Grand Rounds 3.5

Ohhhhh . . . Tuesday Morning . . . feels like a hangover. I'm finally coming down from the caffeine buzz of last weeks Grand Rounds hosted by Kim at Emergiblog. I'm in withdraw after a week of working on the incredible submissions for this week's edition of the best from the medical blogosphere. Actually, I'm looking more like Ground Round! I should have heded Kim's advice - but you know it's difficult for lawyers to take advice.

Lawyers are known for their written and verbal communication but any good defense trial lawyer knows that a photo is worth a thousand words. Hmmm . . . photos . . . theme? Photos tell a story. Photos enhance the story. Social interaction adds value to content. Social networking is content. Using Flickr within a theme? How will online social networking change the landscape of medicine and health? Just some thoughts.

It's a fascinating time to watch the evolution of online social interaction these days and discuss its impact on the health care industry. Not long ago we were all using the internet as a static place to obtain information. Listserves, bulletin boards and early individual blogs became the first generation of social networking. Soon came the growth of more blogs on specialized topics, more interaction, community blogs and carnivals, like Grand Rounds -- all mediums that allow sharing of information and knowledge in a decentralized process, providing a forum for feedback, comments, discussion and disagreement. Lately we are seeing the next generation develop. Two health care examples are Organized Wisdom, a collaborative health information resource, which allows patients and professionals to share health experiences in a learning environment, and Sermo, which allows physicians to consult with colleagues, share clinical observations, challenge or corroborate each other's opinions (for pay) and accelerate the emergence of trends and new insights on medications, devices and treatments, building open, collaborative health care. What next? It's Your World, Your Imagination. What about Second Life Medical? or Project Virtual Hospital?

Flickr , an online social photo sharing service was one of the early web 2.0 success stories. As an experiment to add value to content I've used "keyword" links for each submission. For example, check out alzheimers, new drug or insulin pump. I urge you to drill down and explore some the photo links, comments on the photos and consider how the photos change your impression of the written posts. On with the rounds . . .

First the Host's Favorites . . .

BREAD: From the don't always believe what you see department comes a post at Unbounded Medicine about a Thai student who bakes human being parts out of bread. Yum . . . .

YUPIK: The TundraPA at Tundra Medicine Dreams shares with us the experience of death, funeral, family, and feast as a Yupik Eskimo village loses one of its members in a post called A Village Funeral.

FISH: A fishy topic is on the line at DiseaseProof. In Gone Fishing Again, Gerald Pugliese contemplates a recent article in The Los Angeles Times, pointing out that even the EPA acknowledges the confusion over fish consumption. Mr. Pugliese utilizes Dr. Fuhrman's past comments to add more to the fish tale. Dr. Emer at Parallel Universes is also fishing around this controversy with To Eat or Not To Eat Fish.

DEATH: From The Differential: Medscape Med Students, Ali Tabatabaey, an Iranian medical student, confronts death in The First Patient Death Leaves Its Mark. At why am i still here? a third year medical student confronts whether she would want extravagant measures taken if it were her 16-year-old daughter.

COMPETITION: Dmitriy Kruglyak, at the Medical Blog Network, takes a close look at what's left for hospitals in the current competitive environment in The Shifting Basis of Hospital Competition.

FOOD: I've got the rumblies in my tumblies. May I take your order please? Emergiblog covers the etiquette of ordering food in the ER in Here to Save Your Derrieere, Not Feed It.

The Best of the Rest . . .

FEET: From the foot bone is connected to the ankle bone comes The Foot Blog. A new community blog started this month covering everything for the podiatry community, a great example of a community blog modeling the long tail toe theory.

DIABETES: Amy Tenderich at Diabetes Mine announces the ultimate diabetic "extreme (medical) makeover" in her post Pimp Your Diabetes. A D-Dream Team has been put together and the progress of the individuals will be tracked at Diabetes Mine. Amy also provides a one blog mini-seminar on the thyroid in Hello, Mr. Thyroid and questions all the buzz on the new wireless monitoring devices for diabetes in Remote Control Diabetes? Not.

SPINE: The Science Creative Quarterly by Prashant Nair covers spinal injuries in Spinal Injuries: So many ways to strike a chord. The article made this lawyer confront the altered existence lived by victims of spinal injuries and their hopes for the future. But consider Mark Zupan and don't miss Murderball.

HIPAA: The HIPAA Blog covers the latest recommendations by the National Committee on Vital and Health Statistics . HIPAA may no longer just apply to "covered entities." All that hard work of creating business associate agreements might be for not.

CATHOLIC: Dr. Lei at Genetics Health interviews Catholic genetics blogger, Rebecca Taylor. Ms. Taylor, a clinical laboratory technologist in molecular biology at a Catholic hospital blogs at Mary Meet Dolly, where the world of genetics and genetic engineering (Dolly) meets the teachings of the Catholic Church on the sanctity of life (Mary). Mary Meets Dolly resonates with many people feeling alienated because most science and medicine bloggers are largely atheist or agnostic.

SHOPPING: Comparision shopping, Canada vs. Israel, comes your way via InsureBlog's post titled Isrameds. Canada isn't the only "foreign" country offering discount medications. If you've got a hankerin' for strictly kosher meds, Bob Vineyard has your source. The InsureBlog also has some surprising stats on "What Bothers People About Their Own Health Care" and a followup post poll.

INTUBATED: Homeschooledmedstudent confronts her own sadness and helplessness in Lingering, about an intubated, terminally ill patient.

POLICY: Matthew Holt covers the Six Dirty Little Health Care Secrets of health care.

AUTISM: Dr. Deborah Serani posts Gene Mutation Linked to Risk of Autism highlights further genetic underpinnings for Autism in a study coming out of Vanderbilt University that will be featured in the upcoming Proceedings of the National Academy of Sciences.

DIAGNOSIS: From the "What's Your Diagnosis?" category comes Failure to thrive in a 20-month-old from Rural Pediatrics. The case report involves a 20-month-old toddler with a one-year history of poor weight gain and large, mushy, smelly stools. Turns out the diagnosis was chronic Giardia infection due to likely becoming infected from playing in a mountain stream while his parents gold-panned. The full article can be obtained from Infectionus Disease in Children.

NEW DRUG: Straightfromthedoc discusses Duke University researchers' efforts to significantly prolong the effects of an anti-inflammatory drug by modifying a drug called interleukin-1 receptor antagonist. The engineered drug is potentially useful for providing longer-lasting treatment for osteoarthritis. Gloria Garnat also writes about the recently USFDA-approved drug, ARICEPT, for the treatment of Alzheimer's disease, at The Pharm Voice.

WELLNESS : Musing about the (un)balanced nature of Wellness is Dr. Rob Lamberts' post at Musings of a Distractible Mind. Dr. Lamberts asks the question "does wellness really exist?" and concludes that the physician's role is to "relate to our patients as they go through life and not treat them as a project to complete."

ALZHEIMERS: Mona Johnson at The Tangled Neuron highlights current studies of those diagnosed with mild cognitive impairment and the ongoing efforts to better understand the early stages of dementia and Alzheimers. Why be tested for Alzheimer's when there is no effective treatment? Contribution to research and ultimately finding a cure for the disease. Ms. Johnson, who went through testing at the Wisconsin Registry for Alzheimer's Prevention, recommends participating in testing at a memory clinic, university, or Alzeimer's Disease Research Center so that the results can be used in future studies. West Virginia's own Blanchette Rockefeller Neurosciences Center is leading a shift from laboratory tests to clinical trials.

WIKIPEDIA: Mnmonics Guy (MG) brings us CLMAA and a link to a Wikipedia page that includes volumes of medical acronyms and abbreviations. MG's post speculates that medical acronyms may be a dying art with the introduction of EHRs. MG also highlights the difference between acronyms and abbreviations. My favorite misspelled acronym is HIPPA.

HOSPITAL STORIES: Hospital Impact, authored by Tony Chen, shares the 2nd edition of Friday's Great Patient Stories with Great Patient Stories - Harry Potter, Hamburgers and Hemmorroids. Chen's initial post, along with my Pre-Rounds interview by Nick Genes,inspired me to start a new series of regular posts called The West Virginia Doctor.

STRETCHING: With advice on how not to over-stretch your back comes The Stretch You Need The Least from Dr. Jolie Bookspan at Healthline: The Fitness Fixer. Thanks, Doctor. Your submission was much needed advice after spending hours bent over my laptop working on Grand Rounds.

ODOR: A volunteer ER chaplain writes about wonderful ER odors in The Olfactory Tour at Rickety Contrivances of Doing Good.

BREAST CANCER AWARENESS: In recognition that October is National Breast Cancer Awareness Month, Dr. Emer at Parallel Universes posts about statistics on breast cancer in the Phillipines, catching breast cancer early, and the importance of regular breast self-examination.

PEG Tubes: This week, Dr. Marcucci at Inside Surgery covers the surgical facts and details of Percutaneous Endoscopic Gastrostomy Tubes.

FDA: From the California Medicine Man comes the "story" behind Lester Crawford's departure as the commissioner of the Food and Drug Administration (FDA) and the importance of the FDA maintaining integrity.

MEDICAL SCHOOL: Vitum Medicinus, who is journaling his experiences as he goes through medical school, reminds us of the excitement of practical learning and experience in the post Back in the Hospital: ER Shadowing.

CEO: At Running A Hospital the CEO asks, "How am I doing?" to which Kevin, M.D. responds pretty good job. Congratulations go out to the other blogging hospital CEO who details his trip to Northern Virginia to see Little Lucy for the first time.

VACCINES: Two posts on vaccines from PediatricsInfo . First, the FDA approved the rotavirus vaccine in Febuary 2006. Second, the MMR vaccine has been cleared from causing autistic disorders according to a trial published in the October 2006 issue of Pediatrics.

PERSONA: GruntDoc takes a look at his Work Persona.

BLOOD PRESSURE: South African medical student Karin Little, who blogs at Just Up The Dose, nostalgically remembers her first diagnosis in Thump-thump-thump as she winds down on her degree. Along the same vein comes Hypertension-Silent Killer with a hypertension quiz.

TUNNEL VISION: Wandering Vistor muses about viewing the tunnel from the outside in Are You Suffering from Tunnel Vision?

YUPIK: The TundraPA at Tundra Medicine Dreams shares with us the experience of death, funeral, family, and feast as a Yupik Eskimo village loses one of its members in a post called A Village Funeral.

STINGRAY: Dr. Paul Auerbach, at Medicine for the Outdoors, blogs about Another Stingray Attack reported last week in Florida which follows the tragic death of the Crocidile Hunter, Steve Erwin, in a similar unlikely incident.

CALIFORNIA: Nancy L. Brown, PhD, at Teen Health 411, provides insight into the confidentiality laws related to reproductive health care in California for minors and points out the practical issues related to information leaking through the billing process when the minor seeks care covered under her parent's insurance.

POVETRY: Borneo Breezes recognizes the contributions of Mohammed Yunus, a Bangaladeshi economist and founder of Grameem Bank, who will be awarded the Nobel Peace Prize for his effort at ending poverty through providing credit to the poorest of the poor.

INSULIN PUMP: Kerrie Morrone, a twenty-something type 1 diabetic, contemplates incorporating her insulin pump into the tangles of daily dressing in Insulin Pumping, After a Fashion.

JEFF GOLDBLUM: A Caribbean medical student blogging at the rumors were true explores his own science role model. Jeff Goldblum?

HORMONES: A four-part post on Hormone Replacement Therapy at The Blog That Ate Manhattan.

FLU: In his post, Pediatric Flu Vaccine Supply Delayed, Not a Shortage, Dr. Choi at Tech Medicine helps this lawyer understand why his two-year-old can't get her flu shot -- there is only one FDA-approved flu vaccine for children under three.

NFL: The NFL's Punitive Substance Abuse Policy covers Brett Farve's standing up to the NFL and its substance abuse policy after the suspension of Packer's wide receiver Koren Robinson.

RANT: Citing one of my all time favorite movies, Terry Gilliam's "Brazil," Digital Doorway rants about healthcare bureaucracy in Bureaucracy Now! --- A Rant. Is it Buttle or Tuttle? Also, ranting about medblog ranting comes Pointing The Finger from Medblogopathy.

INFORMATION: David Williams at The Health Business Blog provides us a link to the original piece titled, "Information Is The Answer," used by ABC News in its week-long series, Prescription for Change.

HALLOWEEN: The Family Fork: Feeding the Kids and You provides timely advice for choosing healthly alternatives as you prepare to make the Grand Rounds with the kids next Tuesday Night.

The question remains whether Dr. Hebert's Medical Gumbo will be cooking up tricks or treats as the host of Grand Rounds 3.6.

As the first health care lawyer to host Grand Rounds, I just want to say thanks to Nick Genes for giving me the opportunity to host from the hills of West Virginia. Thanks to the contributors who make Grand Rounds what it is -- a wonderfully eclectic collaboration of individuals and health professionals who share a breadth and depth of knowledge unmatched anywhere.

NOTE: I accidentally change the title of the Grand Rounds post which then automatically changed the permalink that was used in the Pre-Rounds Interview on Medscape. This created a dead link for all of these visitors coming from Medscape. To correct the problem I created a duplicate post of Grand Rounds here. You can read comments posted on the duplicate post here.

Tags: Grand Rounds, medicine, health, health care