Social epidemic of "diabesity" and community-driven solutions - Mark Hyman at TEDMED 2012

Unhealthy lifestyles have brought on a social epidemic of "diabesity," says author Mark Hyman, and community-driven solutions may be the only way out.

Sparring Injuries

Martial arts instructor Jake Mace tells the story behind his scar and arm fracture:

How to Engage Doctors in the Healthcare Reform - Practical Advice from Cleveland Clinic CEO

CEO & President, Dr. Toby Cosgrove reflects on Engaging Doctors in the Healthcare Revolution:



From the article in Harvard Business Review (http://bit.ly/1y1iyOI): "Fixing health care will require a radical transformation, moving from a system organized around individual physicians to a team-based approach focused on patients. Doctors, of course, must be central players in the transformation: Any ambitious strategy that they do not embrace is doomed.

And yet, many physicians are deeply anxious about the changes under way and are mourning real or anticipated losses of autonomy, respect, and income. They are being told that they must accept new organizational structures, ways of working, payment models, and performance goals. They struggle to care for the endless stream of patients who want to be seen, but they constantly hear that much of what they do is waste. They’re moving at various rates through the stages of grief: A few are still in denial, but many are in the second stage—anger. Bursts of rage over relatively small issues are common."

How to move forward?

The authors suggest a framework based on the writings of the economist and sociologist Max Weber, who described 4 motivations that drive social action (that is, action in response to others’ behavior). Adapted for health care professionals, these are:

- shared purpose
- self-interest
- respect
- tradition

"Leaders can use these levers to earn doctors’ buy-in and bring about the change the system so urgently needs.

Sometimes the story of a single patient is enough to galvanize doctors’ buy-in. In 2008, for example, a patient called the Cleveland Clinic’s urology department seeking an appointment because he was having trouble urinating. He was given the next available slot—two weeks away. A few hours later he arrived in the emergency department with acute urinary retention. Doctors quickly solved the problem, but the patient suffered greatly in the hours before treatment.

As a result, the clinic instituted a same-day appointment policy whereby all patients who call are asked whether they want to be seen immediately. About one million of the 5.5 million visits a year now occur on the same day the patient calls. This policy occasionally disrupts physicians’ schedules, but the new system is comforting to patients, and clinic doctors have come to embrace it."

A longer video overview of the topic: Engaging Doctors in the Healthcare Revolution:



References:

Engaging Doctors in the Health Care Revolution - HBR http://bit.ly/1y1iyOI

Disclosure: I am an Allergist/Immunologist at Cleveland Clinic.

"Walk the walk to talk the talk" - Cleveland Clinic video

CCF leaders are running two innovative "walk in my shoes" programs to take Cleveland Clinic to the next level. This involves learning how to do everyone's job, hands-on.

Exam preparation: NEJM Knowledge+ Adaptive Learning Explained

"At the heart of NEJM Knowledge+ is a smart, adaptive engine that will transform your learning experience. This adaptive learning platform quickly assesses the subjects you know well, and identifies the areas where you need reinforcement. It then delivers more of what you need and less of what you already know, continually adjusting based on your performance. Adaptive learning ensures that you’ll spend your time efficiently, focusing on what you need to learn and review.

Take a look at how adaptive learning helps you tackle the challenges of lifelong learning and board preparation. Learn more about NEJM Knowledge+ http://knowledgeplus.nejm.org"

Adult acne: how to treat it?

A Mayo Clinic dermatologist gives tips on how adults can prevent and treat acne. Treatment options include over the counter medications as well as prescription medications.



Acne has 3 stages that can be remembered by the mnemonic "CIN":

Comedonal - black/whitehead, open/closed
Inflammatory - pimples/zits
Nodulocystic

Use Topical Treatment such as Differin gel as on CCC-F: Cheek, Chin, Cheek, Forehead

Top medicine articles for January 2015

A collection of some interesting medical articles published recently:

Nearly half of high school students had ever tried tobacco in 2013, and nearly a quarter were current users http://buff.ly/1xw5dCe

Every Kiss Begins With 80 Million Germs – study published in journal Microbiome. Kissing is a courtship behavior unique to humans and is common in over 90% of known cultures http://buff.ly/1qoEsxy

Generic Versions of ADHD Drug Concerta Not Therapeutically Equivalent - FDA http://buff.ly/1qNSCCU

Colors used in tattoo ink need to be absolutely water-insoluble. That alone makes them a health risk. Only two thirds of the ink used in a tattoo stays in the skin. The other one third spreads through the body. "Tattoo ink migrates into the blood, lymph nodes, organs. Nobody knows where exactly or what happens with it." Red tattoo pigment 22 may decompose in sunlight. The resulting compounds are toxic and can cause cancer. Phthalocyanines make blue or green tattoos, contain metals such nickel, which can cause contact dermatitis. 25% of Americans have tattoos. However, "Tattoo colors are not really safe at the moment", say experts http://buff.ly/1vto5ld

Three tropical diseases—dengue, chagas, and chikungunya—may establish U.S. footholds. Chagas disease spreads in a particularly "disgusting" way: by kissing bugs that bite people's faces at night. Chagas affects approximately 300,000 people in the U.S., though other estimates run as high as one million. Chikungunya virus: "What happens is that people come back from the Caribbean to Florida with virus in their blood". There's no treatment for chikungunya, and no vaccine, though researchers are working on that. http://buff.ly/1pcekVS

How Medical Care Is Being Corrupted - NYT: the power belongs to the insurers and regulators that control payment http://buff.ly/11ARjB3

80% of surgeons play music in the OR. Why surgeons avoid listening to Red Hot Chili Peppers in operations - Telegraph http://buff.ly/1DuHeHi

For a 7-Minute Workout, Try NYTimes New App http://buff.ly/1yQpTAD

"Men who like spicier food are 'alpha males' with higher levels of testosterone" http://buff.ly/1zWrFEr - Study brings more questions than answers.

A New Nephrologic Syndrome: Acute Fellowship Insufficiency – http://buff.ly/1DC3OxA

Disorders of Plasma Sodium — Causes, Consequences, and Correction — NEJM review http://buff.ly/1BdBcaC

International Health Care Systems - interactive graphic from NEJM http://buff.ly/1BqSBdL

The enigmatic illness and death of Constance, wife of Oscar Wilde - The Lancet http://buff.ly/1xmwUwn

The articles were selected from Twitter and my RSS subscriptions. Please feel free to send suggestions for articles to clinicalcases AT gmail.com and you will receive acknowledgement in the next edition of this publication.

Drinking Water: What's the Science?

Who should drink how much water? Bottled or tap? Medscape Expert Commentator, Dr. Jeffrey Berns, and Dr. Stanley Goldfarb discuss the evidence and what you should tell patients. For more from Dr. Berns, visit Medscape: medscape.com/index/list_3468_0

How do vaccines work? TED-Ed video

The first ever vaccine was created when Edward Jenner, an English physician and scientist, successfully injected small amounts of a cowpox virus into a young boy to protect him from the related (and deadly) smallpox virus. But how does this seemingly counterintuitive process work? Kelwalin Dhanasarnsombut details the science behind vaccines.

Lesson by Kelwalin Dhanasarnsombut, animation by Cinematic.



There are a few inaccuracies, but overall this is a good video.

Conversational translation in real time via Google app

"If you're traveling abroad, or facing a language barrier, the Google Translate app can help. WSJ's Nathan Olivarez-Giles takes a look." This is bound to have some use in medicine too.

Blurred Boundaries: The Therapeutics & Politics of Medicinal Marijuana (Mayo Clinic video)

J. Michael Bostwick, M.D., Professor of Psychiatry, Mayo Clinic Rochester, discusses the issue of medical marijuana. In 1970, the Federal Government declared cannabis to be a dangerous drug of abuse without any medical benefit and made it illegal. Over the past two decades, however, more than 20 states have taken matters into their own hands in defiance of federal law and legalized marijuana for medical purposes, recreational use, or both. The result is chaos for physicians and patients alike because there is no uniform law of the land.



Comments from Twitter:

Pat Rich @cmaer: Good Mayo clinic overview of "chaotic" medical marijuana situation facing US physicians

Health risks in extreme cold - and what to do about them

Mayo Clinic emergency medicine specialist Dr. David Nestler talks about how cold weather affects our bodies and what we need to know about frostbite:



“It’s a shame whenever anyone gets a frostbite injury,” says Lawrence Gottlieb, MD, professor of surgery at the University of Chicago and director of the Burn and Complex Wound Center. “People need to be aware of it and take precautions when the temperature drops, like it has this week. Be especially cautious when temps fall below zero, especially when there is a strong wind. Obviously, wear warm clothes. If you are driving a long way, especially at night, make sure you have enough extra clothes to cover up effectively if you get stuck somewhere. And don’t get stuck. Put enough gas in the car.”

Tips for people who go out in the cold

- If the temperature is below zero you could sustain a cold injury in less than 15 minutes.
- Mittens are warmer than gloves.
- Insulate the affected body part to prevent additional heat loss and damage.
- Immobilize and protect the frostbitten tissues from further injury.
- Prevent thaw-refreeze cycles. Do not begin rewarming until there is no risk of further exposure.
- Once in the hospital, physicians recommend rapid rewarming in a water bath at 104°-107.6°F (40°- 42°C) for 15-30 minutes until thawing is complete.

References:

Chicago midwinter – a user’s guide for preventing frostbite | Science Life buff.ly/1xHErpy

"Half-baked research": MD degree does not teach doctors how to tweet scientific meetings

MD degree does not teach doctors how to tweet scientific meetings, reported Reuters (http://buff.ly/1xAOPkO): A study assessed the accuracy of tweets posted by physicians at a medical conference and concluded "it is very easy to misunderstand tone and brevity, so there are dangers here."

First the study authors asked speakers at the meeting to identify key messages for their presentations. Then, they asked the speakers to review tweets posted during their talks to see how accurately these points were communicated.


Duty calls. Image source: Xkcd.com, Creative Commons license.

14 speakers participated in the experiment, and 13 had at least one tweet posted about their presentations. There were only 37 tweets altogether! Editor's note: This seems incredibly low. Allergy/Immunology conferences such as AAAAI and ACAAI generate thousands of tweets, sometimes more than 30-50 for each talk.

The speakers found 16 of the tweets accurately reflected their findings, while an additional 16 posts were partially accurate. In 3 instances, the tweets misrepresented key points. In 2 cases, the speakers were uncertain about the accuracy.

It's possible that the inaccurate tweets indicate that the speakers didn't do a good job of explaining their research. And it's also possible that the doctors listening to presentations didn't use the best language to tweet results.

To be sure, the sample size was quite small. This is the biggest limitation of the study and it qualifies it as what we sometimes call "half-baked research."

This statement also looked inaccurate in the Reuters report: "Asked about the impact of social media on medical education, 82 percent of survey participants said they didn't access websites for medical journals, research articles or major gastroenterology professional organizations." And indeed, it was inaccurate: 82% of GI's didn’t access social media sites of professional organizations, not their main websites.

We all agree on this though: Many physicians prefer to limit use of social media to their personal lives.

Here is an example how to use Twitter when attending a scientific conference:
http://allergynotes.blogspot.com/search/label/Twitter

Here is an approach I suggested a few years ago:

Cycle of Patient Education (click here to enlarge the image):



Cycle of Online Information and Physician Education (click here to enlarge the image):





"And it’s free."



References:

MD degree may not teach doctors how to tweet | Reuters http://buff.ly/1xAOPkO
Are you a SCEPTIC? SoCial mEdia Precision & uTility In Conferences - Emergency Medicine Journal http://buff.ly/1vQCq6j, and bit.ly/1tii1pz Digestive and Liver Disease

Comments from Twitter:

re: SCEPTIC? SoCial mEdia Precision & uTility In Conferences -- Skeptical Scalpel @Skepticscalpel: I've seen some forced acronyms in my time, but that one wins the prize.

@DrVes re: acronym, agree. the whole research endeavor left more to be desired...

Skeptical Scalpel @Skepticscalpel: I liked it because it supported my bias, but really--37 tweets?

Michael Katz @MGKatz036: Pls remember this as I tweet from @Boston_AF! MT @DrVes: MD does not teach doctors how to tweet scientific meetings buff.ly/1xzpiXF

Cytisine is better than nicotine-replacement therapy in helping smokers quit (NEJM video)

Cytisine, also known as baptitoxine and sophorine, is an alkaloid that occurs naturally in several plant genera. In this trial in New Zealand, cytisine was superior to nicotine-replacement therapy in helping smokers quit. The findings are summarized in the NEJM video. Cytisine was first marketed in Bulgaria in 1964 (called Tabex) and then became widely available in other European countries.

Read the full NEJM Original Article: http://www.nejm.org/doi/full/10.1056/NEJMoa1407764

Related reading:

Quitting smoking: Still a challenge, but newer tools show promise - CCJM http://buff.ly/1xCK2fP

Wash your hands for 20 seconds, as long as it takes to sing "Happy Birthday" twice - Mayo Clinic video

From Mayo Clinic: Running your hands under the faucet with some soap for a few seconds isn't enough to kill germs.

To help avoid catching the flu and other illnesses, wash your hands thoroughly and frequently with soap and warm water or alcohol-based hand sanitizer, particularly before leaving a restroom, eating or touching your face.

Wash your hands for about 20 seconds, about as long as it takes to sing "Happy Birthday" twice. When visiting a public restroom, use a paper towel to turn off the faucet and open the door when leaving.