Tuesday, August 14, 2007

Grand Rounds 3:47

sudden change

Featuring Sudden Changes Of All Kinds

Grüezi* and welcome to Grand Rounds! (*hello in Schwyzerdütsch) The hosting plan of this edition has gone through several sudden changes. First I wanted the date of our National Day because, to my knowledge, this is the first time that Grand Rounds are being hosted in Switzerland. But the date already had been taken, so I planned to hack the World Economic Forum website. Their focus is too much on money in my opinion, and replacing their content with Grand Rounds posts could have opened their eyes to what really counts in life. All had been ready so far, pixel number thirty-seven in the WEF logo already been changed testwise. But then it struck me like a flash of lightning: What really counts is content and not the outer form.

It was the day after my sudden change of view on weight loss (see sidebar), and I said to myself: One giant leap for my blog, but only one small step for the medical blogosphere. There must be sudden changes of other dimensions, of real importance out there. And here they are.

Val
I begin with a post specially written for this edition. Val Jones tells us the tragic story that brought her to raise her Voice of Reason at Revolution Health: «My road to a revolution.» Blogging and online information as a weapon to fight the shortcomings of a corrupt health system. Very encouraging for us fellow health bloggers!

Jenni Prokopy's way to Chronicbabe has been very different but not less dramatic. In a sudden shift of view she has come to accept her chronic illness which gave her the power of turning her former hobby blog into a full-time career. Very impressive!

Challenged by the theme of this edition, Kim at Emergiblog suddenly
sees sudden changes everywhere in her life, in private as well as in emergency department nursing. Don't miss the wonderful scene with the four years old skeptic!

And now I have the pleasure to introduce Dr. Bee in our midst. She just has started her new blog Postcards from Kiddieland, telling us how she reacted instinctively on a sudden change to the worse.


Changes of view

cat
It was Sunday morning, I was reading my newspaper and found the story of Oscar the cat that predicts death. The article reported this as a fact without any doubt. Normally I would have bought it, we all love interesting stories and I am a journalist myself. But Sandy Szwarc of Junkfood Science is a must-read in such situations. It is important not to be fooled. Nor by allegedly prophetic cats nor by quacks. Sandy, to my surprise, tells us that even scientists can be fooled - by jumping from correlation to cause and by the confirmation bias. By the way, here is the initial trigger that brought me to our Grand Rounds theme.

#1 Dinosaur, in his musings blog, tells us a story that somehow reminds me of Chronicbabe. Parents have to deal with the inevitable fate that their baby cannot be cured. It suffers from sort of a Phantom of the Opera mask: A picture is worth a thousand words.

Rima Bishara, the Doctor Blogger, tells us about the dramatic changes in view that take place in parents raising a disabled child.

David E. Williams of Health Business Blog always has been against limited health insurance plans (Mini-Meds). But then he came to think it over and found a new, positive understanding that also made him start a medical tourism project.

The war on obesity leads to strange changes: Tony Chen reports a case of a hospital that cuts paychecks for workers with a body mass index of more than 30. Studies show that obese hospital patients survive better. And hospital managers punish obese workers? We live in a strange world, indeed.

Another serious issue: Cancer fears that put people under stress despite lacking evidence. Gloria D. Gamat of Daily Diabetic describes how she has changed her mind by interviewing an expert: Sugar substitute and cancer - there is really nothing to fear!

How To Cope With Pain reports a finding that migraines may be caused by a hole in the heart. Very surprising. Time will tell if this will lead to a shift of view in the understanding of this pain disease.


Changes to the worse

Ylenia
The next post is dedicated to Ylenia, a five years old Swiss girl who recently disappeared. Other than in the Maddy case, more and, I hate to say, worse things are known to the police. All (!) of her clothes have been found. The suspected rapist happens to be a former resident of a village only three miles from where I live. He has killed himself with a gun. Ylenia has not yet been found. Whole Switzerland is shocked. I cannot bring Ylenia out of my mind when I read what Vitum Medicinus in his blog tells us: The sad story of a boy whose life has been destroyed by a rape. - Update: Ylenia has been found dead, poisoned by toluene and without detectable traces of rape, and traces of clandestine pedophiliac activities of the killer have been found.

Another dramatic story is told by Terry Freemark a nurse anesthetist blogging at Counting Sheep: A patient who dies on the operating room table from multiple gunshot wounds.

Laurie Edwards, in A Chronic Dose, recently had to tackle the sudden death of a near person and tells us how she found a positive spin, based on her experience with chronic illness: Mourning thoughts.

Adam, at NY Emergency Medicine, describes how it feels negotiating death with a terminally ill patient who cannot make up his mind whether to be intubated or not. A strong piece!

Even if intubation seems all to be normal, things can suddenly turn to the worse. Anonymous Therapist of Respiratory Therapy 101 tells us such a story where family members added even more problems by their presence.

Sometimes, changes to the worse follow a seasonal variation. Allergy Notes tells us why children with asthma get sick in September.


Changes to the better

Lisa
Lisa who lets us follow her Cushing's Disease Journey is very happy to report a dramatic improvement after surgery which has turned her whole life to the positive.

The same is true for Rachel. In her Tales she lets us know about a sudden change in work environment.

Even everyday movements may be subject to positive change, that is, to a healthier way. For instance, do you know how to gaze at meteors without doing harm to your neck? Jolie Bookspan, the Fitness Fixer, tells you how to do it the healthy way.

And do not forget all these technical gadgets! They are being improved all the time. For instance, Amy Tenderich of Diabetes Mine is quite enthusiastic about a new glucose meter that is combined with a cell phone.


Not so sudden changes

chart
Aman runs a Technology, Health and Development blog and has submitted the first time ever to a carnival. Welcome him and watch his report on a slow but important increase of health reporting in the business press.

Important changes are not necessarily sudden changes. Teri Polick shows us such a case at Nurse Ratched's Place: The slow but huge changes in nursing practice over the past decades.

Pregnancy is one of the most natural examples of a slow change. Tara Gidus, serving advice on her Diet Dish Blog, tells more about the subtle changes and the dos and don'ts in pregnancy.

Alvaro Fernandez of Sharp Brains warns us about the slow but substantial trend in ageing workforce and the importance of keeping their brains fit.

A very slow, sort of glacial change is reported by David C. Harlow in his HealthBlawg: The Centers for Medicare & Medicaid Services (CMS) are moving in the direction of payment for performance, an important trend in healthcare insurance.

Another slow but important trend is towards Consumer Driven Health Care: Retail-based clinical models may provide better care for lower cost, as Henry Stern in his InsureBlog points out and asks why the AMA is still in opposition to such such models.


Virtual changes

second life
There are people like me who have one life. And there are people like Bertalan Mesko who have two lives. At Scienceroll, he shows us how his double ego at Second Life has come together with a couple of other participants for the first medical simulation. Second life, according to Clinical Cases, is one of six important elements of Web 2.0 in medicine.

Blogs are also such an element. Hsien of Eye on DNA every now and then makes sudden changes of authorship by interviewing other bloggers and, like this time, by inviting guest bloggers. Don't miss Sarah Ost's guest post about ethical guidelines for health bloggers and consider, like me (as soon as I have more time, cross my heart) to join the Healthblogger Code of Ethics.

Will emails become an important communications tool between patients and physicians? Joshua Schwimmer at Tech Medicine discusses the requirements that must be met.

If you want to quit smoking, is it better to make a sudden change or to reduce gradually? Jonathan Foulds at Freedom from Smoking discusses the pros and cons of both ways.

Trisha at Ideas For Women has a more global scope of the problem and muses about what should be done.

Increasing tobacco taxes is a plan favoured by Jon Schnaars of Treatment online.

Many plans that are yet far from reality are hatched in the labs all over the world. GrrlScientist at her Scienceblog reports about a bone hormone that may help against obesity and diabetes in the future.

Bird flu is a case where we all hope there will never be a sudden change at all as long as the bug keeps quiet. But at the vax front, a change is badly needed for being prepared against a pandemic. InsideSurgery has an interview with noted bird flu vaccine researcher Dr. James Campbell.

A piece of science fiction that may turn reality by 2009 is told by Steven F. Palter at docinthemachine: A battlefield robot surgeon. I'd rather prefer not to send soldiers to war.


Some things never change? (Hope dies last!)

blood diamond
Si verräbled det une! If we Swiss get emotional, we cannot help saying it in Schwyzerdütsch. Sorry, I have to repeat: They are croaking down there! Be well prepared because it is hard stuff that Bongi of Other Things Amanzi tells us: The shocking story of bureaucrats that hassle a doctor until his patient is dead. A must read for all of us others who have the privilege to live in a better world.

Did you think that bad hand washing of doctors is a problem of the past? You are wrong. Tiny Shrink knows better. At Why am I still here, she tells us why doctors still do not wash their hands.

When it comes to science in general and to genetics in particular, I can be a hard fighter against religion. But on the other hand I have a deep respect for people like Susan Palwick who meet the spiritual needs of people suffering from serious disease or approaching death in a hospital. In her blog, Improbable Optimisms, she deals with the role of spirituality in the age of evidence-based medicine.

Type 1 diabetic Kerri Morrone, about to mark 21 years with the disease and blogging at Six Until Me, realizes that while she doesn't count on a cure, she still remembers how to hope. A great post that brings us back to where this edition has begun: If we cannot change things, we always can change ourselves.

better

This concludes volume 3, number 47. I am indebted to all who have submitted these wonderful posts and to Nick Genes for maintaining Grand Rounds. Also he has interviewed me for his Pre-Rounds column at Medscape. If you have missed Hsien's beach house edition, visit it at Eye on DNA. Next edition will be hosted by Med-Source.

It has been my great pleasure to be your host. I hope you enjoyed my presentation. And may things change to your best or stay if they already are.

Heartbeat curve by Crescendo

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