Useful Tools for Blogging, Medicine, and Getting Things Done

These are tools I use often and recommend (including what's on my Treo). Other suggestions are welcome.

• AvantGo (for Treo)
• Blogger
• Bloglines
• Chatteremail (for Treo)
• Cholesterol (for Treo)
• CommuniKate
• Datebk5 (for Treo)
• Del.icio.us
• Del.icio.us Extension for Firefox
• Developing Clinical Problem Solving Skills
• Documents to Go (for Treo)
• eReader
• E&M Coder (for Treo)
• Epocrates (for Treo)
• Feedburner
• Findory
  
• Firefox
• Flickr
• Getting Things Done
• Gmail
• Google
• Google Desktop
• Google News
• Google Page Creator
  
• Google Scholar
• Initiate (for Treo)
• iTunes (for podcasts)
• Lifebalance (for Treo)
• Medcalc (for Treo)
• Performancing for Firefox
• Popurls
• Pubmed
• Technorati
• Treo 650
• UpToDate
• VolumeCare (for Treo)
• Wikipedia
• Writely

Technorati Tags: blogging, medicine, getting things done, recommendations, treo 650

Hilarious Journal Articles #56: "Our grip on reality is slim."

Via EurekAlert:

The neurological basis for poor witness statements and hallucinations has been found by scientists at UCL (University College London). In over a fifth of cases, people wrongly remembered whether they actually witnessed an event or just imagined it, according to a paper published in NeuroImage this week.

From "Discriminating imagined from perceived information engages brain areas implicated in schizophrenia:"

Some of the symptoms of schizophrenia may reflect a difficulty discriminating between information that was perceived from the outside world and information that was imagined. This study used fMRI to examine the brain regions associated with this reality monitoring ability in healthy volunteers, who recollected whether information had previously been perceived or imagined, or whether information had been presented on the left or right of a monitor screen. Recent studies have suggested that schizophrenia may be associated particularly with dysfunction in medial anterior prefrontal cortex, thalamus, and cerebellum. In our data, activation in all three of these regions of interest was significantly greater during recollection of whether stimuli had been perceived or imagined versus recollection of stimulus position. In addition, reduced prefrontal activation was associated with the same misattribution error that has been observed in schizophrenia. These results indicate a possible link between the brain areas implicated in schizophrenia and the regions supporting the ability to discriminate between perceived and imagined information.

Technorati Tags: schizophrenia, neuroscience, neuroimage, neurology

Flickr: Showing his true colors

From Flickr. Uploaded by jaki good on 23 Jun '06, 1.21pm EDT PST.

Avian Flu Mutates "Slightly" in Indonesia

Via the Wall Street Journal Avian Flu News Tracker:

A World Health Organization investigation showed that the H5N1 virus mutated slightly in an Indonesian family cluster on Sumatra island, but bird-flu experts insisted Friday it didn't increase the possibility of a human pandemic. The virus that infected eight members of a family last month -- killing seven of them -- appears to have slightly mutated in a 10-year-old boy, who is then suspected of passing the virus to his father, the WHO investigative report said. It is the first evidence of possible human-to-human-to-human transmission of the H5N1 virus, said Tim Uyeki, an epidemiologist from the U.S. Centers for Disease Control and Prevention, adding that the virus didn't pass outside the family. "Then it stopped. It was dead end at that point," he said, stressing that viruses are always slightly changing and there was no reason to raise alarm bells.

Technorati Tags: avian flu, who, infectious disease, indonesia, wall street journal

Hilarious Journal Articles #55: Testosterone and the Home Team Advantage

From "Salivary Testosterone and Cortisol Responses to Athletic Competition: Rule of Game Outcome, Athletic Setting and the Home Advantage:"

In humans, hormonal responses to athletic competition have often been
studied within the context of a single athletic contest and/or a
weekend tournament. Furthermore, the majority of studies have
primarily focused on individual sports. The present study investigated
the relationship between hormonal responses to competition and game
outcome (win/loss) throughout an athletic season among elite hockey
players. Furthermore, the current study examined the concept of the
‘home advantage’ and possible differences in pre-competition hormone
levels and psychological states depending on game location. Game
outcome was a significant moderator of the testosterone response to
competition (F (1, 12) = 9.91, p = .008). Consistent with Mazur’s
(1985) biosocial model of status, winning a status contest led to
significantly higher increases in pre- to post-game testosterone. In
addition, pre-game testosterone levels were significantly higher for
games played in the team’s home venue, which extends the findings of
Neave et al (2003) and suggests a human territoriality phenomenon.
Furthermore, salivary cortisol levels were also higher when the team
performed in their home venue, which may be the result of increased
social pressure associated with competing in front of friends and
family. Pre-game psychological measures also varied depending on game
location. Self-confidence ratings were significantly higher for home
games while somatic and cognitive anxiety ratings were higher for away
games. Therefore, in contrast to previous reports examining the
hormonal response to competition with team sports (Gonzalez-Bono et al,
1999), testosterone changes were directly related to the outcome of the
game. It may be that measuring a team’s hormonal responses to
competition throughout the athletic season may be a better indicator of
the testosterone/social status relationship.

Technorati Tags: hilarious journal articles, hockey, sports, home team advantage, testosterone, cortisol

New England Journal of Medicine Audio Summary for June 22, 2006

From the NEJM:

This summary covers the issue of June 22, 2006. Featured are articles on condom use and the risk of genital HPV infection in young women, cyclophosphamide in scleroderma lung disease, stimulatory autoantibodies to the PDGF receptor in systemic sclerosis, connexin 40 gene mutations in atrial fibrillation, bioterror and bioart, and on TGF-Β signaling, vascular remodeling, and hypertension; a review article on omalizumab for asthma; a case report of a boy with rapid growth of subcutaneous nodules; and Perspective articles on ADHD in adults and on condoms and sexually-transmitted infections.

Technorati Tags: new england journal of medicine

Patient DNA To Be Analyzed By Default At Vanderbilt University Medical Center

From the Tennessean:

DNA from as many as 400,000 people will be fed over five years into a database at Vanderbilt University Medical Center under a $5 million research program expected to launch in the fall.

Patients at the hospital and its clinics will have the option to call a hot line and opt out.

The data will be extracted from blood that would otherwise be thrown out, from lab tests or other uses...

Technorati Tags: vanderbilt, genetics, dna, privacy, tennessean

Flickr: New Mexico Skies

From Flickr. Uploaded by Oasis Man on 17 Jun '06, 8.25am EDT PST.

FreeMedMatrix, A Free Text Medical Search Page

Via Medical Matrix:

We have updated our clinical search resource on the Internet, "FreeMedMatrix" - http://www.FreeMedMatrix.net.

FreeMedMatrix offers search windows that comprehensively search the Internet's free full text clinical content: articles, images, lectures, news, and guidelines. FreeMedMatrix links to free full text articles archived by Medline. In addition, FreeMedMatrix features "hot topic" keyword links to global Powerpoint clinical lectures.

We hope that FreeMedMatrix will be visited frequently by physicians who prefer to research clinical knowledge with full text. We hope that FreeMedMatrix will encourage rapid distribution of new discoveries.

Technorati Tags: freemedmatrix, medical literature

New England Journal of Medicine Audio Summary for June 15, 2006

From the NEJM:

This summary covers the issue of June 15, 2006. Featured are articles on dasatinib in imatinib-resistant Philadelphia chromosome-positive leukemias, nilotinib in imatinib-resistant CML and Philadelphia chromosome-positive ALL, retinol-binding protein 4 and insulin resistance in lean, obese, and diabetic subjects, a comparison of two fluid-management strategies in acute lung injury, and obesity as the new frontier of public health law; a review article on idiopathic short stature; a case report of a woman with numbness and weakness of the feet and legs; and Perspective articles on monitoring EEG activity during executions and on food marketing and childhood obesity.

Technorati Tags: new england journal of medicine

Flickr: Untitled

From Flickr. Uploaded by »Mî§s Ð×ß « on 10 Jun '06, 4.31am EDT PST.

Hilarious Journal Articles #54: The Roulette Wheel, An Aid to Informed Decision Making

From PLoS Medicine:

We therefore felt that it would be useful to create a tool whereby patients could make a choice between different strategies, based on a simple visualization of the probable outcomes associated with each of them. There is some evidence that visual tools, of various sorts, can enhance aspects of communication about risk; in addition, we thought it important that the tool in question not require efforts to weigh, indirectly, various harms and benefits, or to understand concepts of probability and risk, but to rely simply on a direct appreciation of the differences in likely outcomes. Thus we created the “roulette wheel” model of probabilities, which provides viewers a simple visual tool upon which to base choices. (Of course the utility of this tool may be diminished among patients with visual impairment, such as color-blindness, or perhaps cataracts.)

Technorati Tags: hilarious journal articles, plos, decisionmaking

Grand Rounds 2.38

Grand Rounds 2.38, this week's best posts of the medical blogosphere, is up at The Haversian Canal.

Technorati Tags: grand rounds

What's Wrong with "Best Doctor" Lists in Magazines

By Dr. Kent Sepkowitz in Slate:

About this time every year, doctors across New York City begin to cast a wary eye at local newsstands. When the bundle of New York magazine's "Best Doctors" issue drops onto the pavement, torture commences for the city's prim and laconic physician class. (Other cities get their chance at other times of year.) It's high school all over again, a life lived at the mercy of cruel arbiters of who is up and who is down. To their credit, I suppose, the compilers of the Best Doctors list define worthiness with more objectivity: They poll local doctors and ask whom they would refer a family member to. With this quasi-statistical information in hand, they go behind closed doors and construct the dreaded list.

To my expert eye, every year the New York survey gets it about half right: Half of the selections are first-rate doctors, no doubt about it. Another 25 percent are people whom I don't know well (though I have my doubts), and 25 percent are certifiable duds—doctors who (hopefully) haven't seen a patient in years but have risen to the lofty realm of high society and semi-celebrityhood.

Technorati Tags: slate, medicine, new york magazine, best doctors

Flickr: Propeller

From Flickr. Uploaded by antimega on 11 Jun '06, 4.19pm EDT PST.

Google Earth 4 Beta

Via Google:

The latest version of Google Earth is being released in beta form. We've added several new features that will make your Earth browsing even better...

Technorati Tags: google earth

Patient Quote of the Day: Blindness

A blind patient: "A woman asked me if I go to an eye doctor. I asked, would you take a dead dog to the vet?"

Grand Rounds 2.37

Grand Rounds 2.37, this week's best posts of the medical blogosphere, is up at The Medical Blog Network.

Technorati Tags: grand rounds

First-Trimester Exposure to ACE Inhibitors Associated with Major Congenital Malformations

From the New England Journal of Medicine -- Major Congenital Malformations after First-Trimester Exposure to ACE Inhibitors:

Background Use of angiotensin-converting–enzyme (ACE) inhibitors during the second and third trimesters of pregnancy is contraindicated because of their association with an increased risk of fetopathy. In contrast, first-trimester use of ACE inhibitors has not been linked to adverse fetal outcomes. We conducted a study to assess the association between exposure to ACE inhibitors during the first trimester of pregnancy only and the risk of congenital malformations...

Results Infants with only first-trimester exposure to ACE inhibitors had an increased risk of major congenital malformations (risk ratio, 2.71; 95 percent confidence interval, 1.72 to 4.27) as compared with infants who had no exposure to antihypertensive medications. In contrast, fetal exposure to other antihypertensive medications during only the first trimester did not confer an increased risk (risk ratio, 0.66; 95 percent confidence interval, 0.25 to 1.75). Infants exposed to ACE inhibitors were at increased risk for malformations of the cardiovascular system (risk ratio, 3.72; 95 percent confidence interval, 1.89 to 7.30) and the central nervous system (risk ratio, 4.39; 95 percent confidence interval, 1.37 to 14.02).

Conclusions Exposure to ACE inhibitors during the first trimester cannot be considered safe and should be avoided.

Related Links: Patient Information on High Blood Pressure

Technorati Tags: drugs, new england journal of medicine, ace inhibitors, pregnancy

New England Journal of Medicine Audio Summary for June 8, 2006

From the NEJM:

This summary covers the issue of June 8, 2006. Featured are articles on a biologic definition of Burkitt's lymphoma from transcriptional and genomic profiling, molecular diagnosis of Burkitt's lymphoma, major congenital malformations after first-trimester exposure to ACE inhibitors, single dose azithromycin for the treatment of cholera in adults, and a better way for cancer cells to die; review articles on microarray analysis and tumor classification and on measured and estimated glomerular filtration rate in assessing kidney function; a case report of a man with cavitary lung lesions; and Perspective articles on the FDA's new labeling regulations and on the HIV–AIDS pandemic at 25.

Technorati Tags: new england journal of medicine

Advair and Serevent May Increase the Risk of Asthma-Related Death

This meta-analysis suggests that long acting beta-agonists like Advair and Serevent may increase the risk of asthma-related hospitalization and death.

Meta-Analysis: Effect of Long-Acting {beta}-Agonists on Severe Asthma Exacerbations and Asthma-Related Deaths -- Salpeter et al., -- Annals of Internal Medicine:

Background: Long-acting ß-agonists may increase the risk for fatal and nonfatal asthma exacerbations.

Purpose: To assess the risk for severe, life-threatening, or fatal asthma exacerbations associated with long-acting ß-agonists...

Study Selection: Randomized, placebo-controlled trials that lasted at least 3 months and evaluated long-acting ß-agonist use in patients with asthma. All trials allowed the use of as-needed short-acting ß-agonists...

Data Synthesis: Pooled results from 19 trials with 33 826 participants found that long-acting ß-agonists increased exacerbations requiring hospitalization (OR, 2.6 [95% CI, 1.6 to 4.3]) and life-threatening exacerbations (OR, 1.8 [CI, 1.1 to 2.9]) compared with placebo. Hospitalizations were statistically significantly increased with salmeterol (OR, 1.7 [CI, 1.1 to 2.7]) and formoterol (OR, 3.2 [CI, 1.7 to 6.0]) and in children (OR, 3.9 [CI, 1.7 to 8.8]) and adults (OR, 2.0 [CI, 1.1 to 3.9]). The absolute increase in hospitalization was 0.7% (CI, 0.1% to 1.3%) over 6 months. The risk for asthma-related deaths was increased (OR, 3.5 [CI, 1.3 to 9.3]), with a pooled risk difference of 0.07% (CI, 0.01% to 0.1%)...

Technorati Tags: asthma, annals of internal medicine, advair, serevent

Google Spreadsheets Signup Page

The Google Spreadsheets signup page is here.

Flickr: 060306

From Flickr. Uploaded by austinspace on 3 Jun '06, 11.22pm EDT PST.

Was Morgellons Disease Created as a Viral Marketing Campaign for A Scanner Darkly?

Via Adrants:

There's a little rumor going around that a disease called Morgellons, a creepy skin disease that involves little bugs a bug-like sensation under the skin, and the websites associated with it are just a viral marketing campaign for the upcoming movie A Scanner Darkly. Michael Shostack of The Halting Point has collected some information pointing to the likelihood the disease is, in fact his opinion, a viral campaign. Shostack, who, since one never knows when it comes to virals, may actually be part of the viral campaign, points to a Slashdot story which says "Imagine having a disease that is so controversial that doctors refuse to treat you..."

UPDATE III: CDC Communication Specialist Dan Rutz returned our call and has verified that Morgellons is a syndrome, as he refers to it, the CDC is looking into. The CDC has received numerous calls from those citing symptoms associated with what is being called Morgellons Disease and has, in fact, formed a group to explore the syndrome and define it. All angles from environmental to medial to psychological will be taken into consideration. Rutz says, based on information the CDC has collected to date, it's highly unlikely this syndrome was "invented" as some us originally thought. Whether Morgellons is being leveraged in some clandestine fashion to promote A Scanner Darkly is unclear bit if it is, it's sick, twisted and wrong.

The single paper in Medline (so far) on Morgellons disease is here.

Technorati Tags: adrants, morgellons disease, cdc, a scanner darkly

Preventing Kidney Stones with Lemonade

Via WebMD:

Kidney stones form when urine in the kidney becomes supersaturated with stone-forming salts -- and when the urine doesn't contain enough stone-preventing substances. One of these substances is citrate.

For people prone to stones, doctors usually prescribe potassium citrate. It can be taken as a pill or in liquid form. But lemon juice is full of natural citrate.

When made into low-sugar or sugar-free lemonade, Nakada and colleagues found, lemon juice increases the amount of citrate in the urine to levels known to inhibit kidney stones. It doesn't work quite as well as potassium citrate. But for patients who'd rather avoid yet another medication, lemonade is an attractive alternative...

To make lemonade, Stoller, Nakada, and Kang recommend mixing 1/2 cup of concentrated lemon juice with 7 cups of water. A sugar substitute may be added to taste. Sugar should be avoided, as the extra calories in sugared lemonade are too much for most people's health.

Technorati Tags: kidney stones, lemonade, nephrology, urology

Hilarious Journal Articles #53: An experimental model of sudden death due to low-energy chest-wall impact (commotio cordis)

Like many Hilarious Journal Articles, this one is pretty awful.

(Thanks to John, the Cardiology Fellow.)

N Engl J Med. 1998 Jun 18;338(25):1805-11:

BACKGROUND: The syndrome of sudden death due to low-energy trauma to the chest wall (commotio cordis) has been described in young sports participants, but the mechanism is unknown. METHODS: We developed a swine model of commotio cordis in which a low-energy impact to the chest wall was produced by a wooden object the size and weight of a regulation baseball. This projectile was thrust at a velocity of 30 miles per hour and was timed to the cardiac cycle. RESULTS: We first studied 18 young pigs, 6 subjected to multiple chest impacts and 12 to single impacts. Of the 10 impacts occurring within the window from 30 to 15 msec before the peak of the T wave on the electrocardiogram, 9 produced ventricular fibrillation. Ventricular fibrillation was not produced by impacts at any other time during the cardiac cycle. Of the 10 impacts sustained during the QRS complex, 4 resulted in transient complete heart block. We also studied whether the use of safety baseballs, which are softer than standard ones, would reduce the risk of arrhythmia. A total of 48 additional animals sustained up to three impacts during the T-wave window of vulnerability to ventricular fibrillation with a regulation baseball and safety baseballs of three degrees of hardness. We found that the likelihood of ventricular fibrillation was proportional to the hardness of the ball, with the softest balls associated with the lowest risk (two instances of ventricular fibrillation after 26 impacts, as compared with eight instances after 23 impacts with regulation baseballs). CONCLUSIONS: This experimental model of commotio cordis closely resembles the clinical profile of this catastrophic event. Whether ventricular fibrillation occurred depended on the precise timing of the impact. Safety baseballs, as compared with regulation balls, may reduce the risk of commotio cordis.

Technorati Tags: hilarious journal articles, commotio cordis, cardiology, new england journal of medicine