Grand Rounds Vol. 3, No. 10

Welcome to Grand Rounds Vol. 3 No. 10! Many thanks to all who contributed, and special thanks to Nick for all the hard work organizing this event and for walking me, a first time host, through the process. Thanks also to blogger for sparing me one of their many unscheduled outages this particular day!

It’s trendy nowadays at traditional academic Grand Rounds for the speaker to disclose any potential conflicts of interest. Here are mine. I have no financial ties with drug or device companies. A Zithromax clock, a hand me down from National Nurses Day, graces one wall of my office. I have attended about four drug company lunches in the past year. That’s about the extent of any blandishments from Evil Pharma.

Although under appreciated, non-financial conflicts, perceived or real, are just as important as the financial kind. We all have them. I, for example, am a) a Christian, b) a member of the vast right wing conspiracy and c) a staunch adherent to the principles of science. (Note that a is not inexorably linked to b or in opposition to c). I’ve become opinionated and crotchety in middle age and have many biases. But not to worry, dear readers! I’ve done my darndest to keep those biases out of this edition of Grand Rounds. To that lofty end there will be no editor’s choice, best of the best, or best of the rest! Everything included here gets equal billing in hopes that this carnival will be a good time for all.

I’ve restricted my editorial prerogative to adding a running commentary, stream-of-consciousness style, to provide some structure to this incredibly diverse collection of links and perhaps liven things up a bit. I’ll sneak a few opinions in here and there, but you’ll know them when you see them. Well, enough of the preliminaries. There’s some heavy duty blogging to get to, so let’s rock and roll.

Mother Jones suffered through pandemic flu not long ago. Well, an inservice on pandemic flu, anyway. On her day off, no less.

Enjoying the eye candy on the wards? Dr. Derlet of Rural Pediatrics has some sobering advice for health care professionals on what not to wear. Strutting too much of your stuff may turn heads but it lowers patients’ confidence. And that’s evidence based! Worse yet, the credentialers are watching how you dress. Just ask our favorite credentialer Rita over at MSSPNexus blog! Yikes!

Are there moral absolutes? Is there a free lunch? Rohin, author or The Daily Rhino, finds himself in an existential crisis as he ponders these weighty questions after making the transition from student to doctor. It’s tough trying to balance medical student idealism against the allurement of Big Pharma freebies.

Wandering Visitor has some friendly infection control advice in Don’t Get Raunchy with Mr. Open Sores. Trouble is, Mr. Open Sores isn’t likely to tell you he has a problem. Nuff said. While we’re on the subject of taking medical advice, Dr. Nic at Shoe Money Tonight explains why it’s easier said than done.

I can remember being abused as a medical student and house officer, but I thought such abuse went out like the dark ages. Not so according to Anthony Rudine, blogging on the Medscape Med Students blog. In reading his post (recommended by Medscape editor Christine Wiebe) it appears that the grand tradition of med student abuse, like fraternity hazing, is alive and well. Isn’t it about time for a kinder, gentler medical curriculum?

Another Medscape student blogger (again, thanks for the tip, Christine) Ali Tabatabaey, reflects on one year of blogging on his first blogiversary (or is it blogoversary?). Congrats and keep up the good work, Ali!

A wise medical sage once told me that when it comes to being sued there are two types of doctors: those who have been and those who will be. It’s like the Sword of Damocles! Medical student Vitum Medicinus and his classmates are being lectured about the ever present threat. He shares his concerns here.

Ectopia what??? Ectopia cordis---a rare developmental anomaly in which the heart is situated outside the chest. Dr. Anonymous writes about a recent case.

NHS Blog Doctor speaks against physician assisted suicide and euthanasia, sparked by the recent story of another assisted suicide at Switzerland’s Dignitas institute.

RDoctor posts an interview with Emergiblog author Kim, exploring a wide range of nursing and blogging issues. Particularly interesting were her comments on arrogant physicians (they’re becoming an anomaly, she thinks), hospital case managers (nurses and social workers who facilitate discharge planning and troubleshoot financial, social and administrative problems in patient care) and the nurse’s role in facilitating ED patient flow.

And now that the kids have returned to school from Thanksgiving break The Fitness Fixer has some tips for ergonomically smart book carrying.

Now to reflect on matters of the psyche. Sigmund Freud started as a neuroanatomist, and maybe the behavioral sciences are coming full circle. Psychologist blogger Dr. Deborah Serani writes of a recently discovered gene (a variant of the serotonin transporter) which is associated with mental illness and enlargement of a group of thalamic nuclei known as the pulvinar, a deep region of the brain associated with emotions. Now there are those who might say this is all just pseudoscience. I’m waiting for them to demonstrate a neuroanatomic locus for engrams. But I digress. I think this discovery is pretty cool.

By the way, Dr. Serani has been a technical advisor for “Law and Order: Special Victims Unit.” (My wife is addicted to that show). I’ll be browsing her blog with interest in the near future. There’s a post on the psychological aspects of “If I Did It” and other interesting stuff.

Tempering our enthusiasm for bench-to-bedside correlation in the behavioral sciences, Health Business Blog reminds us that we have a ways to go, particularly in the area of pediatric psychiatric diagnosis.

Are we really what we eat? On some level, yes. The Wellness Tips blogger takes it literally and recommends organic food. Healthy? I’m sure, but rather spartan, it seems to me. I like the advice given in the poem Desiderata: Beyond a wholesome discipline, be gentle with yourself.

Oh, those perverse incentives! Everybody’s talking about conflicts of interest these days. The popular buzz in medicine is almost exclusively focused on the conflicts that arise from the influence of Big Pharma. But Number 1 Dinosaur has a thing or two to say about another conflict: ordering unnecessary tests to pad the bottom line. Dino’s insightful (or should I say inciteful---read what his commenters had to say!) and entertaining post and its update bemoan the decline of basic clinical skills and the use of technology as a substitute for clinical reasoning.

Now for your fix of hardcore clinical content---

Unbounded Medicine presents a case, along with some interesting images, of Tetralogy of Fallot.

Corpus Callosum cites a small study from the American Journal of Medicine suggesting that baclofen is as good as diazepam for the treatment of alcohol withdrawal. It’s not enough evidence to change current practice. At the risk of sounding trite, more studies are needed.

Inside Surgery has a nice series of posts on seizures in the ICU. Here’s Part 7, the most recent post. You can access the rest from the main page.

Dr. Kenneth Trofatter of Fruit of the Womb presents a case of cervical incompetence and discusses the possible role of insulin resistance syndromes.

And for patients and families---

Dr. Auerbach, blogger of Medicine for the Outdoors, offers some tips for the safe buying and handling of fresh produce and Cancer Treatment and Survivorship has some timely advice this holiday season on traveling with supplemental oxygen.

Now for some exciting news about the medical blogosphere. Dr. Ves Dimov, Clinical Assistant Professor at Cleveland Clinic Lerner College of Medicine and author of the Clinical Cases and Images blog reports back from the American Society of Nephrology’s Renal Week 2006 where one of his poster presentations (which you can view on the blog entry) dealt with medical blogging as an educational tool for students and house staff. The medical blog is emerging as an educational vehicle in no small part due to the efforts of Dr. Dimov. Nice work!

Second opinions come in many forms. Some patients go doctor hopping. Grunt Doc saw a patient the other night who went drugstore hopping.

Our “From Bench to Blogosphere” segment features docinthemachine with some original research he recently presented before the American Association of Gynecological Laparoscopists on a little appreciated variant of Asherman’s Syndrome along with discussion about potential applicability to the treatment of other gynecological disorders.

Kim at Emergiblog discusses the progression of signs and symptoms along the road to burnout and what to do about it. She’s been there and done that.

Tundra PA describes a case of steam bath boil. The culture came back MRSA. Given that it was sensitive to TMP-SMX it’s almost certainly one of the new community associated strains (CA-MRSA). Looks like it’s made its way up to the villages of Southwest Alaska!

When less is more: Insureblog comments on a study suggesting that more intense care doesn’t always help patients with chronic illness and wonders how patients would respond if the results were widely known.

Amy at Diabetes Mine writes about the bright future of continuous glucose monitoring systems. Unfortunately she missed out as a study subject for Abbott’s latest device because of skin sensitivity to the adhesive patch!

The folks at Anxiety, Addiction and Depression Treatments have posted some information on drug-grapefruit interactions. It’s not confined to psychiatry drugs, by the way. Felodipine, which I take for high blood pressure, is noted for the interaction. Although grapefruit might give me a bigger bang for my buck by exaggerating the effects of the medicine (it inhibits gut mucosal CYP34A, doubling systemic absorption) it’s too risky. Don’t try it. Always ask your doctor or pharmacist about food-drug interactions!

Susan Palwick, volunteer ED chaplain, describes a particularly difficult shift with several very ill children in Peds Night. A chaplain never knows what a distressed family might want---prayer, affirmation, maybe just someone who will listen.

Well, that’s about it for this edition of Grand Rounds. Don’t miss next week’s edition at The Antidote.