The Plague- Random Thoughts

Physician during the Great Plague

This morning I was perusing Daniel Defoe's Journal of Plague Year.  This book was published in 1722, well after the 1665 bubonic plague that ravaged London. Defoe's inspiration and source for much of the book was from English physician Dr. Nathaniel Hodge's (1629–1688) book on the  Great Plague- Loimologia, or, an historical Account of the Plague in London in 1665, With precautionary Directions against the like Contagion, published in 1672.

Of note is the now very antiquated medical term Loimologia (loimology), the study of pestilential diseases and plagues.

In a few hours I am off the the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America Conference in San Diego, where, without doubt, loimology will not be on the agenda.

Stay tuned for updates.

The Future of Medical Publications

Source: wisdom.blogs.com

For those of you interested in medical publications and scientific journals, here is a recent perspective on interactive journals and the future of medical publishing, printed in the American Journal of Medicine.

In academics, a coveted accomplishment is the peer reviewed paper. In this process, manuscripts are received by journals, reviewed by editors, and then distributed for peer review. If deemed suitable, the manuscript is then published. This time honored practice allows for quality and scientific rigor. Critics point out that reviewers and editors may have their preferences and biases that affect manuscript publication.

Over the years, individual medical blogs (like this one) have flourished.  Many medical journals have not fully embraced novel technologies afforded by the internet. Of the 588 journals reviewed in the above perspective, 9% had a journal based blogs, 8% allowed for direct web based commenting on an article, and 90% utilized social media/email sharing.

In the information age, the paucity of journal based blogs and direct commenting on medical articles by readers is lamentable. Allowing readers to more fully participate, interact and comment on scientific publications will result in wider dissemination of ideas, enhance perspectives and promote further inquiry. 

The tools for this are available, the time is now.

Chocolate Consumption, Cognitive Function and Nobel Laureates

It has been a long and hard week. Yesterday, I took the Infectious Diseases Board Examination for re-certification. This is a requirement every 10 years. Effective immediately, I am back to more pleasant distractions, like blogging.

Here is an article worth a perusal, recently published in the New England Journal of Medicine. In brief, the study concludes that chocolate consumption enhances cognitive function and closely correlates with the number of Nobel laureates in each country. This study describes a correlation and by no means assesses individual chocolate consumption, by Nobel Laureates or otherwise, in a dose response fashion. The data are intriguing yet by no means definitive. 

Regardless, I could have used some chocolate yesterday during the Board Examination.

Inviting Patients to Read Their Doctors' Notes

Electronic medical records have many purported benefits. Now, access by patients to their medical record may be added to the list.  He is an article published in the Annals of Internal Medicine (free, full text) of a year long trial that provided patients with electronic links to their doctors' notes.

11,797 of 13,564 patients with visit notes available opened at least 1 note. 5391 patients completed a post-intervention survey. The majority of the survey respondents (87%) reported that open notes helped them feel more in control of their care; 60% to 78% of those taking medications reported increased medication adherence; 26% to 36% had privacy concerns and 1% to 8% reported that the notes caused confusion, worry, or offense. 

On the provider end, few doctors reported longer visits (0% to 5%) or more time addressing patients' questions outside of visits (0% to 8%).

At the study's end, 99% of patients wanted open notes to continue and no doctor elected to stop.The majority of the patients reported an increased sense of control, a greater understanding of their medical issues, improved understanding of their plan of care, and greater likelihood to take their medications as prescribed. 

This is all very positive initial data but it falls short of answering the coveted final question; will it actually result in sustained improvements in patient outcome? In other words, by opening the medical record to patients, will they be sufficiently motivated to take medications as prescribed, undergo diagnostic and screening testing, lose weight, quit smoking etc?

My hope is that as we open up the medical record to patients, that we attempt to measure improvements in care and outcome.

Revisited: Eating Organic, is it Safer and More Nutritious?

Several weeks ago I blogged about a paper about organic food published in the Annals of Internal Medicine. In brief, the study's authors concluded that the published, peer reviewed literature lacks strong evidence that organic foods are significantly more nutritious than conventional foods.

This study has received much attention and criticism, as best summarized by Mark Bittman's (NY Times Food Columnist) recent opinion article. Many feel that the study is misguided and that its conclusions are misleading.  This counterpoint is worth a read and has valuable hyperlinks.

My morning bowl of granola is calling me.......

(Chronic) Lyme Disease Made Political.

Source: Slate.com

(Chronic) Lyme Disease made political, and in Virginia too.

Check out this related posting by Dr. Dan Diekema (of the University of Iowa). An insightful article on the matter was recently published in Slate.

Conspiracy over medical science and for political gain too. Disturbing.

 

Smoking Cessation Quitlines- Use Them!

Source: VDH.gov

Those who know me are well aware of my anti-smoking stance. I am always a bit perplexed when my patients are seemingly über-concerned about their cholesterol, the HIV management parameters, such as the CD4 and viral load counts, getting their influenza vaccine on time, etc, yet, continue to smoke with reckless abandon. Apart from the HIV medications, quitting smoking is the single most important healthy choice that they can make.

Lately, I have been handing out the Quit Now Virginia smokers quitline pamphlet to all of my patients who smoke. 

What evidence exists to suggests that quitlines are effective smoking cessation interventions?

Here is a scholarly (and open access) publication on smoking cessation quitlines. Bottom line,  smoking cessation quitlines are of varied structure yet most employ counseling with follow up calls to assist, encourage and promote smoking cessation. The efficacy of quitlines for smoking cessation is supported by various studies.

From my perspective, quitlines represent a convenient, evidence-based referral resource for physicians advocating smoking cessation but who cannot themselves provide the intensive intervention and follow up needed.

I am a big proponent of smoking cessation quitlines.