October 2010 MDNG: Hospitalist Check Up

MDNG Hospital Medicine, August 2010, Volume 4, Issue 4

Hospital BeatLearning How to Die

Atul Gawande, MD, MPH, centers this tragic and uplifting New Yorker piece around the story of Sara Thomas Monopoli, who finds out in her 39th week of pregnancy that she has non-small cell lung cancer that has “metastasized to multiple lymph nodes in her chest and its lining.” She and her family struggle to balance the competing desires for survival and quality of life, a dynamic that spirals out of control as Thomas Monopoli’s condition worsens and all involved find themselves unprepared to make end-of-life decisions on the fly. Gawande, who is the Associate Director of Brigham and Women’s Hospital’s Center for Surgery and Public Health, was one of the unprepared, having seen Thomas Monopoli for an unrelated thyroid cancer. “Given the extent of the surgery that would have been required, and the potential complications, the best course was to do nothing. But explaining my reasoning to Sara meant confronting the mortality of her lung cancer, something that I felt ill-prepared to do.” The moral of the story? Have these discussions before you get sick, and if you get sick and haven’t, start talking early. No one wants family members to have to decide by committee in an ICU whether you’d be better off dying.


It Don’t Matter if You’re Black or White

What’s in the water over there in crazy old England? Am I right? Am I right? *elbow nudge* Quite a few stories have cropped up in recent years about both black and white children being born to the same mixed race parents (http://hcp.lv/92Mz34), including two sets of twins born of the same mother (http://hcp.lv/9BxQ7I), and the strange case of a blond-haired, white-skinned child born to two Nigerian parents with no mixed-race ancestry. Experts chalk it up to the mysterious ways of genetics, but remain baffled by the blond hair. “The hair is extremely unusual. Even many blond children don’t have blond hair like this at birth,” said Professor Bryan Sykes, head of Human Genetics at Oxford University.


Monkey MadnessMacaque Brain MAPPED!

A team of IBM scientists used 410 anatomical tracing studies of the macaque brain to create what is possibly the most complete and complex map of the primate organ.

The researchers report that their map has “383 hierarchically organized regions spanning cortex, thalamus, and basal ganglia; models the presence of 6,602 directed long-distance connections; is three times larger than any previously derived brain network; and contains sub-networks corresponding to classic corticocortical, corticosubcortical, and subcortico-subcortical fiber systems.”


Monkeys Hate Flying Squirrels, Report Monkey-annoyance Experts

Yes, this is the actual title of the article, which begs so, so, so many questions.


In the Public InterestThe Radiation Boom

In a confluence of ineptitude, CT brain perfusion scanners nationwide are delivering far more radiation (as much as 13 times the typical amount) than is indicated or necessary because of a desire for clearer images, a “counterintuitive” scanner feature intended to lower radiation that actually increases levels, and a lack of standards on both state and federal levels. Case in point: Alabama (where more than 10% of cases occurred) “does not define an acceptable dosing level. ‘No such thing as an overdose,’ said James L. McNees, director of the Alabama Office of Radiation Control.” Meanwhile, patients are left with thick bands of missing hair on their heads, other associated conditions, and no apologies.


A Good Night’s Sleep? Seven Hours

“Independent of age, smoking, alcohol intake, physical activity, diabetes mellitus, hypertension, and depression,” getting more or less than seven hours of sleep was associated with cardiovascular disease in a West Virginia University School of Medicine study published in Sleep. The association “persisted in subgroup analyses by gender, race-ethnicity, and body mass index categories. Also, similar associations were observed when we examined myocardial infarction and stroke separately.”


Gadget Watch

For Bread Arrhythmias

A good joke gift for colleagues, or for yourself if you’re into that sort of thing.


Dictation Tool Doesn’t Eliminate Typing, but Comes Close

Nuance recently released version 11 of its highly successful Dragon Naturally-Speaking dictation software that boasts 99.6% accuracy, which, according to a New York Times review, means users no longer have to read training text in order to acclimate to the product, and vice versa (http://hcp.lv/bixI9l).

Beyond simple dictation, the program allows users to control computer functions to the extent that you can tell it to Google something or search through your e-mail. NaturallySpeaking is a bit pricey (up to $799.99 for the Legal version), but with performance “three times faster than typing” and an automatic algorithm that learns from transcription errors to improve accuracy even further, you’ll more than make up for the outlay in increased productivity.


Social Media NotebookMayo Clinic Unveils Healthcare-first Social Media Center

On July 27, the Mayo Clinic announced the debut of a healthcare-first Social Media Center, a tool the organization hopes will “accelerate effective application of social media tools throughout Mayo Clinic and spur broader and deeper engagement in social media by hospitals, medical professionals and patients to improve health globally.” For now, the site basically houses a (very informative) blog discussing topics such as keeping staff in the loop, dealing with the legal issues surrounding social media, and the importance of asking for forgiveness rather than permission. Mayo Clinic will reveal more about the Social Media Center when it hosts its second Social Media Summit, September 27-29 in Jacksonville, FL.


Microsoft One-ups Google in Map Tech Race

In our opinion, Bing Maps does not offer a better alternative to Google Maps, but if Microsoft has anything to say about it, they’re about to make the race much more competitive by incorporating Street Slide into Bing’s tool belt. Whereas current street-level map viewing tools “do not provide a good visual sense of a larger aggregate such as a whole city block,” Street Slide allows users to zoom out and view a “multi-perspective panorama” and slide sideways to view “a series of intersecting streets.” It doesn’t sound all that exciting as a technical explanation, but watch the video—you’ll be impressed.


BuffooneryFree Tax Prep? But that Doesn’t Benefit Us!

If your state operates an easy-file tax program, watch out, because Intuit could be gunning to gut it. Despite “user satisfaction above 98%” for California’s free ReadyReturn and CalFile programs, and annual savings to taxpayers and the state of $4-10 million and $500,000, respectively, the makers of TurboTax have spent $3.37 million since 2005 lobbying politicians to end the free program and replace it with their own, which costs more and provides less.

Though their lobbying has been unsuccessful thus far, legislators aligned with Intuit “held back votes on 20 bills [in 2009]…kill[ing] funding for domestic violence shelters, police and fire departments, and prevention of swine flu outbreaks.”


111-year-old Man Actually 81…and Dead

We at MDNG don’t like to make fun of death (other than when it tries to take us from our beds at night while we’re hiding in the closet), but when egg-faced government officials are involved, we can’t help but snicker. Tokyo authorities, looking to congratulate the city’s oldest man, Sogen Kato, on his 111th birthday, went to his house and found a pajama-ed mummy that had been lying in bed for 30 years.

Whoops! The family, of course, had been collecting his pension all the while. Naturally, this revelation initiated a meeting with Tokyo’s oldest woman, 113-year-old Fusa Furuya, who, it turns out, hasn’t been seen since 1986 (http://hcp.lv/dzuMnH). Might want to tighten up the record keeping system.