Grand Rounds v.2 n.33

Welcome to Grand Rounds at Aetiology! Grab a cup of joe, take a seat, and enjoy the best of this week's medical blogging. Just make sure to wash your hands when you're done...you never know what's lying around here, between the kids, the dog, and the lab...

First, a programming note. Just a few weeks back, our Grand Rounds host was The Fat Doctor. Since then, she has suffered several strokes. As of the time I'm writing this, there hasn't been an update since Friday, but it seems like things are going OK. Check out her blog and please send along your well wishes; though it appears she doesn't have a network connection, her loved ones are passing along the comments to her.

Second, the setup. Allow me to note that my sister always jokes that I was the kindergartener who would ask for a shirt in "a sensible gray." My creativity rarely extends far beyond the lab, and coupled with my anal-retentive and sometimes perfectionist tendencies, this ended up being, well, a bit vanilla after going through a few other incarnations.

Second number 2, hello to those of you new to Aetiology. In case you didn't gather, I'm do basic research for a living--and hence, that's what gets top billing in this week's edition of Grand Rounds. I also recruited some posts from a few of the biomedically-oriented blogs on the ol' blogroll off to the left there, so you'll hopefully see some new sites that may interest you. It'll likely grow after I get a few hours' sleep to digest some of the new finds from hosting this!

Fourth, thanks again to Nick for his assistance, and for taking the time to carry out the "Pre-Rounds" interviews.

So, without additional rambling, onto the good stuff!

Basic research

From The Heart of the matter, a discussion of a pet topic o' mine: infectious causes of "chronic" disease--in this case, bacteria and coronary artery disease. Though Dr. Ng's post suggests the outcomes of several studies "put the nail in the coffin" of that idea (though acknowledging inflammation may still play a role), I'll just say I disagree and think the jury's still out. Perhaps a topic for an upcoming post here...

Via the NHS Blog Doctor, a post on another frequent Aetiology theme, "bird flu;" specifically, questionable treatments for the infection. This post wins my favorite quote of the week:

There is a connection between avian flu and homeopathy. Avian flu is transmitted by birds. Homeopathy is quackery.

In a bit more serious influenza news, Revere at Effect Measure discusses genetic susceptibility to avian influenza. What do we know--and where are our gaps in knowledge in this area?

Continuing on the influenza theme, some of you may realize the government has released the new pandemic influenza plan this past week. Mike the Mad Biologist discusses a few of the big limitations.

Medpundit also notes that we're not ready for a major disaster, such as a pandemic. Meanwhile, JKS of Superstrain notes that ABC is airing a "bird flu" movie Tuesday (tonight) at 9PM EST.

Here at Aetiology, I highlighted a recent paper showing that prions remain infectious in soil--which has big implications in preventing their spread among grazing animals, as well as eradicating them in an environment where they're already present.

At Parallel Universes, Dr. Emer gives a run-down of our germiest surfaces. Though these include things like your keyboard, I do just want to note the last paragraph of the BBC article he links:

"We don't want to make people overly paranoid here," Gerba added. "You can reduce your risk of getting colds and flu by a few simple actions. You are always gambling with germs. You just want to keep the odds in your favor."

From the Nurse Practitioner's Place comes news of a new report suggesting that Alzheimer's and diabetes may be linked.

Are there any limits to the use of aspirin? At ThePharmVoice, we learn about yet another benefit: preventing hearing loss caused by aminoglycoside antibiotics.

At the Biotech Weblog, Ruth comments on a new JAMA paper examining alternatives to estrogen for symptoms of menopause. Check out what worked and what didn't.

The latest diet craze has made its way to the Haversian Canal; it's full of olive oil and Niels invites us jump in.

Shinga of Breath Spa for Kids (and at least that name carries an explanation!) did some research of her own, examining kids' reactions to a pick of, well, picking. One's nose, to be precise.

From Straightfromthedoc, we find out about a new procedure certain to give actors in medical roles fits for years to come: percutaneous cryoablation. Read all about it--and then try to say it 3 times fast.

At John Hawks weblog, he notes a recent study suggests a particular allele increases risk of prostate cancer. Of course, if you're a regular reader of his blog, you'd know that's not the end of it--he teases out some of the underlying issues that make studies like that even more interesting.

What about spreading the research and medical update mojo around the web? Obviously Grand Rounds is one way to bring the best in the medical blogosphere together; Clinical Cases and Images highlights another possibility.

Tony of The Happystance Project discusses why laughter really is good for us.

On Disease Proof, find a discussion and 2 case reports dealing with the Atkins diet, with the authors coming down hard against it.

Workin' 9 to 5...

From The Examining Room of Dr. Charles comes a tale of his patient's close encounter with a modern-day body-snatcher.

Living in Iowa, hunting is, of course, a way of life for many. I've heard of deer season, pheasant season, rabbit season...but liver season? PixelRN explains.

Living in Alaska, however, makes Iowa hunters seem like a bunch of babies. A new blog, Tundra Medicine Dreams, describes what her patient had to go through just to be examined. Hint: dogsledding is involved.

Dr. Flea is annoyed at the daycare provider--and it's not even his own, it's his patient's. Has common sense been replaced by a knee-jerk reaction to anything potentially infectious? Interesting discussion in the comments as well.

Lisa of Inside Surgery is jonesing for some more of JFK's medical history--and a recent read seems to have raised as many questions as it answered. Check out the run-down of JFK's medical chart--and many unanswered questions--in her post here.

I'm calling Sheepish of The Paper Mask weird. It's not an insult--I'm directed to in this post, describing a coming invention--the digital Probablility of Survival (pS) monitor. You heard it here first, folks. Well, second, but close enough.

NeoNurseChic sends along a post detailing the need for occupational, physical, and speech language therapists as part of comprehensive care for neonates.

Some very practical advice on preparing to call a healthcare professional from Nurse Practitioner News. Note that it's not only dealing with how nurses should prepare when getting ready to call up a doctor--but also how said doctors can sometimes be rude in their replies. And of course, the over-arching theme of simply being prepared whenever getting ready to take up the time of someone who has limited amounts of it is a good one, no matter what field you're in.

Of course, many have followed the circus that is Tom Cruise/Katie Holmes (aka "TomKat") for the past several months, culminating in the birth of their daughter, Suri. (I'm soooo sad that I know that). Sumer comments on one of the stories that circulated during their pregnancy--the report that the expectant parents bought an ultrasound machine, and that Cruise claimed he was qualified to use it. Sumer thinks that's irresponsible. I tend to agree.

A reader of Confessions of a Venial Sinner submitted this post on MUSes (that would be "medically unexplained symptoms," not to be confused with ROUSes).

Hey! GruntDoc is in the news! (Just a note that I totally stole that post--he wasn't being a publicity hog by submitting it).

Over at Dr. Serani's Psychological Perspectives, she offers up Alexithymia: What the Heck *Is* That?. Upon reading the title, my curiosity was piqued--find out what it is, and why it's important, at the link.

As a medical student, MD/PhD's job is currently to learn. Check out part 1 and part 2 for an examination of med student attendance--where's the balance between school and "life?"

Keith of Digital Doorway sends along a touching story of his patient's journey home.

Let's talk about sex, baby

Anxiety, Addiction, and Depression Treatments takes a different angle on all the sex, discussing "cyber-cheating" and a whole lot more. And I really mean, a lot more--such as "teledildonics."

Over at ChronicBabe.com, Isobel discusses her learning experience regarding Celexa and sex in a frank and entertaining post.

Didn't think I'd have anough posts to make up an entire block on sex? O, ye of little faith. From Trick-cycling for beginners (yet one of several blog names that really need some 'splainin') comes a story of a variety of psychiatric drugs, and a whole carnival of side-effects. Take-home lesson from both of these posts:

Patients - tell your doctor about the side-effects, especially if it's bad enough to make you want to stop taking the medication....Doctors - ask your patients about side-effects, especially the embarassing ones...

The other side of the story--patients and caregivers

Ricky describes one of his worse nights--and what helps him to get through it.

Over at Nickie's Nook, the discussion is about ablism in healthcare. Imagine having to have your mother fill out all your paperwork--and answer your questions about sex, drugs, and rock 'n' roll. Potentially, within earshot of others. Nickie discusses that and more.

From Dream Mom, the mother of a special-needs child, comes a tear-jerker about a real champion, unrecognized to the world.

Another mother at A Difficult Patient describes the battle of getting a ten year old to take his meds and the difficulty in trying to get him in to see a child psychiatrist.

Kelly of It's a Wonderful Life notes her special relationship with her child's doctors, and the importance of viewing them as partners in the care of our children (and ourselves!).

A bit more upbeat at Diabetes Mine, where the highlight is an overview of the recent AACE (American Association of Clinical Endocrinologists) conference, featuring...Newt Gingrich? Sounds like an interesting meeting!

Medical issues in the news

From the strangely named Shoe Money Tonight comes a post discussing a topic that's been very much in the news lately: kicking soft drinks out of schools. Graham also discusses the issue. Both reach the same conclusion--it ain't just the soda, and juice isn't exactly a healthy alternative.

In a similar vein, Neonatal Doc describes the delivery of a baby by a 400-pound mother, and wonders if the next generation will be the first to have a shorter lifespan than their parents--due largely to obesity.

When one thinks about poaching, doctors aren't generally the first thing that comes to mind. But Interested Participant discusses just that: poaching doctors from Canada. The solution? Canada should "poach" from elsewhere, apparently.

This is just a Kennedy kind of Grand Rounds. In addition to the JFK post above, Abel PharmBoy uses news of Patrick Kennedy's prescription drug cocktail as a teaching moment.

I mentioned this on Aetiology as well, but Christine Gorman of Time's Global Health blog elaborates on rumors that the Vatican may soften its stance on condoms.

Controversy

Kevin, M.D. saw some fireworks in the comments of his post describing the practice of some Chicago docs, who asked their patients to sign a "no frivolous lawsuit" contract.

PZ's been on a tear about plan B the past few weeks. Start here for his intro post on the topic; then read yesterday's post noting how ABC News gets it wrong. DarkSyde also criticizes the sloppy reporting.

From The Blog that ate Manhattan, a "shame on you" post regarding the American Medical Association's practice of selling personal information to pharmaceutical companies.

Also on the theme of selling out to pharmaceutical companies, Peg asks if she looks like a drug whore, after being tempted by a real-life, hot breakfast at a conference. Where do you draw the line in accepting products from companies?

Orac is used to sparring with all sorts of anti-science folks, but it seems to get him down a bit when they're fellow MDs. He posts about two recent incidents here, but afarensis tries to provide a silver lining.

Nick at The Scientific Activist discusses a recent Nature editorial, which suggested the medical community should abstain from assisting in lethal injections, in order to bring about an end to the death penalty. What role should doctors play here? Sounds like an excellent segue into...

The hard questions

How far should doctors go to be culturally sensitive?, asks Clark of Unintelligent Design after a recent incident at a local hospital.

Dr. Andy has a similar difficult situation: what's the limit on free advice, especially if it's directed toward a colleague who may have practices you find distasteful? Where is the line between medicine and business?

Should your colleagues be your friends? Find out what Kim of Emergiblog thinks about the issue.

Dr. Hebert sends along a thoughtful post on the balance between providing a patient hope, and giving them the brutal truth--and how, perhaps, the two can mesh.

At Tales from the Womb, Phillip offers "sort of an extreme situational ethics piece," about a hepatoblastoma case that a surgeon is unable to cut out. Check out Part 1 here; Part 2 here.

The business side

At the InsureBlog, The_Prof muses about managed care and mental health coverage: counterintuitive?

From Hospital Impact comes an update on an update on "Revolution Health," the company that Steve Case (of AOL fame) has founded--check out the link for a pretty impressive list of acquisitions so far.

At Fixin' Healthcare, we're reminded that, well, fixin' healthcare just ain't easy, and prevention is sorely lacking in the U.S. Hippocrates also offers his thoughts on healthcare "market failure."

To bring the whole problem of the healthcare crisis home, Elisa at HealthyConcerns.com also points out that this is Cover the Uninsured Week, complete with links to plenty of stats and stories.

Clearly, the Health Business Blog was made for this category. David sends a post asking, What would it take to bring health care costs under control?" A number of suggestions are listed, but the tone isn't one of optimism.

Misc.

Do Japanese women have a 10-month long pregnancy? Check out last week's host, Scott at Polite Dissent, to find the explanation for the discrepancy.

From A Hearty Life comes the reminder that smoking causes way more than cancer.

From Cricoid Pressure comes a short story, "Bleeding."

Finally, just in case you need another dose of medical blogging, be sure to check out the second edition of Pediatric Grand Rounds.

Thanks to everyone for their submissions! Next week's edition will be hosted at Doc Around the Clock.

--------------------------------------
Images from http://www.pcbypaul.com/wpclipart/recreation/party/heart-ballons_benji_…; http://a.abc.com/images/20050919/moviesandspecials/fatalcontactbirdflui…; http://www.aperfectworld.org/cartoons/menopause.png; http://www.call-wild.com/photos/dogsled-racer.JPG; http://www.dancewithshadows.com/society/images/tomcruise/tom-cruise-kat…; http://www.buy-adderall.com/buy-celexa.jpg; http://upload.wikimedia.org/wikipedia/en/d/d2/NewtGingrich.jpg; http://www.vpul.upenn.edu/ohe/library/Sexhealth/news/condoms.jpg; http://www.gavpolitics.co.uk/www3/images/lethalinjection.jpg; http://www.gothamgazette.com/graphics/uninsured.jpg