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Health News Updated Daily by Internist and Allergist at Cleveland Clinic Florida



Last Build Date: Thu, 20 Jul 2017 08:52:53 PDT

 



Who are the doctors who don't get stressed at work? Check if you have the personality type

Wed, 21 Jun 2017 05:00:37 PDT

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Who are the doctors who don't get stressed at work? According to this meta-analysis, the personality type to have is: extravert who is open to experience and has a deep learning style. If you are this type, congratulations! If not, read below, and be sure to check the references at the end.

The Big Five personality inventory measures personality based on 5 key traits:

1. neuroticism
2. extraversion
3. agreeableness
4. openness to experience
5. conscientiousness

There are several approaches to work (SSD):

- Surface-disorganised approach is apparently the worst, and is predicted by surface learning in medical school and by higher neuroticism scores and lower conscientiousness

- Surface-rational approach to work is predicted by strategic learning in medical school, and by less openness to experience and higher conscientiousness

- Deep approach to work is predicted by a deep approach to learning at medical school, by greater extraversion, by greater openness to experience, and by lower emotional exhaustion. This is supposed to be the best.

A deep approach to work occurs in extraverts who are open to experience and have a deep learning style. The surface-rational and surface-disorganised approaches to work are both greater in those with a surface learning style. However, a surface-disorganised approach occurs in individuals with higher neuroticism scores, in those with lower conscientiousness scores, and in those who have been stressed, whereas the surface-rational approach to work occurs in strategic learners and in those who are low in openness to experience.

A workplace climate dominated by a high workload is predicted by higher stress and emotional exhaustion measures five years earlier, and by lower openness to experience. A supportive-receptive workplace is predicted by lower stress and depersonalisation, and a higher sense of personal accomplishment when measured previously, and by a more agreeable personality.

"A critical element contributing to the stress that many conscientious doctors experience is internal". According to researchers, stress is not a characteristic of jobs but of doctors. Different doctors working in the same job being are no more similar in their stress and burnout than different doctors in different jobs.

References:

Stress, burnout and doctors' attitudes to work are determined by personality and learning style: A twelve year longitudinal study of UK medical graduates. BMC Medicine20042:29, DOI: 10.1186/1741-7015-2-29.

Physician Burnout Now A Top Concern Across the United States. Wael Barsoum.

Who blogs? Personality predictors of blogging(image)



Unprecedented range of therapeutic options for rheumatic diseases is now available — challenge is to make them accessible

Mon, 12 Jun 2017 06:14:14 PDT

From The Lancet:

Small molecule inhibitors of Janus kinase (JAK)

Much of the recent knowledge of the underlying mechanisms that drive rheumatoid arthritis and other diseases has come from preclinical studies of key cytokines, including tumour necrosis factor alpha, interleukin 6, and granulocyte–macrophage colony-stimulating factor. New Janus kinase (JAK) inhibitors include tofacitinib and baricitinib which are approved for treatment of arthritis and other rheumatoid diseases.

Aggressive treatment, early

For a complex, progressive, chronic disease such as rheumatoid arthritis, the timing of intervention is critical. In the past, the recommended treatment approach was slow and steady, referred to as “the pyramid”—ie, a base of physical therapy and non-pharmacological interventions, followed by conservative treatment with non-steroidal anti-inflammatory drugs, then glucocorticoid steroids and, finally, administration of a conventional disease-modifying antirheumatic drug (DMARD). This concept is now inverted. Intensive intervention, initiated earlier, with conventional and biological DMARDs is increasingly recommended.

Biologics and small molecule inhibitors are added to the therapeutic arsenal. Focus on early window of opportunity for management, with treat-to-target approaches that include rapid intervention, and adjustment of medications for patients who do not achieve remission within 6 months. The new campaign, “Don't delay, connect today”, highlights this approach.

Affordability

Biosimilars might provide affordable options.

An unprecedented range of therapeutic options for rheumatic diseases is now available—the new challenge is to make them accessible.

References:

A platinum age for rheumatology - The Lancet http://buff.ly/2slCFPw(image)



Get Ready for Your Next Meeting With the Boss–at the Gym

Fri, 02 Jun 2017 04:59:30 PDT

From WSJ: As an alternative to meetings, buff bosses are inviting their employees to exercise and work out (video):

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Some prospective employers ask baffled applicants to take jogs, lift weights or do sit-ups; ‘I thought I was going to pass out’, says one job applicant. Read more in WSJ here: Thanks for Your Job Application—Shall We Begin at the Squat Rack? http://buff.ly/2qNEG24(image)



How to live to 100: avoid "major agers", choose foods that love you back

Fri, 02 Jun 2017 04:54:06 PDT

The one and only Dr. Roizen shares tips for Living to 100, using some memorable buzz words, among them:

- avoid the "major agers" of stress and lack of sleep
- have a relationship with your food - choose foods that "love you back"

Here is the Cleveland Clinic Chief Wellness Officer, Mike Roizen, M.D.:

allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/HFODmALyYPQ?rel=0" width="560">

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Even short term use of oral steroids (less than 30 days) linked to increased risk of severe infection (sepsis), blood clots and fracture

Mon, 08 May 2017 06:45:00 PDT

One in five American adults in a commercially insured plan were given prescriptions for short term use of oral corticosteroids during a three year period, with an associated increased risk of adverse events. Of 1.5 million adults, 21% received at least 1 prescription for oral corticosteroids over 3 period.

The most common indications for use were:

- upper respiratory tract infections
- spinal conditions
- allergies.

Within 30 days of drug initiation, there was an increase in rates of:

- sepsis
- venous thromboembolism
- fracture

Risk over the subsequent 31–90 days.

The increased risk persisted at prednisone equivalent doses of less than 20 mg/day.

References:

Short Term Use of Oral Corticosteroids and Related Harms http://buff.ly/2pI5qDY(image)



Eurovision 2017 - what are your favorite songs?

Wed, 29 Mar 2017 04:00:05 PDT

Here are some of the more popular ones:

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The full list is here:

Eurovision 2017 - Official Music Videos(image)



How to be happier at your workplace: from employee, and from employer, perspective

Wed, 22 Mar 2017 05:30:17 PDT

Robert Steven Kaplan has addressed these 2 topics in 2 Google talks and 2 books, they are linked below. I developed 2 sheets based on the ideas from the talks, embedded below.

How to be happier at your workplace: from employee perspective:

Robert Steven Kaplan: "What You're Really Meant to Do" | Talks at Google:

width="560" height="315" src="https://www.youtube.com/embed/8sY-qwEYjs0?rel=0" frameborder="0" allowfullscreen>

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How to be happier at your workplace: from employer perspective:

Robert Steven Kaplan | What to Ask the Person in the Mirror: Critical Questions for Becoming a More Effective Leader and Reaching Your Potential:

width="560" height="315" src="https://www.youtube.com/embed/KqnB2Ew0SFM?rel=0" frameborder="0" allowfullscreen>

style="width:120px;height:240px;" marginwidth="0" marginheight="0" scrolling="no" frameborder="0" src="//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ac&ref=qf_sp_asin_til&ad_type=product_link&tracking_id=clicasandimab-20&marketplace=amazon®ion=US&placement=1422170012&asins=1422170012&linkId=5a2efbf7079e760dae34c356e5164232&show_border=true&link_opens_in_new_window=true&price_color=333333&title_color=0066c0&bg_color=ffffff">


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Kaplan was vice chairman of The Goldman Sachs Group, he worked there for 23 years, then he had a change of heart, and became a Professor of Management Practice at Harvard Business School. He wrote the 3 books above in his second role, but that was not the end of road for him. In 2015, Kaplan was appointed as president and CEO of the Federal Reserve Bank of Dallas.

References:

Robert Steven Kaplan - Wikipedia http://buff.ly/2nzCsWH
Federal Reserve Bank of Dallas http://buff.ly/2mOcCd8
Who Is Robert Steven Kaplan? The Next Dallas Fed President at a Glance http://buff.ly/2nzKWgs
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Indoor Tanning is Out - video message from the American Academy of Dermatology

Fri, 03 Mar 2017 04:00:32 PST

American Academy of Dermatology: Not only can the ultraviolet radiation from indoor tanning beds lead to wrinkles, it also increases the risk of skin cancer, including melanoma, the deadliest form of skin cancer. On an average day, more than 1 million Americans tan in tanning salons. Research shows that nearly 70 percent of indoor tanners are female, primarily 16 to 29 years old.

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"Bodies have a way of not keeping up with your brain or your career" - Glover from Deep Purple on approaching retirement

Thu, 02 Mar 2017 05:00:17 PST

Roger Glover from Deep Purple:

"We're all about late 60s, early 70s, and bodies have a way of not keeping up with your brain or your career. The time is approaching when it will end, but we don't want to face that. We don't actually want to make a date or a final tour or anything. We just want to carry on as long as nature allows or is kind of dignified. If we can't do what we do anymore, then yes, it's time to stop. But we're still doing it, and we're still enjoying it very much. So all we're saying is the door is closing, but it's not closed yet."

Glover and Paice's Rock Antenne interview:

allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/Lo0_4qFIijs?rel=0" width="560">

References:

Hamburg http://buff.ly/2luoS1E
Photo Shoot for Deep Purple's 'Infinite': Exclusive Behind-the-Scenes Footage http://buff.ly/2mbtyxv(image)



"Everything changes and nothing remains still, you cannot step twice into the same stream" vs. Occidentali's Karma

Tue, 21 Feb 2017 04:00:17 PST

Francesco Gabbani won Festival di Sanremo 2017 with his catchy song “Occidentali’s Karma” (“Westerners’ Karma”) and will represent Italy during Eurovison 2017 song contest. You don't often hear quotes from William Shakespeare and Erich Fromm in the the first two lines of a song:

allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/xmpc3fcrNJQ?rel=0" width="560">

Excerpts from the lyrics:

"Internet experts,
Honorary members of the selfie-addicted anonymous
Cleverness is out of fashion,
Easy answers,
Pointless dilemmas.

Whatever happens, panta rhei
And 'Singing in The Rain'."

The phrase panta rhei, "everything flows" either was spoken by Heraclitus or survived as a quotation of his. This famous aphorism used to characterize Heraclitus' thought comes from Simplicius, a neoplatonist, and from Plato's Cratylus. The word rhei is the Greek word for "to stream", and is etymologically related to Rhea according to Plato's Cratylus.

The philosophy of Heraclitus is summed up in his cryptic utterance:

"Ever-newer waters flow on those who step into the same rivers."

The quote from Heraclitus appears in Plato's Cratylus twice:

"All entities move and nothing remains still"

and

"Everything changes and nothing remains still ... and ... you cannot step twice into the same stream".

More from his YouTube channel: https://www.youtube.com/user/GabbaniVEVO/videos

Another clip of the song:

allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/-OnRxfhbHB4?rel=0" width="560">

References:

Italy sends rising star Francesco Gabbani - and an ape - to win Eurovision 2017 http://buff.ly/2loRH10
"Occidentali's Karma" lyrics - Francesco Gabbani (Italy, Eurovision 2017) http://buff.ly/2loSNd2(image)



The Corrs are back with a new album

Sat, 18 Feb 2017 05:00:00 PST

The Corrs are back with a new album, here is one of the singles: The Corrs - I Do What I Like - recorded at Church Studios:

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The first single from the album: The Corrs - Bring On The Night - recorded at Church Studios:

width="560" height="315" src="https://www.youtube.com/embed/2zt5E-ue-MA?rel=0" frameborder="0" allowfullscreen>

frameborder="0" marginheight="0" marginwidth="0" scrolling="no" src="//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ac&ref=qf_sp_asin_til&ad_type=product_link&tracking_id=clicasandimab-20&marketplace=amazon®ion=US&placement=B015H4UUTE&asins=B015H4UUTE&linkId=ca4ec7a57c01d8806f2f5cb269895fad&show_border=true&link_opens_in_new_window=true&price_color=333333&title_color=0066c0&bg_color=ffffff" style="height: 240px; width: 120px;">


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The freak accident that changed Charles Krauthammer's life

Fri, 17 Feb 2017 04:00:22 PST

From Wikipedia: Charles Krauthammer is an American syndicated columnist, author, political commentator, and non-practicing physician whose weekly column is syndicated to more than 400 publications worldwide. Krauthammer became permanently paralyzed after a diving accident while in his first year studying at Harvard Medical School. After spending 14 months recovering in a hospital, and although wheelchair-bound, he returned to medical school, graduating to become a psychiatrist involved in the creation of the Diagnostic and Statistical Manual of Mental Disorders III, and later developing a career as a Pulitzer prize-winning writer.

Fox TV interview:

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References:

Charles Krauthammer - Wikipedia http://buff.ly/2lpQ5Gr(image)



What happens when you have lunch with Chuck Norris

Wed, 15 Feb 2017 16:23:15 PST

"I heard medicine takes Chuck Norris to feel better", and more in this commercial by UnitedHealthcare (US insurance company):

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The whole playlist is here:

https://www.youtube.com/playlist?list=PL27D67B7541104930(image)



Plan-based Diet and Uprooting the Leading Causes of Death - by Michael Greger, M.D. (video)

Mon, 23 Jan 2017 05:00:17 PST

Plan-based Diet and Uprooting the Leading Causes of Death - by Michael Greger, M.D. (video), a lecture and Q&A session at Tompkins County Public Library, Ithaca, NY:

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Patient-centered communication: what are the basic skills?

Tue, 17 Jan 2017 05:26:06 PST

Communication skills needed for patient-centered care include:

- eliciting the patient's agenda with open-ended questions, especially early on
- not interrupting the patient
- engaging in focused active listening

Practice this at least in the first 60-seconds, the so-called "golden minute".

Understand patient's perspective

Understanding the patient's perspective of the illness and expressing empathy are key features of patient-centered communication.

Understanding the patient's perspective entails exploring the patient's:

- feelings
- ideas
- concerns
- experience regarding the impact of the illness
- expectations from the physician

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Patient-centered communication - basic skills (click here to enlarge the image).

Empathy

Empathy can be expressed by:

- naming the feeling
- communicating understanding, respect, and support
- exploring the patient's illness experience and emotions

Before and after a diagnosis

Before revealing a new diagnosis, the patient's prior knowledge and preferences for the depth of information desired should be assessed.

After disclosing a diagnosis, physicians should explore the patient's emotional response.

Treatment options

Shared decision making empowers patients by inviting them to consider:

- pros and cons of different treatment options
- no treatment

Instead of overwhelming the patient with medical information, small chunks of data should be provided using repeated cycles of the "ask-tell-ask" approach. Using "tell-tell-tell" does not engage patients.

Example:

1. Ask permission to start a conversation
3. Ask what the patient thinks about their health
4. Ask questions to find out what the patient already knows
5. Tell the patient information in a way that is easy to understand
6. Gauge the patient’s understanding by asking questions after you tell

What Is “Ask, Tell, Ask”? video:

allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/cTwektQpxUg?rel=0" width="560">

References:

Patient-Centered Communication: Basic Skills. Hashim MJ. Am Fam Physician. 2017 Jan 1;95(1):29-34.
https://www.ncbi.nlm.nih.gov/pubmed/28075109
The 10 Building Blocks of Primary Care - “Ask Tell Ask” Sample Curriculum - UCSF
Ask-Tell-Ask: Simple Technique Can Help Hospitalists Communicate Difficult Messages http://buff.ly/2jeNVIN(image)


Media Files:
http://feedproxy.google.com/~r/CasesBlog/~5/xVWYiRAFLgw/Curriculum_sample_14-0602.pdf




Percentage of U.S. residents with up-to-date screening for colorectal cancer remains at 60% - what options, other than colonoscopy, do we have?

Mon, 16 Jan 2017 05:24:02 PST

From the NEJM:

The percentage of U.S. residents with up-to-date screening for colorectal cancer has not increased appreciably since 2010 and remains at approximately 60%. To achieve the highest level of adherence to colorectal cancer screening, it may be best to provide participants a choice, because the “best” strategy is the one that they will adhere to consistently.

The NEJM reviews all the options in this table:

http://blogs.nejm.org/now/wp-content/uploads/sites/6/2017/01/nejmcp1512286_t2.jpeg

Full article is here:

Screening for Colorectal Neoplasia - Now@NEJM http://buff.ly/2ikfKA0(image)



Physician ratings at Cleveland Clinic (video)

Tue, 10 Jan 2017 05:00:09 PST

The CEO and the Chief Experience Officer explain the rationale behind the physician ratings at Cleveland Clinic:

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Disclaimer: I am an allergist at Cleveland Clinic Florida.(image)



Problem solver

Sun, 08 Jan 2017 20:22:53 PST

From Italian: Pedro and Domenico jump, but Oreste thinks about it a bit... and finds another solution.
#donkey #problemsolving

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Related:

This little video even made it to Daily Mail: Donkey shows off his brains by using his TEETH to remove a fence http://buff.ly/2iYmpzn(image)



Gadgets Galore - Best of CES 2017

Fri, 06 Jan 2017 05:39:55 PST

From WSJ: As the tech world reveals the products that will impact the year ahead, Personal Tech columnists Geoffrey A. Fowler and Joanna Stern hunt for the most exciting and unusual, from AR glasses to breast pumps (video is below):

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http://on.wsj.com/2j9crYt(image)



Minutes Count in the Cleveland Clinic Florida Emergency Room: Patient Story

Fri, 16 Dec 2016 05:00:07 PST

"A Florida woman is rushed to the emergency room with life-threatening injuries and only minutes to live. Experience her story as the Cleveland Clinic Florida Emergency Department team springs into action to save her":

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Disclaimer: I work at Cleveland Clinic Florida, but I am not paid for this post.

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“99 percent of all claims of being 115 or older are false.”

Fri, 18 Nov 2016 04:00:01 PST

(image) An engaging story from the NYTimes about runners older than 90, and more.

Among the quotes:

“99 percent of all claims of being 115 or older are false.”

“Old age always wins. It’s shocking. No matter how hard you try, it beats you.”

Apart from that, nothing would stop him, not even a colostomy bag:

"The oldest competitor would be an Australian legend, John Gilmour, 97, a World War II veteran who was captured by the Japanese and put into forced labor. Malnutrition and the harsh conditions permanently shrouded his vision. Still, he resumed his running career after the war. He knew what a body could withstand. The pain of sport was nothing compared with the pain of capture.

In his mid-60s, he could still run a marathon under three hours."

Read the full story here:

http://www.nytimes.com/2016/11/20/sports/119-year-old-runner-world-masters-championships.html

Image source: OpenClipart.org, public domain.(image)



7 classical virtues of trust, justice, hope, temperance, wisdom, courage and compassion - and how this applies to medicine

Fri, 04 Nov 2016 06:45:13 PDT

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We often receive an email from the Chief of Staff on Wednesdays. The email is meant to unite the physicians at Cleveland Clinic around a common idea/topic/thought for that week.

One of the emails mentioned "A virtuous culture built on the seven classical virtues of trust, justice, hope, temperance, wisdom, courage and compassion. These virtues offer us 25 centuries of wisdom about human conduct at its best."

As a simple exercise, try thinking about one of those each day of the week, make it the "theme of the day":

Monday - Trust
Tuesday - Justice
Wednesday - Hope
Thursday - Temperance
Friday - Wisdom
Saturday - Courage
Sunday - Compassion

These concepts are not new, of course. There have been multiple different variations proposed throughout the centuries. Some examples are references below. If you feel adventurous, don't limit yourself to 7 virtues but consider the 24 Prussian virtues below:

https://en.wikipedia.org/wiki/Prussian_virtues

https://en.wikipedia.org/wiki/Cardinal_virtues

https://en.wikipedia.org/wiki/Seven_virtues(image)



"Bottle-flipping" is the latest fad, see why schools are banning it - WSJ video

Mon, 31 Oct 2016 10:59:19 PDT

From WSJ: Bottle-flipping has become a worldwide phenomenon. But some schools are trying to ban the flippers:

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Easier schedule for HPV vaccine: 2 doses instead of previously recommended 3

Fri, 28 Oct 2016 05:04:34 PDT

From Mayo Clinic: To protect against cervical cancer and other cancers caused by HPV infection, the Centers for Disease Control (CDC) is now recommending that 11- and 12-year-olds receive two doses of HPV vaccine at least six months apart. This is a change from the previously recommended three-dose series.

The CDC says adolescents ages 13–14 also can receive the HPV vaccine on the new two-dose schedule. However, those who start the series later will continue to need three doses.

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Self-administered HPV Test is one of the Top 10 Medical Innovations 2017, selected by the Cleveland Clinic:

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How to administer "Emotional First Aid"

Wed, 12 Oct 2016 03:30:10 PDT

Do you know that feeling lonely impacts your ability to build up an immunity after getting the flu vaccine?

From the Google Talks lecture series: "Although we have bandages for cuts, chicken soup for colds, and ice packs for bruises, most of us have no idea how to treat day-to-day emotional injuries such as failure, rejection, and loss. But, as Guy Winch, Ph.D., points out, these kinds of emotional injuries often get worse when left untreated and can significantly impact our quality of life. In this fascinating and highly practical book he provides the emotional first aid treatments we have been lacking."

allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/vBqoA1V6Fgg?rel=0" width="560">(image)