Remember To Blink

Squinting at a computer screen can cut in half the number of times someone blinks each minute. And that could lead to an irritating condition called dry eye, new research suggests.

The more that the participants in this study squinted their eyes, the less they blinked. And the less they blinked, the more their eyes ached or burned, and the more they reported sensations of dryness, irritation and tearing.

Just a slight amount of squinting reduced blink rates by half, from 15 blinks a minute to 7.5 blinks a minute.

“People tend to squint when they read a book or a computer display, and that squinting makes the blink rate go way down,” said James Sheedy, the study's lead author and a professor of optometry at Ohio State University. “Blinking rewets the eyes. So if your job requires a lot of reading or other visually intense work, you may be blinking far less than normal, which may cause eye strain and dry eye.”

One more occupational hazard for all of us to worry about.

From TechNudge.

Read before you crank up the volume.

...CBS News medical contributor Dr. Mallika Marshall reports when the volume goes up, so does the risk of hearing loss — dramatically.

Audiologist Brian Fligor of Children's Hospital Boston has found that personal stereo systems, like the iPod, can lead to significant hearing loss. He says there are two critical factors: how loud the music is and how long you listen.

"Noise induced hearing loss develops insidiously," Fligor says.

He tested to see how loud Dr. Marshall likes her music. She was safe at around 80 decibels — or about half way up the dial.

But at decibel levels over 85, Fligor suggests no more than an hour a day with headsets outside the ears — and only 15 minutes with those inside.

"For some types of inner ear phones, most certainly, there is greater potential for danger," Fligor says.

While kids might be the most vulnerable to hearing loss, the generation which included the first Walkman users is now showing some of the worst hearing loss.

As our patients listen to these their MP3 music players for hours each day, unfortunately, hearing loss will increase.

More Compressions & Add Some Cold

In a radical change from the way everyday people do CPR, new recommendations urge many more chest compressions.

The revised guidelines issued Monday by the American Heart Association on cardiopulmonary resuscitation change the ratio of chest compressions to rescue breaths from 15 compressions for every two rescue breaths to 30 compressions for every two rescue breaths.

And while the guidelines advocate a "back to basics" approach for the public, they recommend that emergency personnel get more high-tech by cooling cardiac arrest patients for 12 to 24 hours to about 90 degrees Fahrenheit.

Two significant studies have shown that such cooling resulted in improved survival and brain function for those who were comatose after initial resuscitation

Every two years most of us recertify our ACLS skills to be up to date on the latest cardiac resuscitation techniques. The AHA is changing the ratio to 30 compressions to two breaths. Also, some tolerable hypothermia post arrest (assuming they make it) is good for the brain.

Some more info here.

Your Vote Is Needed

I just read about this contest today, and I would love to get our blog some recognition. I know we're quite new, but if you like what you see, then vote for us in the Medical Weblog competition over at MedGadget. Please vote for us (by writing into the comments section on the link provided in the title) in the "Best New Medical Weblog" category. Thanks for your support.

Welcome to the second annual Medical Weblog Awards! These awards are designed to honor the very best in the medical blogosphere, as decided by you--the readers of these fine medical blogs.

It's been another year filled with explosive growth, stirring debate, and excellent writing -- in a number of fields. Our categories reflect this diversity. The categories for this year's awards will be:

-- Best Medical Weblog

-- Best New Medical Weblog (established in 2005)

-- Best Literary Medical Weblog

-- Best Clinical Sciences Weblog

-- Best Health Policies/Ethics Weblog

-- Best Medical Technologies/Informatics Weblog

"I like playing in traffic." Bill O' Brien (and I like it too)!

Surprised...?

Doctors will provide higher quality care when given financial incentives to do so, concludes a three-year study of seven so-called P4P (pay-for-performance) programs. However, it's still not clear "whether the return on investment and the quality gains outweigh the financial and human effort," according to the Robert Wood Johnson Foundation, which funded the study.

We needed a three year study on this? After all, isn't this why communism fell?

From eWeek.

Free Medical Books

FreeBooks4Doctors.com is to medical texts what TBR is to regular textbooks. A fantastic site, no ads, all the books are really free, and there are plenty of books in other languages. Books are viewable online in HTML or as free PDF downloads. Highly Recommended!

We all know the price of medical books. What drives me crazy is that there always is a new edition coming out, and it's hard (and expensive) to stay current. Well, here's a way to be really up to date, and you can't beat the price! Starving med students rejoice. I looked around and found a wealth of info for every specialty! Check it out.

Treadmill Bike

There is nothing wrong with just walking!

Wireless Voice Dictation

This is the wave of the future. Not only is it faster, and more convenient, but also cheaper. What else could you want?

"There's something quaint about the way Dr. Matthew Doppelt used to take electronic notes. The solo practitioner at South Eastern Dermatology Consultants P.A. in Knoxville, Tenn., used to speak into a digital recorder, upload the files, and send them to a transcription service. Then he'd cough up $1,600 a month for next-day service to get Word files of the reports.

Things changed last year when Doppelt got a wireless Toshiba M200 tablet PC running Dragon NaturallySpeaking Medical voice-recognition software from Nuance Communications Inc., an app he bought for less than $1,000. Now his dictation is electronically transcribed immediately as text. Doppelt can store those reports in patients' electronic medical records, using software from eClinicalWorks to manage those records.

Doppelt isn't alone in making this change. Medical functions that were commonly outsourced are increasingly being automated. Not only that, but in medical practices, where wireless networks are becoming important tools for clinical applications such as writing electronic prescriptions, the ability to transcribe notes using wireless devices is becoming critical. Other providers of voice-recognition dictation products include Philips and IBM."

Switching To An Electronic Medical Record

Let's face it: our profession is one of the last things out there that still uses handwriting on paper. We've all heard the benefits of an electronic patient record, but most hospitals are still state of the art 1975 when it comes to charting. This is a nice article about one clinic's success in the move from paper to digital.

While there are obvious benefits of a major computer upgrade, the real focus of the Mary Street project was converting to EMR. That was not a trivial undertaking.

“Mary Street went through a learning curve,” says Mitchell. He notes that there’s an inevitable performance hit, but that it quickly pays off. “You tend to lose twenty percent of your productivity the first month, ten percent in the second month, then break even in the third month. You then become very efficient.”

Dodds agrees that it took some effort to make the transition. “Different people within our clinic did it differently,” he notes.

“I’m one of the technophiles,” says Dodds. In particular, he types moderately well. So his own approach was to computerize everything he could. “I would go through the entire chart and try to archive it,” he recalls.

But even so, it was far from a trivial process. “How do you go from a paper chart to electronic records?” asks Dodds. Especially when that ‘chart’ may be a folder a half-inch thick... and you may have filing cabinets full of ones just like it? “It’s the single biggest issue with going electronic,” says Dodds. “You don’t just scan it all. You have to pick out what’s relevant.”

“We did a dual system for quite a while,” Dodds continues. Thus, the clinic opted to digitize old information as-needed, while keying new information directly into the new EMR system. The result was that after about four visits, most patients’ relevant information would end up in the EMR system.

Anything missing at that point can still be retrieved from the old paper folder and scanned in, as required. Fortunately, the scanning process is fairly efficient. “Scanning and OCRing [optical character recognition] are extremely fast and very accurate,” says Dodds.

At this point, the clinic is over the worst of the transition. “I get maybe one chart a week that we haven’t finished archiving,” he reports. Still, even now, when a patient is being sent to a surgeon, the full history needs to be dug out.

Cranberries Beneficial To Teeth

I thought of this today while I was eating some cranberry sauce.

"Cranberries, which already are known to help thwart urinary tract infections, may also prevent tooth decay and cavities, dental researchers reported in the January issue of the journal Caries Research.

The same sticky compounds in the small, hard red fruit -- which is boiled into a jelly that is a staple at American winter holiday meals -- that help keep bacteria at bay in the bladder also appear to help prevent bacteria from clinging to teeth, according to the researchers.

They also found it seemed to help ward off plaque, a gooey substance formed from bits of food, saliva, and acid that can harbor bacteria and eventually irritate the gums.

"There's potential to find compounds there that prevent dental cavities," said Hyun Koo, an oral biologist at the University of Rochester Medical Center in New York."

Rx: Internet Therapy???

Just one more use of the world wide web.

Internet-based treatments for sufferers of panic disorder may be just as effective as face-to-face methods, a study by Monash University researchers has found....

The study compared the effectiveness of three types of treatment -- internet-based cognitive behaviour therapy sessions, face-to-face sessions, and the use of medication (Selective Serotonin Reuptake Inhibitor) monitored by a psychiatrist.

Some more info:

"If the online method is as effective as face-to-face sessions, as our research suggests, this is likely to improve treatment accessibility for so many people, particularly in rural areas where people may not be able to access face-to-face treatment easily," she said.

"It could also be particularly useful to people suffering agoraphobia, who may feel unable to leave the house."

"We're not saying there will be no need for face-to-face therapy, this is just another method of therapy that people can access."

CABG1 + Stents Shows Promise

DALLAS, Nov. 16 — Combining robotically assisted coronary artery bypass surgery (CABG) with stented angioplasty shows promise for treating extensive coronary artery disease, researchers reported at the American Heart Association Scientific Sessions 2005.

“The minimally invasive procedure effectively bypassed or opened blocked arteries in all 27 patients, an outcome as good or better than you would expect with open chest surgery,” said Marc R. Katz, M.D., lead author of the study and chief of cardiac surgery and director of the Virginia Transplant Center at Henrico Doctors’ Hospital in Richmond.

“The patients stayed in the hospital an average of only two and a half days, compared with five or six days for conventional CABG surgery,” Katz said. “And they were back to work in a week or so, compared with the usual six to 12 weeks.”

The study involved patients with multi-vessel coronary disease, including obstruction of the left anterior descending coronary artery (LAD), the main artery in the front of the heart.

During the closed-chest bypass procedure, the left internal mammary artery (in the chest) was harvested. Doctors then sutured the mammary artery to the obstructed LAD, bypassing the obstruction, all done endoscopically.

During the angioplasty procedure, doctors used stents (mesh tubes) to unblock other arteries and then prop them open.

Bird Flu In Canada

Bird flu is definitely on the move.

Ken Falk, President of Fraser Valley Duck and Goose Ltd., lost 140,000 birds in the outbreak of a bird flu in Canada's western province of British Columbia in 2004. Now he is bracing for another possible hit to his family-owned business.

Falk's farm remains under quarantine a day after one of his 60,000 ducks tested positive for the H5 strain of bird flu.

Officials from the Canadian Food Inspection Agency (CFIA) are visiting farms in a five-km radius around the duck and goose farm in the town of Chilliwack in southern British Columbia. They are warning bird owners to practise strict biosecurity.

Swab samples from the infected ducks are on their way to a national health research center in Winnipeg, which houses one of the world's most secure labs for the testing of deadly diseases, for further testing. It will take two days of tests to determine if it is the same type that has infected humans in Asia.

On Saturday, local reports say the CFIA will order the cull of all birds on Falk's farm, meaning a precautionary killing of Falk's birds.

"We have to do something to ensure this H5 strain doesn't mutate and get into the environment," Cornelius Kiley with the CFIA told CTV.

"Obviously we're very sad about that. And it's going to be hard but as an industry, we've decided to be proactive," Falk said.

According to Saturday's Vancouver Sun, the virus showed up after Falk sent a sample of birds from his farm to a government lab to be tested for something unrelated to avian flu.

Viagra For Pulmonary HTN

I'm thinking patient compliance will be high with this one.

NEW YORK (Reuters Health) - Treatment with Viagra (sildenafil) can improve exercise capacity and functional ability in patients with pulmonary arterial hypertension, a serious disease involving high pressure in the blood vessels that enter the lungs, new research suggests.

The findings, which appear in The New England Journal of Medicine, are based on a study of 278 patients who were randomly selected to receive Viagra, at one of three doses, or inactive "placebo" three times daily for 12 weeks.

The main endpoint was the distance walked in 6 minutes. According to the report, the study did not have enough patients to assess the effect of Viagra on the risk of death.

At all of the doses tested, Viagra significantly improved the 6-minute walking distance when compared with placebo, lead author Dr. Nazzareno Galie, from the University of Bologna in Italy, and colleagues note. For the 222 patients who used Viagra for 1 year, the improvement in distance was 51 meters.

In addition, all of the Viagra doses were associated with a significant drop in lung blood pressure and with an improvement in functional ability.

Printing Skin

I wonder if they will charge more for the cartridges than the printer? HP would love to sell this to my hospital.

You have a printer. What would you normally do with it? Print documents, probably forms and even a few photographs? Did you ever think you could print skin for yourself? How about organs, or even notebook screens?


If you think I’ve lost all of my senses, you are more wrong than Bill Gates was about future memory requirements.


So what exactly am I talking about? Researchers at the University of Manchester have developed an exciting technology where you take cells from the patient’s body and feed them into the computer. The system then analyses and multiplies them to the required level, which then fills up as "ink" in the first cartridge while the second cartridge contains the necessary gel. Once the process has started, multiple print layers ensure that a complex 3D skin is created and the dimensions are exactly as required

Prevention Is the Best Medicine

Sometimes the basic things can make the most impact.

If people avoided major risk factors for cancer, more than a third of the 7 million annual deaths from the disease could be prevented, scientists said on Friday.

In a report in The Lancet medical journal, the researchers estimated how many deaths from 12 types of cancer were caused by exposure to nine risk factors.

They calculated that smoking, alcohol, obesity, poor diet, unsafe sex, lack of exercise and other factors contributed to 2.43 million cancer deaths worldwide in 2001.

"A third of cancer deaths could have been avoided had those risks been reduced," said Dr Majid Ezzati of the Harvard School of Public Health in the United States.

"Prevention is probably still our best bet for reducing cancer deaths. It is by far larger than what we may be able to achieve using medical technology."

Smoking, which is linked to lung, mouth, stomach, pancreatic and bladder cancers, is the biggest avoidable risk factor, followed by alcohol and not eating enough fruits and vegetables.

"Of the 2.43 million deaths, 37 percent of them are from lung cancer," said Ezzati. "The total lung cancer deaths in the world are 1.23 million and of those 900,000 of them are caused by these risk factors."

Vein Transplants

The next time you tell a patient they "have no veins," think of this possibility.

The AP is reporting an advance in tissue-engineered vessels for the purpose of improving access for diabetics, dialysis patients, and maybe as a source for bypass grafting. Two patients had vessels grown from their own skin samples:


Like many patients in dialysis, the two Argentines, a 56-year-old woman and a 61-year-old man, were faced with the prospect of running out of healthy blood vessels. To grow new ones, doctors took a small piece of skin and a vein from the back of the hand, and nurtured them in a laboratory dish with growth enhancers to help produce substances like collagen and elastin, which give tissues their shape and texture.

The process produced two types of tissue: one that forms the tough structure or backbone of the vessel and one that lines it and helps it to function.

The feel of the new tissue "was very similar to the other vessels" that were present from birth, said Dr. Sergio Garrido, the surgeon who implanted it in the two patients.

The woman's new vessel has withstood needle punctures three times a week for six months and the man's for almost three months.

More info here.

Thank the Lawyers of America For This!

The rate of caesarean-section deliveries performed in the U.S. reached a record high in 2004, despite efforts by the government to reduce the rate, according to data released on Tuesday by CDC's National Center for Health Statistics, the AP/Las Vegas Sun reports. Almost 1.2 million c-sections, or 29.1% of all births, were performed in the U.S. in 2004, which is an increase from 27.5% in 2003 and 20.7% in 1996. The government in 2000 introduced an agenda to reduce the rate of c-sections to 15% by 2010. The increase in the c-section rate can be attributed to patient and physician preference, physicians' fears of malpractice lawsuits over problems resulting from vaginal delivery and risks surrounding vaginal birth after c-section, according to the AP/Sun (Stobbe, AP/Las Vegas Sun, 11/16). Many physicians and hospitals will not allow VBACs because of malpractice and liability concerns. In addition, the American College of Obstetricians and Gynecologists in 1999 revised its guidelines to say that only hospitals with a surgical team immediately available should allow VBACs, spurring community hospitals to prohibit the procedure (Kaiser Daily Women's Health Policy Report, 8/24). The rate of VBACs has decreased 67% since 1996, accounting for 9.2% of births in 2004. A study released in December 2004 said 75% of VBACs observed were successful, with fewer than 1% of participants experiencing a uterine tear (Rubin, USA Today, 11/16).

iPod-itis

How often do I get to name a new disease?

Music fans may enjoy the ability to spool through 10,000 songs on their iPods, but medical experts warn that jumping from tune to tune has its risks.

Carl Irwin, from the British Chiropractic Association, said: "This is a really serious problem. The action needed to move the wheel on an iPod is totally unnatural and effectively separates the joint in the thumb every time you use it.

"This causes inflammation in the thumb or fingers and can be very painful. We have also seen cases of iPod users where the problem has spread to their elbow and neck."

Mr Irwin said he expected to see a rise over the next six months of patients complaining of symptoms typical of repetitive stress injury (RSI). Children using their players for extended periods could be storing up problems for adulthood as their joints were still growing, he added.

Apple, the maker of the iPod, has refused to comment on the warning. The company also faces pressure from American health experts who share the same concern over potential RSI risks.

Drive Thru Angioplasty

Getting you arteries cleaned in a day is getting easier and easier...

It has not become quite as routine as having your teeth cleaned, but a growing number of people are going to hospitals to get their heart arteries unclogged and going home the same day.

New research presented Sunday at an American Heart Association conference suggests the approach is safe. It found complications were no greater in people who went home a few hours after having angioplasty than in those who were hospitalized overnight.

Doctors have been reluctant to adopt the outpatient method but ``this is the kind of study that's going to turn the trend,'' said Timothy Gardner, a Delaware cardiologist who heads the meeting committee but had no role in the research.

Patients, however, might not like being rushed out the door. Some may view it as the cardiac equivalent of ``drive-through deliveries,'' where new moms are sent home the day they give birth.

Angioplasty is one of the most common medical techniques in the world. About 600,000 are done each year in the United States.

The article goes on to say that accessing the arterial system through the arm, as opposed to the groin, reduces bleeding complications and enhances the safety of sending patients home early.

Eye Telescope

So, it seems a company called Visioncare has come up with a tiny “telescope” that can be implanted in your eye. And no, no, it’s not for you to play bionic man with. Instead, it’s for people with age-related macular degeneration. That’s medspeak for when your retina starts going down the pooper. The implant gives you a 3X magnification, and focuses the light onto the parts of the retina that still work. It’s meant to be used on one eye, with central vision, while the other eye focuses on the periphery.

Some more info here.

Bird Flu: The Perfect Storm

Finally, a reason for someone to understand the cytokine system. Every time one of these diseases comes along, we should realize how little we all know about the immune system in the end.

Scientists in Hong Kong say they may have helped explain why the H5N1 bird flu virus kills so many healthy young adults -- it apparently causes a "storm" of immune system chemicals that overwhelms the patient.

The H5N1 virus caused proteins known as cytokines to rush to infected lung tissue -- evidence of a so-called cytokine storm, an immune system overreaction that can be fatal.

The study, published in the online medical journal Respiratory Research, might suggest that if H5N1 does cause a pandemic, it could disproportionately affect the young and healthy as compared with seasonal flu, which kills many elderly people but few young adults.

It also raises questions about how effective drugs will be in controlling such a pandemic, experts said.

"We have to see if it is true and if we can do anything about it," cautioned Dr. Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases, who was not involved in the research.

But if the experiment does accurately show what happens in people, it may mean patients with H5N1 infections will need drugs that depress the immune response in addition to antivirals, Fauci said.

Government Confusion

Leave it to the federal government to make something more complex than it needs to be. These are the same folks that brought us the tax code in the end, and we're all still trying to figure that one out.

Bewildered by the complexity of the new Medicare outpatient prescription benefit, seniors will not be rushing to sign up, according to a comprehensive survey released Thursday as open enrollment approaches.

Although the government has spent more than $250 million to promote and explain the benefit, only 20 percent of seniors have initially made up their minds to enroll, the survey by the Kaiser Family Foundation and the Harvard School of Public Health found.

An additional 37 percent said they would not sign up, while 43 percent said they had not decided what to do.

The open enrollment runs from Tuesday to May 15.

If the doubts harden into disdain, that could force major changes to one of President Bush's top domestic policy accomplishments.

"The potential is grim," acknowledged John Rother, policy director of AARP, the seniors' lobby, which lent critical support in winning congressional approval of the program.

"If only 20 percent or even 30 percent of seniors sign up, that is every negative for the future of the program because the people most likely to sign up are the people with high drug expenses, and you don't have insurance if you don't spread the risk among people who are healthy," Rother explained.

The government has estimated that about two-thirds of seniors will sign up in the first year. But many appear to be stumped

Picky, Picky

I think they need to learn to work with what they've got.

LOS ANGELES, CA, United States (UPI) -- The University of California-Irvine Medical Center reportedly has rejected dozens of livers that were accepted for transplantation at other hospitals.

The Los Angeles Times said more than 30 people awaiting transplants died at the UCI hospital in Orange, Calif., during the past two years, as the medical center refused to accept scores of organs that might have saved them.

The newspaper, under the Freedom of Information Act, obtained a federal report indicating the medical center has performed only five liver transplants this year, well below the minimum number required for continued federal funding.

The report from the U.S. Centers for Medicare and Medicaid Services said the hospital received 122 liver offers between August 2004 and July 2005, but only 12 were transplanted, including two that went to the same patient because the first one failed.

Even when patients did receive liver transplants, they did not fare as well as they should have, the Times said. Federal investigators said only 68.6 percent of patients receiving liver transplants at UCI from January 2002 to June 2004 survived at least a year -- well below the 77 percent survival rate required for federal certification.

Handhelds Help CHF Patients

There are a lot of applications out there for the Palm platform, but this is one of the more interesting...

Savacor Inc. is betting that you have congestive heart failure and that you want to be able to keep control of it digitally. So they bought up every last Handspring Visor from the junkyard they could find and slapped their software onto them. The result is the HeartPOD, a system designed to help monitor the patient via a sensor implated into the heart and an old-skool Palm. Currently it’s still in trials and testing but could one day be available to all heart failure patients who need constant monitoring.

I'm just wondering why they decided to go with an older Palm model. With so much more processing power in today's handhelds, I just can't imagine why they needed such an older model. Maybe it's to keep the budget down.

Avian Flu Website

This is definitely a sign of the times. I was thinking of starting a "bird flu" blog, but someone is already up and running. Let's hope this blog doesn't get too popular.

New vaccine production methods

With all the attention that potential bird flu is getting, it's nice to hear that some new methods of vaccine production are being looked into. They could speed things up considerably from the traditional, and somewhat archaic "chicken and egg" technology currently employed.

Several biotechnology companies are at work on a new and quicker way of making a flu vaccine they hope can replace one that requires people to be inoculated with the entire influenza virus. Their technique: extract just a few genes from the virus and inject it into people. The nascent technology, called DNA vaccines, is a form of gene therapy that proponents argue is the best way to overhaul a 50-year-old vaccine manufacturing system.