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Tuesday, November 25, 2008

Grand Rounds 5:10

Welcome to Grand Rounds, the weekly anthology of the best of the health blogs. (For those of you unfamiliar with Grand Rounds, which is hosted by a different health blog every week, you can read more about it here.)

Bongi, a pseudonymous South African general surgeon, writes about a recent gunshot case he handled at an awful-sounding hospital (he refers to it simply as "hell") and the rather colourful language he had to resort to using to get the blood bank to cough up the amount of blood he asked for. [other things amanzi]

In a rough but refreshingly raw essay on personality and chronic illness, Leslie, a young woman with rheumatoid arthritis and lupus, describes her process of learning to accept her illness and come to grips with what it means for her life. [Getting Closer to Myself]

Yes, the JUPITER study indeed showed that the statin Crestor was of clinical value to patients, Dr Rich thoughtfully writes. No argue otherwise, he says, is spurious. However, that doesn't mean everyone should take the very expensive statin. What's the rationale for not giving an apparently safe drug to patients who stand to benefit from it? "[T]here’s simply no good answer to this question as long as we insist on pretending that rationing is not necessary and is not already occurring." The solution, Dr Rich says, is to break the taboo and actually discuss healthcare rationing openly, honestly and rationally. [The Covert Rationing Blog] Sandy Szwarc, however, isn't convinced that JUPITER is nearly as powerful a study as many people have claimed. She describes her many problems with the trial, including the decision to end the study early. [Junkfood Science]

Ms Szwarc also tears apart the fawning media coverage of a recent abstract that was widely (and incorrectly, she says) reported to show that obese kids and kids with high cholesterol levels develop thick-walled carotid arteries, which could therefore put them at risk of serious cardiovascular problems. There were plenty of questions that no journalist asked and are crucial to understanding the claims made by the promoters of the research. [Junkfood Science]

Doc Gurley came up with a fantastic idea for a new series on her blog, called "Well Worth It," a round-up of cheap and easy things you can do for your health that don't get enough attention. In the first entry, published last week, her simple treatments are: electric fans to prevent SIDS, old-fashioned treatments for IBS, and an inspirational article on quitting smoking. [Doc Gurley]

American plastic surgeon Ramona reports on new evidence that breastfeeding does not, despite what many women believe, contribute to sagging or any decrease in the esthetic appearance of the breasts. It's an important point because there are women who might otherwise breastfeed who elect not to because of fears about their appearance. Despite its methodological limitations, Ramona hopes this study will dispel women's anxieties about breastfeeding's effect on their looks. [Suture for a Living]

How to Cope with Pain looks at the drug methylnaltrexone bromide, marketed as Relistor, and approved earlier this year to relieve opioid-induced constipation in the United States and then in Canada. [How to Cope with Pain]

Jolie Bookspan, who writes about back pain and fitness, answers a reader's question about how much "inward curve space" should exist at the lower back. [The Fitness Fixer] Dean Moyer explains how twisting can cause a herniated disk, and what activities can eventually lead to a problem. [The Back Pain Blog]

Dr Paul Auerbach writes about a recent presentation by the Colorado emergency physician "altitude medicine" specialist Peter H Hackett on how to treat acute mountain sickness and high altitude cerebral edema. Did you know 15-40% of skiers in Colorado develop acute mountain sickness? I sure didn't. [Medicine for the Outdoors]

Neurology professor and researcher Joshua Steinerman is thinking about the value of routine cognitive screening. And he's looking for readers' input. [SharpBrains] In another post, Alvaro Fernandez interviews an expert on cognitive decline. [SharpBrains]

A pathology resident's friend wondered what pathologists actually do with surgical specimens. Here's the answer. [PathResBlog]

Don't miss the American College of Physicians ACP Internist blog's weekly "Medical news of the obvious" column. Recent entries include studies that found suntanners often get burned at the beach, that people hate waiting in line, and that media coverage affects people's perception of infectious disease threats. "As opposed to people just going out and conducting their own field research about all the infectious disease in the world," snickered Jessica Berthold. [ACP Internist]

Testifying in court against a patient who attacked her and three colleagues with a makeshift blade, this nurse urged the judge to sentence the attacker to jail time rather than a psychiatric hospital where he could talk his way out of being locked up for very long. "A lot of people have 'issues'," she writes in her compelling account of the day, "but they don’t try killing three old nurses, a pregnant nurse and her unborn child." [Nurse Ratched's Place]

American readers already know that Thanksgiving -- that most holy of holidays, replete with blessed bird and sacred stuffing -- is this Thursday. (We Canadians already enjoyed our Thanksgiving well over a month ago. I had a bite of a turkey sandwich and a pickle.) Laurie Edwards, a writer and sufferer of celiac disease, writes about the challenge of trying to eat gluten-free at Thanksgiving dinner. (I have to admit that the Brussels sprout hash doesn't tempt me.) [A Chronic Dose] Jenni Prokopy compiled a list of eating advice for people with gluten problems and other food-related illnesses. [chronicbabe] Both Ms Edwards and Ms Prokopy recommend Gluten-Free Girl, who has provides recipes for celiac-safe versions of gravy, stuffing, chutney and pumpkin pie. [Gluten-Free Girl] I'd like to give thanks for the internet and all the dedicated altruists who share such great advice.

Med student Peter Zavislak recently performed his first surgery, in Afghanistan -- an excision of a Baker cyst. Things don't go exactly as planned. First, he tries cutting with the wrong side of the scalpel ("The curved side is blunt, the flat side is sharp. How counter-intuitive. Is this some sort of ritual hazing by surgeons?") but things turn out okay in the end. "See one. Do one. Teach one," he writes. "I skipped the first step. I'm not quite ready on that last one." [Medical Pastiche]

An odd story from Norway: A surgeon left a 20 cm sponge inside a patient. Then a radiologist saw the sponge in an X-ray... and didn't do anything about it. Finally, the sponge was found and removed. Multi-million malpractice suit, right? Wrong. The patient told a reporter, "Do I have confidence in the hospital after this? Yes, I do. To err is human." "Surgeons are not omnipotent deities," The Sterile Eye comments, in admiration of the patient's attitude. [The Sterile Eye]

Dr Drew Rosielle, from Milwaukee, travelled to Montreal this fall to take part in a conference on palliative care and produced this very thoughtful essay on the role of grief in medicine and his own feelings about his patients and his family. Walking through an exhibit of photos of palliative care patients, he found himself crying. He wrote, "[I]t may only be the last few years - getting older, kids, hundreds of patients dying a year - that I had something that needed catharsis, particularly as the stimulus to much of my grief is one that I have to repress/manage as it unfolds." [Pallimed: Arts & Humanities]

Nursing has become increasingly complex over the years but nursing education may not be doing enough to exposes nursing students to a variety of different care contexts they might face, emergency nurse Kim writes. "I can’t help but think that nursing students are missing out of many learning opportunities," she says, such as in a rural hospital, a major city hospital or a psych unit. [Emergiblog]

Amy Tenderich explains the origins of the plain blue circle as a symbol of World Diabetes Day. "The blue color is meant to evoke the color of the sky, and the circle is a symbol of unity," she writes. Unfortunately, most people -- including some from the American Diabetes Association -- seem not to have the faintest clue what the blue circle is all about. [DiabetesMine]

Dr Dainius Drukteinis, who holds degrees in both medicine and law, discusses a 2007 New York malpractice suit in which an emergency physician was found negligent for failing to hurry his patient through an excessively long series of diagnostics, consults and referrals for his two severed fingers. Seven-plus hours of waiting before orthopedics gets on the case is "about the upper limit without trying to break records," one expert witness testified. "[W]hatever the systems failure or distraction, it must be remembered that it is the emergency medicine physician who is ultimately accountable for those delays in time," conlcudes Dr Drukteinis. [Detroit Receiving]

To bring malpractice claims under control, Duncan Cross writes, the costs that arise from medicine's inherent risks shouldn't fall to the injured patient. Instead, he writes, we should look for a solution that gives providers incentives to avoid medical errors (perhaps a touchy suggestion; do providers really need incentives to avoid screwing up?); distinguish better between illegitimate and legitimate claims of malpractice; and make the medical system's error rates more transparent. [Duncan Cross]

The recently adopted American health information privacy law, HIPAA, was supposed to help patients. But Mexico Medical Student Enrico discovered -- in a frustrating way -- that the law can just as easily become a major roadblock in the way of patients trying to get access to their own records in some situations. [Medico Medical Student]

Dr Val Jones wonders what former Senate majority leader Tom Daschle's appointment as Barack Obama's secretary of health and human services will mean for the future of American healthcare. She complains that "equal access to nothing is nothing." [Getting Better with Dr Val]

Massachusetts health lawyer David Harlow comments on the fast-approaching implementation of federal legislation on patient-safety organizations, intended to allow safe, confidential reporting by healthcare providers of medical errors and adverse events. "All in all," he writes, "this is a welcome step forward for the further development of evidence-based medicine, taking into account details of negative outcomes and using those outcomes as learning opportunities for the system as a whole without exposing individual providers to additional potential liabilities." [HealthBlawg]

My contribution to this week's Grand Rounds is an article I wrote recently on doubt among the medical community about whether doctors' sex scandals should be made public or not. [Canadian Medicine]

One last article, which arrived in my email this morning: Toronto-based clinical psychologist and Red Cross volunteer Romeo Vitelli on AIDS in South Africa. [Providentia]

Also worth mentioning is a new RSS feed designed just for Grand Rounds, created by Marshall Kirkpatrick.

Grand Rounds will be edited next week by Mexico Medical Student.


  1. Thanks for the link, but I don't actually argue that "tort reform is certainly needed". There's a distinction between "malpractice reform" and "tort reform" - maybe drawn a little too subtly in my post, but crucial nonetheless. Not only is tort reform not "needed", I doubt it will even be useful.

  2. Thank you for an especially professional and informative Grand Rounds.

  3. Thank you for the clarification, Duncan. I've updated the brief on your post to reflect your comment. My apologies for any confusion.

  4. Thanks Sam! I appreciate the correction.

  5. terrific job with grand rounds today. thank you - i know how much work it takes to put it together! thanks for including chronicbabe as well. bestest, jenni

  6. Thanks for the mention of the RSS feed at the end! I just now tagged this post into it but will try to do so as early as possible in future Tuesdays.

  7. thank you for your kind opinion of my submission. i'm humbled

  8. Nice edition! Thanks for including me!

  9. I like it also. I bookmarked. Thanks,