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In the wake of the horrific floods that struck Colorado recently, many people have debated whether global warming is to blame. The same goes for wildfires that hit that state this summer and for the massive tornado that struck in Oklahom...
In the wake of the horrific floods that struck Colorado recently, many people have debated whether global warming is to blame. The same goes for wildfires that hit that state this summer and for the massive tornado that struck in Oklahoma this spring. In the wake of that tornado, for instance, Senator Sheldon Whitehouse from Rhode Island claimed that Republican opposition to climate change legislation was at fault, for trying to “protect the market share of polluters.”  Senator Barbara Boxer was confident about the cause of the terrible twister too: “This is climate change” she said. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
about 2 hours ago
“What do you think, Doctor?” For a novice physician, these worlds can quickly jolt a relatively straightforward conversation into a jumble of partially formed thoughts, suppositions, jargon, and (sometimes) incoherent ramblings. Even for...
“What do you think, Doctor?” For a novice physician, these worlds can quickly jolt a relatively straightforward conversation into a jumble of partially formed thoughts, suppositions, jargon, and (sometimes) incoherent ramblings. Even for simpler questions, the fumbling trainee does not have a convenient script that has been refined through years of recitation. Thus, many conversations that residents have with patients are truly occurring for the first time. And unfortunately, this novelty can result in poorly chosen words that can have lasting effects. An inauspicious slip of the tongue could significantly alter the patient’s perceptions and decisions. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
about 4 hours ago
Proteins control nearly all of life’s functions, but how they self-assemble or fold is an unsolved problem in biology. Understanding how folding goes awry could lead to cures for diseases such as Alzheimer’s and ParkinsonR...
Proteins control nearly all of life’s functions, but how they self-assemble or fold is an unsolved problem in biology. Understanding how folding goes awry could lead to cures for diseases such as Alzheimer’s and Parkinson’s, which are caused by protein misfolding. One of the winners of the 2013 Nobel Prize in Chemistry, Michael Levitt, PhD, is an early pioneer in “computational biology,” the development of complex software algorithms that allow researchers to simulate and experiment with biological processes such as protein folding. In 1969, he realistically modeled tRNA, a helper molecule for building proteins inside the body. He also discovered the architectural patterns in proteins, devised a protocol for simulating how water interacts with proteins and designed the first simulations of humanized antibodies. In this video, Levitt’s Stanford colleague, Vijay Pande, PhD, shows a simulation of protein folding, and explains why computational biology is important to the future of medicine. By modeling protein folding, Pande says, “We hope to get exquisite detail and information that you might not be able to get from experiments.” Previously: Stanford’s Michael Levitt wins 2013 Nobel Prize in Chemistry
about 4 hours ago
When is it justified to force treatment on someone? Some would shout a resounding,impassioned, all inclusive, “Never!” No psychiatric coercion, not ever, not even under the most seemingly urgent of circumstances. I once put t...
When is it justified to force treatment on someone? Some would shout a resounding,impassioned, all inclusive, “Never!” No psychiatric coercion, not ever, not even under the most seemingly urgent of circumstances. I once put the question to its supreme test — 35 years ago while having dinner with Tom Szasz. Tom was the probably the greatest defender of patient rights since Pinel (the father of modern psychiatry who, two centuries ago, started the profession off on the right foot by releasing the mentally ill from their chains). Tom’s landmark book The Myth of Mental Illness, written one half century ago, contained a crusading bill of rights for psychiatric patients. He argued passionately for the dignity and freedom of choice of mentally ill inmates who were then often warehoused for life in hospitals that were aptly compared to snake pits. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
about 6 hours ago
New data from an analysis of online job postings confirms that employment growth in health information technology (HIT) has even further exceeded projections, driven by funding from the Health Information Technology for Economic and Clin...
New data from an analysis of online job postings confirms that employment growth in health information technology (HIT) has even further exceeded projections, driven by funding from the Health Information Technology for Economic and Clinical Health (HITECH) Act. In addition, two other reports show that the job market for those working with electronic health record (EHR) and related systems continues to be strong for employees and challenging for employers.In the new analysis, Schwartz and colleagues used a comprehensive database of 84 million online job postings, extracted out those related to HIT, and built a model aiming to determine the influence of HITECH [1]. The authors limited their focus to jobs that would be defined in the realm of clinical informatics. Although this was important for their goal of assessing the influence of HITECH, from the perspective of a biomedical informatics graduate program director like myself, this excluded other important informatics jobs, such as those in imaging informatics, bioinformatics, clinical research informatics, and other areas where a graduates of our program are employed.The analysis classified jobs into two broad categories, HIT core jobs and HIT clinical user jobs. The former category included those developing, implementing, supporting, and selling EHRs, while the latter included clinicians, receptionists, technicians, and other personnel making heavy use of EHRs in their jobs. Wearing my informatics educational program director's hat, I was most interested in the authors' results for the HIT core job listings, as these individuals would be most likely to be employed in (and to seek education preparing them for) informatics careers.Schwartz et al. counted a total of HIT-related 434,282 job postings between 2007-2011, with 226,356 HIT core jobs and 207,926 HIT-related clinical user jobs. Yes, not 41,000 [2], not even 51,000 [3], but over 226,000!For both categories of HIT jobs combined, the authors categorized employer type and provided a percentage of all HIT jobs for each. The largest employer category was IT vendor, which included IT service providers, consulting firms, sales firms, and IT staffing firms hiring developers and posted 42% of all HIT-related listings. Another 39% were posted by healthcare provider organizations. The remaining 19% were either ambiguous as to the employer type (15%) or another type of employer (4%).For all HIT jobs, they also categorized and tallied job responsibilities, which could be assigned to more than one category for a given posting. The most frequent job responsibility was implementation support, with 43% of jobs including responsibilities such as system installation, customization, building, debugging, purchasing, or workflow redesign. The next highest category was user training (27%), followed by system development (22%). This was followed by technical support, with 21% of jobs including the maintaining of continued technical functionality or providing customer support. Other responsibilities included IT strategy (long-term IT planning and system optimization in the clinical setting - 13%), sales (11%), and research (quantitative hypothesis testing using health IT systems - 6%).Their model estimated that about 48% of the job growth was due to HITECH, with the remainder due to growth that would have continued at historical trends prior to HITECH. Some other interesting findings for the time period between 2007-2011 included HIT jobs growing from 0.75% to nearly 2.5% of all healthcare job postings (consistent with prior findings of healthcare organizations hiring one IT employee per 48-60 non-IT employees [2]) and an approximately four-fold increase in the number of jobs posted.It will remain to be seen how strong the job market remains as the HITECH incentives wind down, although HIT will continue to be a cost of doing business in healthcare, especially as the system moves to payment models that require better management and use of data
about 6 hours ago
A new study published in The Lancet provides the most definitive evidence to date that chronic cerebrospinal venous insufficiency (CCSVI), a hypothetical syndrome of narrowed veins draining the brain that some believe is the true cause o...
A new study published in The Lancet provides the most definitive evidence to date that chronic cerebrospinal venous insufficiency (CCSVI), a hypothetical syndrome of narrowed veins draining the brain that some believe is the true cause of multiple sclerosis (MS), is not associated with MS. In a science-based world, this study would be yet one more nail in the coffin of this failed hypothesis. But that’s not the world we live in. CCSVI background CCSVI was first proposed in 2009 by Italian vascular surgeon, Dr. Paolo Zamboni – that multiple sclerosis (MS) is caused by chronic blockage of the veins that drain the brain. The current scientific consensus is that MS is a chronic autoimmune disease, and the pathology is caused by primary inflammation. Dr. Zamboni believes that the venous anomalies he has discovered are the primary cause and the inflammation is secondary. That is a fairly radical hypothesis, up there with the notion that bacterial infection and not stress causes gastric ulcers. Of course the latter hypothesis turned out to be true. As more and more research was done on C. pylori, the evidence pointed increasingly in the direction of a correlation and causation, and the consensus of scientific opinion followed the evidence. The story for CCSVI has been quite different. The evidence has been mixed at best, and mostly negative. Zamboni initially claimed a nearly 100% correlation between MS and narrowing of the cerebral veins. If true this could potentially change our understanding of MS and lead to new treatments. The MS research community received the claims, as they should, with intense skepticism. Many in the patient community, however, saw the claims as a ray of hope. The key to any new claim in science is replication – do the results hold up when independently replicated? So far, no one has replicated Zamboni’s near-100% results, but that aside, what has the follow up research shown about CCSVI? In 2011 I reviewed the major replications to date, seven of them, mostly negative. The largest study at the time did find some correlation between CCSVI and MS, but half of MS patients in the study did not have CCSVI and many subjects with other neurological disease or healthy controls also had CCSVI. So it appears that CCSVI does not always cause MS, and MS patients do not always have CCSVI. While the study left the door open for some relationship, it certainly did not support Zamboni’s claims to have found “the” cause of MS. Since my 2011 review, additional replications have been devastatingly negative for the CCSVI hypothesis. A 2013 study of 1767 subjects (with MS, another neurological disease, and healthy controls) was dead negative – no association between MS and CCSVI. This study used ultrasound criteria similar to Zamboni’s. A recent meta-analysis of 9 studies (included out of 19 identified) did show a correlation between CCSVI using ultrasound criteria and MS, but the data did not establish causation. The results, in my opinion, reveal the weakness in the meta-analysis approach because it can potentially include early false positive data skewing the outcome. A best-evidence analysis is a better approach – looking at the pattern in the research, which clearly shows that later, larger, more rigorous studies (as with the latest one above) tend to be more negative. The Lancet study The new Lancet study by Traboulsee et al., including 177 subjects, 79 with multiple sclerosis, 55 siblings, and 43 unrelated controls from three centers in Canada is not the largest study of CCSVI and MS. However the study is large enough, and it does have the advantage of comparing ultrasound investigation of the venous system with full dye catheterization, which is the gold standard. The results of this study are also completely negative – no correlation between CCSVI and MS. They found that: Catheter venography criteria for chronic cerebrospinal venous insufficiency were po
about 7 hours ago
Today we’re excited to share an international view from another of our 2013 DiabetesMine Patient Voices Scholarship Contest winners (announced in August). Julia Neese is a 43-year-old business economist and native of Munich, Germany, who...
Today we’re excited to share an international view from another of our 2013 DiabetesMine Patient Voices Scholarship Contest winners (announced in August). Julia Neese is a 43-year-old business economist and native of Munich, Germany, who’s been living with type 1…The post How CGM Re-Energized Patient Winner About Diabetes Tech appeared first on DiabetesMine: the all things diabetes blog.
about 8 hours ago
My kids were at the dentist this weekend for their routine cleaning and check ups (yes, Saturday hours!) when the hygienist mentioned x-rays. I smiled and mentioned I’d rather discuss the need with the dentist after his exam. This isn’t ...
My kids were at the dentist this weekend for their routine cleaning and check ups (yes, Saturday hours!) when the hygienist mentioned x-rays. I smiled and mentioned I’d rather discuss the need with the dentist after his exam. This isn’t a dental x-ray thing, this is what I do for every test that involves ionizing radiation. My son, Oliver, has had more radiation than most people will have. Ever. In fact, as he was extremely premature he had more radiation than most people will have in a lifetime before he was supposed to be born. In addition to the 30 or so x-rays he had over 9 1/2 weeks in the neonatal intensive care unit (NICU) he had a challenging procedure done under fluoroscopy to pop open his pulmonary valve when he weighed 3 lbs (when he should have still been a fetus). I read that the estimated radiation dose from that specific procedure is calculated at about 1,000 chest x-rays. It’s an older study and so I hope the calculations don’t apply to today’s imagining, but I admit I felt sick. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
about 8 hours ago
Moments ago, we learned from the Royal Swedish Academy of Sciences that Michael Levitt, PhD, the Robert W. and Vivian K. Cahill Professor in Cancer Research, is winner of the 2013 Nobel Prize in Chemistry. The award was given for “...
Moments ago, we learned from the Royal Swedish Academy of Sciences that Michael Levitt, PhD, the Robert W. and Vivian K. Cahill Professor in Cancer Research, is winner of the 2013 Nobel Prize in Chemistry. The award was given for “the development of multiscale models for complex chemical systems.” What a week for Stanford’s School of Medicine! The news comes two days after Stanford molecular neuroscientist Thomas Südhof, MD, won the Nobel Prize in Physiology or Medicine. (In addition, Stanford’s Brian Kobilka, MD, shared the chemistry prize last year!) We’re thrilled about the news, and we’ll post details here and on our Twitter feed as the day progresses. Previously: Stanford’s Thomas Südhof wins 2013 Nobel Prize in Medicine and Stanford’s Brian Kobilka wins 2012 Nobel Prize in Chemistry
about 8 hours ago
From MedPage Today: Size a Key Factor in ACO Formation. Accountable care organizations (ACOs) tend to form around larger integrated hospital systems and larger primary care physician groups, and in areas with a higher prevalence of hosp...
From MedPage Today: Size a Key Factor in ACO Formation. Accountable care organizations (ACOs) tend to form around larger integrated hospital systems and larger primary care physician groups, and in areas with a higher prevalence of hospital risk-sharing. Malaria Vaccine Candidate Has Protective Effect. A candidate vaccine against malaria had significant efficacy in a randomized controlled phase III trial in Africa. Bisphosphonates Raise Afib Risk. Bisphosphonate use was associated with significantly increased risks of atrial fibrillation and serious atrial fibrillation. Hypothermia Has No Benefit in Meningitis. Patients with severe bacterial meningitis were not helped by induced hypothermia in a randomized trial and may actually have been harmed. Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
about 10 hours ago