

Early last month I wrote a post about how the high prices of medicines can "kill" sick patients. Much of the reason for high drug prices stems from the profit-oriented and patent-based global system for new drug development, marketing and pricing. Since the people behind this system operate only based on business methods and how to upset competition, the fate and welfare of poor sick people are largely neglected. Not all sick people have spare money to spend on medicines. More often than not, they would prefer buying food than medicine. And so, you know what happens next. They die even when they're not supposed to.

From InsureBlog:

Ms. Kiehl states that “(i)f you walk into a (doctor’s office) and ask, ‘What does it cost?’ they can’t tell you. (The medical industry)…is trying to keep this information a secret.” This statement is not only incorrect, but shows a lack of knowledge of the operations of physicians’ offices.

From Kevin, M.D.:

So, let's assume the reason we go to trial is to find the "truth" (i.e. whether medical error lead to the injury). We "test" with a malpractice trial. It has a false positive rate of 37 percent according to Studdert. This leaves us a test with a 63 percent specificity. Furthermore, the costs of performing this test are ridiculously high, which everyone agrees on...

Humor

From Doc Around the Clock:

Every once in a while when working the ED, we have a patient come in where we question whether or not their pacemaker is functioning correctly. In these instances we call the cardiology department and ask them to come down and interrogate the pacemaker. This is basically a technique where the pacemaker is checked via a computer to see if it is pacing the heart correctly and appropriately. Using the word interrogate in reference to an inanimate object always strikes me as funny. I always imagine the interrogator taking the pacemaker into an enclosed, darkened room, with nothing but a bright light shining on the device in question.

From Trick-Cycling for Beginners:

Occasionally, one gets bleeped for something so mind-blowingly trivial or downright stupid, one decides to add it to the list of Stupidest Things I Have Ever Been Called For. For two years, I have been swearing that I am going to compile such a list, and now, through the marvellous medium of the blogosphere, I am going to do just that.

From Fixin' Healthcare:

Well, I met with my consultant, Pogo. He called in another consultant and we reviewed the matter in great detail. It was my first time to meet the Lorax in person. Impressive fellow. Focused and no nonsense. Very little humor. But, Pogo made up for that and together they are a great team. Like most consultants they spent some of the time telling me what I already know.

From Ad Libitum:

Elevators are microcosms of human behavior in modern society. Riding up and down our hospital elevator, I’ve had countless opportunities to observe people. Of late, I’ve started trying to categorize them. There are a few distinct types of elevator passengers...

Medical Education

From The Rumors Were True:

So I'm not big-picture. The sooner I make peace with that, the sooner I can look at the glint form my shiny scalpel and forget about it. I'll sing the scalpel song that Todd from Scrubs taught me:

"Dum, did de dum, did de dum, did de SHINY SCALPEL!"
"Dum, did de dum, did de dum, did de GONNA CUT HIM UP!"

From Med_school:

Today, dear Medical School, you finally helped me accomplish what has held me back all those years in elementary school. This morning, during my Medical Physiology final, I finally surpassed that final hurdle that has prevented me from a perfect score on that coveted presidential fitness award. I have beaten my past demons.

Nurses Stories

From Emergiblog:

There are three theories to how triage should be handled.

• The Down and Dirty Doorway Destination Decision
• Surf ‘em and Turf ‘em
• The Triage Trifecta

From PixelRN:

I am thinking about leaving the MICU for another type of nursing. I've been in the MICU for almost 2 years (if you include my student rotation). I've thought about leaving before, but up until now I hadn't crossed the threshold of thinking, "I'm leaving because I can't do this" to "I'm leaving because I don't want to do this."

Patients Stories

From All Blogged Up:

Now, she’s struggling with two very active toddlers, managing somehow to maintain a 4.0 at college … and the entire time, she’s in relentless pain. Close to discouraged tears, she called me and said, “Moof, the doctor sent me to the emergency room, and when I got there, they were rude, and harsh, and acted as if I was lying to them! They didn’t believe that I was in pain..."

From A Difficult Patient:

I won't go into details, but my doctor went beyond what should be done during a pelvic exam. He didn't ask my permission to do what he did, he didn't warn me before he did it, and what he did was entirely inappropriate. I never told anyone about this--I'm sure that no one would have believed me anyhow. Worse, I went back to this doctor. On that particular day, I left feeling confused, ashamed, and violated. But I rationalized his actions--He was my doctor, and I trusted him.

Pregnancy

From NHS Blog Doctor:

Two weeks ago, Patricia Hewitt announced that doctors were to be instructed to offer pregnant women the choice of a home birth. I am implacably opposed to home births in the UK and I posted an article saying so. My reason for this opposition is straightforward. Safety. There are not adequate facilities to resuscitate a mother or baby in the home environment and it is not possible to predict who may need such resuscitation. Until such time as there are such facilitates, and this means country wide availability of Obstetric flying squads, able to respond within minutes, home births are not a sensible option.

From The Brown Stuff:

I've had reason to review my knowledge of morning sickness recently. Most women get this to one degree or other in pregnancy in the early stages of pregnancy. Most don't require treatment and it usually settles around the three month mark.

Rants

From GruntDoc:

Recently, I seem to be approached by more and more people with what amounts to "I have this problem, and I want you to fix it". This is usually medically related (IV access, meds), but is often just personality-conflict in action, or occasionally plain sloth.

From Disease Proof:

[Howard] Stern mentioned that over the weekend he read the article in The New York Times by Nicholas D. Kristof, entitled Killer Girl Scouts. Kristof argues, and Stern agrees, that high trans-fat content in food is no less a threat to Americans than Iranian dictators and terrorists organizations.

Science

From Clinical Cases and Images:

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

From Allergizer:

Dr. Yael Graif is the lead author of an article published in the latest issue of Journal of Allergy and Clinical Immunology. His study shows that a lot of children who get serious insect stings are not brought to the hospitals.

From Genetics and Health:

After recent discussions over genetic testing for autism (both prenatal and postnatal), I’m glad to have found this Philadelphia Inquirer editorial by Dr. Arthur Caplan, Emanuel & Robert Hart Professor of Bioethics, chair of the Department of Medical Ethics, and director of the Center for Bioethics at the University of Pennsylvania... The editorial makes me want to stand up and cheer. You must go read it. RIGHT NOW.

Also from Genetics and Health:

This chart from Google Trends comparing the search and news reference volumes for the terms genetics, genes, genome, and DNA surprises me somewhat.

From Breath Spa for Kids:

Preliminary results from on-going studies suggest that the stress caused by environmental exposure to violence is significantly linked to both poorer lung function in children and asthma exacerbations.

That concludes this week's Grand Rounds. Thank you for your submissions.

Next week's Grand Rounds will be hosted at Health Voices. (Please read this post prior to submitting.)

As always, thanks to Dr. Genes.