Grand Rounds LIVE!

Welcome to first Grand Rounds LIVE edition. You can view our show, or scroll down for the more traditional written version!

Improv on the run to reduce exertion? If you do, is the oxygen cost really lower? Jolie explores the Jody – Jody calls, that is, otherwise known as military cadences. In her post, our blogging fitness expert, Dr. Jolie Bookspan, at The Fitness Fixer gives us a great cadence audio-example and asks the questions – Do Military Chants Help Running? – The Jody Calls.

Highlight HEALTH explorers whether or not we might achieve Lifetime Immunity From the Flu. In his post, Walter Jessen discusses that scientists report the isolation of a group of high-affinity antibodies that are potent inhibitors of a wide range of influenza viruses, including the H5N1 avian flu, the 1918 Spanish flu and some seasonal strains, which may someday be used to create a vaccine that provides lifetime immunity from the flu.

At the The WELLalarm Blog, Stephanie Cion makes a thoughtful, passionate argument (both written and in Vlog format) that people living with chronic illness should maybe consider entrepreneurship as a career option in her post: Entrepreneurship – It Can Dramatically Reduce The Cost of Chronic Illness to Tax Payers.

Amy at Diabetes Mine discusses AAD (Ambiguity About Diabetes) Syndrome. Great article, great comments too. When you’ve got AAD, sometimes every answer to every question has to be improvised. Sigh. And while you’re there, check out the 2009 Diabetes Mine Design Competition – on-going now.

Can humor help your pain? That’s an improv topic covered over at How to Cope with Pain. Pain is an invisible illness. Not funny. Yet invisible can be funny – in fact, here are 10 ways. And we all – especially those with pain – can use a laugh.

Feeling out of your depth when it comes to holding your own discussing genetics? No need to stumble or improvise. At the blog – Medicine and Man, we’ve got a post – Genetics – A guide to understanding the literature. This presentation explains some of the basic concepts of genetics and provides a framework to analyze and understand medical literature pertaining to genetic studies – all in a PowerPoint slideshow!

At the blog, Six Until Me, our author tackles the topic of Diabetes Snake Oil. As a type 1 diabetic for over 22 years, blogger Kerri Sparling is tired of being peddled miracle cures for diabetes. It’s a 60-minutes-style undercover investigation!

Is there anything more improvisational that parenting? Especially when you’re parenting teens? Over at Teen Health 411, there’s a post about parenting teens and improv with such great, practical tips that Doc Gurley has printed them out to hang on her frig. Even if you don’t have teens, these are wonderful tips for staying focused in the moment. Check it out!

Knowledge is Power. Except when it’s not…If you’re a doc, do you really talk with your patients? And if you’re a patient, do you think your doc really communicates with you? InsureBlog’s Henry Stern reports that patients who take the time to actively discuss treatment options often end up with better care.

Let them eat drugs: An update. Grocery stores have been winging it when it comes to in-store pharmacies handing out free antibiotics (now that’s a kind of improvisation that’s not so great…). The CDC stepped in to restore order. Learn more at ACP Internists’ blog.

As everyone jumps in the ring of the healthcare reform wrestling match, patients are often the ones left on the outside, watching. Duncan Cross offers up some fabulous suggestions on what patients can do to be involved in healthcare reform. Are you listening, New York Times?

Can you improvise – or be creative – during a failing resuscitation? Here’s a post from Notes of an Anesthesioboist, titled Acupuncture Chronicles II: Waking the Dead. You have to read it to believe it – and as a special DVD-type bonus feature, the post includes a great, reasoned discussion on the possible integration of Western and Eastern approaches.

The authors at Canadian Medicine have a post titled, “Pro-medicare doc nominated to be CMA president.” They weigh in on this development and discuss its implications: “Considering our current CMA president and the previous one were both private clinic owners and advocates of allowing more privatization in the Canadian healthcare system, nominating Dr Jeffrey Turnbull is a major departure and potentially a huge development in efforts to protect the integrity of the public system here.”

The amazing Barbara at In Sickness and In Health takes on the ultimate improvisational topic: If improv is creating something purposeful out of separate elements, then this clever dating website creates the possibility for singles with a mental illness to find each other.

Does Twitter = Improv? Clinical Cases and Images Blog has a practical post every science conference attender should read – Tips for live tweeting from a science conference!

Then, to shift from the general to the highly specific, Allergy Notes has a post titled “Mepolizumab Useful in Refractory Eosinophilic Asthma, a Rare Subtype of Asthma,” about a new treatment for people with seriously hard-to-control asthma.

Loiuse, over at Colorado Health Insurance Insider, has an article about a pilot project (hey – that’s an improv, right?) from IBM and United Health – implementing the medical home model for primary care. The authors state “The medical home pilot program approach is designed to eliminate the under-treatment that sometimes occurs when doctors are just given a set fee to treat a patient, regardless of how much care is actually provided and the over-treatment that can occur in a fee-for-service model, where doctors are reimbursed for every visit and test, regardless of how successful the treatment is.”

Pretty much everyone would agree that excessive documentation is the opposite of improv. Here’s a medico-legal conundrum (see, we can use polysyllabic words here) with New York’s No Fault Personal Injury law – Eric Turkowitz asks in his article, New York’s No-Fault Mess (Do Our Judges Want Doctors To Go To Law School?). He points out that judges give increasingly more specific rules for doctors on how they are supposed to write reports when it comes to litigation, even if you’re the first doctor seeing the patient. He concludes that, essentially, this puts patients in the position of choosing the doctor they like the best or the one that knows how to write medico-legal reports that judges will like. Read it and see how your patients might fare in court after a car accident.

Sometimes the bottom line is, indeed, the bottom line. Neuroanthropology weighs in on the recent studies showing that calories (and really, only calories) are what – ahem – count, when it comes to weight-loss, and then argues for a paradigm shift in the post Calories Not Diets.

In a bit of improvising genius, Dr. Rob takes a swing at the insanity of our healthcare system – and knocks one out of the park! It’s titled What if real life were like healthcare? My favorite – you go to school and discover that your teacher teaches for about 15 minutes and documents her teaching for 45 minutes. You want to ask questions, but the bell rings and you have to move on to your next class before any can be answered.

In the Covert Rationing Blog, DrRich confesses that when it comes to taking care of patients, maybe we’re all merely improvising. “As a recent study in JAMA reveals, a large proportion the many volumes of clinical guidelines habitually advanced by the American College of Cardiology and the American Heart Association are based not on the terra firma of validated clinical evidence, but rather, on the thin soup of ‘”expert opinion.'” DrRich being a cardiologist, and therefore somewhat embarrassed by this revelation, attempts to do some ‘splaining. While generally light-hearted and insightful, here’s a Doc Gurley unbiased editorial opinion about this piece: If you know ANYONE who’s got severe heart disease, make sure they read this post. Yes, it’s that important.

It’s hard to be excited about improvising when your throat is killing you. For tips from a pro on what to do with this miserable symptom, check out Dr. Paul Auerbach’s informative post on the Sore Throat.

In another practical post, Dr. Shock discusses the long-term outcomes with deep brain stimulation in treatment resistant depression, stating, “New data are being published about deep brain stimulation and treatment resistant depression. Especially longer follow up is of importance. In recent published research about deep brain stimulation for treatment resistant depression, six months after surgery, 60% of patients were responders and 35% met criteria for remission, benefits that were largely maintained at 12 months.”

For an insider look at the evolving credentialing world for healthcare (the anti-improv experience!), check out Supporting Safer Healthcare’s Interview with Vicki Searcy. And for more practical tips, check out their What Not To Say At Work tips.

In a comic improvisational aside, the author at Kennedy’s Tumor: The Final Parable for Healthcare writes about the mini-controversy surrounding Obama’s gift of DVDs to Britain’s Prime Minister, Gordon Brown. Why would anyone give such lame-oh gifts to a PM? The post’s list of (suggested? improvised?) DVD titles explains all – my favorite was “Who’ll Stop The Rain.”

Dr. Zhang at The Cockroach Catcher: Reflections of A Child Psychiatrist, is wondering how far ICD-9 codes can go in improvising new codes. In a post titled “Tasmania: Whales & Dolphins – Mother & Baby,” she asks, would being taken to save whales and dolphins at 4 months of age appear on the new DSM or ICD code? Just the photos alone make this post worth a visit.

At Nuts for Healthcare, the author brings a cautionary note to Obama’s push for generic biologics in a post titled “Replicating Biology Not So Generic,” stating, “As Obama said, we need generic biologics to come onto the market as an impetus for drug innovation, but it won’t be easy (manufacturing complexity) nor will it be as cheap as people expect.

Will you have to improvise if you travel? Certainly, which is why ChronicBabe on the road again… with travel tips for sick chicks. Jenni Prokopy offers practical advice for traveling successfully with disability or chronic illness. My favorite? Getting a one-week trial membership at a local destination gym – brilliant!

Would you want your gynecologist to improvise? Over at The Blog That Ate Manhattan, there’s a great article about the invention of the speculum. Did someone really just use a pair of spoons? Or not? And is this a topic mired in social controversy? Check it out and see for yourself.

In a wonderful bit of real-time interaction, Rich Elmore over at Healthcare Technology News sent this article in response to the Doc Gurley sample poll – giving us all both a giggle-worthy cartoon and a glimpse at the horror show that is ICD-10 (undoubtedly R-rated due to inappropriate complexity).

Finally, are thousands of physicians being scammed – right now? Dmitriy over at Trusted.MD warns that Medical Justice may be a scam, taking advantage of concerned physicians and offering no real protection in return for substantial fees.

Don’t forget to stop by last week’s Grand Rounds’ host’s site – David Williams at Health Business Blog – and give him a shout out for his fourth anniversary edition (my God, 4 years is like 86 years in internet time!). Then, be sure and stay tuned for the next Grand Rounds at the online site of the American College of Physicians – ACP.

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