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

Last Build Date: Fri, 23 Mar 2018 07:41:13 PDT


Creative tension and different personalities

Sat, 10 Mar 2018 07:55:09 PST

The WSJ on the creative tension between Keith Richards and Mick Jagger :

“They’re two really different guys, and that’s what makes it so powerful. It’s like a rubber band pulled really tight. When you release it, it goes flying—that creative tension is what makes it so enduring. They understand that something special happens when the two of them get together. The cognizance of that magic that only comes from the two of them can be frustrating, but also really powerful.”

I wish Ritchie Blackmore and Ian Gillan of Deep Purple had recognized this years ago. We would have gotten a few other brilliant albums in the 1970s and 1980s.

"No band has lasted as long as the Rolling Stones."


The Wisdom of Keith Richards

New blood pressure guideline creates a new level of disease affecting people previously deemed healthy

Mon, 12 Feb 2018 12:02:03 PST

(image) From NEJM:

The guideline defines normal blood pressure as below 120/80 mm Hg and elevated blood pressure as 120 to 129. What is now called stage 1 hypertension was previously labeled “prehypertension” — a term meant to alert patients and to prompt physicians to provide lifestyle education

By reclassifying people formerly considered to have prehypertension as having hypertension, the guideline creates a new level of disease affecting people previously deemed healthy. According to this definition, about 46% of U.S. adults have hypertension, as compared with about 32% under the previous definition.

The guideline recommends daily sodium intake of less than 1500 mg — a goal that’s difficult for many people to achieve and that was derived from short-term studies.

The primary change in recommendations regarding pharmacologic therapy is the elimination of beta-blockers from first-line therapy for patients with primary hypertension.

Read more here:

Redefining Hypertension — Assessing the New Blood-Pressure Guidelines | NEJM

Main complications of persistent high blood pressure. Image source: Wikipedia, public domain.

Image sources: Top left, Record breaking snowfall March 2008 at Aubrey, Texas, Wikipedia, public domain; Top Right, Mercury manometer, Wikipedia, GNU Free Documentation License.(image)

Your choice of social media service/website/app may reveal your personality

Tue, 06 Feb 2018 08:31:04 PST

This study from Germany included 633 students.

Use of computer games was found to be negatively related to all personality and mental health variables: self-esteem, extraversion, narcissism, life satisfaction, social support and resilience.

The use of platforms that focus more on written interaction (Twitter, Tumblr) was linked to depression, anxiety, and stress symptoms.

In contrast, Instagram use, which focuses more on photo-sharing, was linked to positive mental health variables.


What does media use reveal about personality and mental health? An exploratory investigation among German students

The key to successful ageing is to be a master of 3 domains: physical health, mental wellbeing, and social connectedness

Mon, 05 Feb 2018 03:30:24 PST

From The Lancet:

Life expectancy in the UK continues to increase by 2 years per decade. Unfortunately, these extra years do not seem to be spent in better health, with morbidity and dependency increasing over the past 20 years. So what can be done to develop resilience with increasing age? Seize control of your health and be better prepared—physically, mentally, and socially—for our later years. This a recurring theme covering 3 domains: physical, mental and social.

The Lancet reviewed the book Enlightened Aging: Building Resilience for a Long, Active Life, by Eric B Larson and Joan DeClaire. One of the most memorable vignette from the book was of Evangeline Shuler, a centenarian, with a “glass half full” approach to life: as she grew older and her friends died, her attitude was to go out and “make new ones”; an avid reader, as she became blind, she switched to audio books.

Translating scientific facts into practical strategies early in the life course can help us live better for longer. Here is what the science shows:

- Maintain a healthy heart, a healthy brain and healthy social existence to achieve successful ageing.

- Proactively build resilience — the ability to adapt to changing circumstances and bounce back from injury, loss, or setbacks — in 3 areas: physical health, mental wellbeing, and social connectedness, to better enjoy our later years. Developing and strengthen emotional resilience.

- Financial independence. In many UK cities, there is a 10-year discrepancy in healthy life expectancy between more socially deprived and affluent areas.


Eric B Larson and Joan DeClaire's Enlightened Aging: Building Resilience for a Long, Active Life.
Successful ageing - Lancet

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Snap judgments about other people are formed in milliseconds but are often wrong: here is what to do about it

Fri, 02 Feb 2018 04:30:36 PST

From WSJ:

Snap judgments people make about others’ trustworthiness are wrong more often than most people think. These first impressions are formed in milliseconds, based on instinctive responses in the brain’s emotion-processing center, the amygdala.

Some people conclude a stranger is reliable because he or she looks like someone trustworthy the person already knows. Or they make judgments based on stereotypes, such as an unconscious belief that older or more feminine-looking people are more trustworthy.

This poses a challenge to anyone who must gain others’ trust to perform well in meetings, interviews or other gatherings.

There are ways to head off other people’s shaky snap judgments, try this:

- a happy expression, with the corners of the mouth turned upward and eyebrows relaxed, is likely to inspire trust. Facial expressions are important even when you think no one is looking. People tend to distrust others whose “dominant face,” or habitual expression, is grumpy, disapproving or angry.

- prepare mentally to impress new acquaintances by pausing for a few moments beforehand to think about what you want to accomplish with the other person.

- use breathing techniques to foster relaxed, confident movement, and striving for “symmetry in your stance, with your shoulders straight and even. That first entrance in the room is the same as that first entrance of your character on stage.

- adjust your stance and posture, leaning or turning toward the other person to show you’re focused intently on what he or she is thinking and feeling. Rather than extending your arm stiffly to shake hands at a distance, relax your arm and lower your elbow to your side, drawing the other person closer to you. “This shows you’ve made a subconscious decision to trust the person, without having spoken a word”. Never reach across a table to shake hands - walk around it to greet them face-to-face and offer a relaxed handshake, elbow at your side. In summary:

-- Keep your elbow at your side when shaking hands, drawing the other person closer than arm’s length.
-- Lean forward and focus intently on the other person when he or she is speaking.
-- Stand erect with shoulders squared, balancing your weight evenly.
-- Smile in response to what others say or do, rather than grinning nonstop.
-- Remain mindful of what others are thinking and feeling.

The WSJ article was based on part on an interview with Dr. Alexander Todorov. Here is Google talk: Dr. Alexander Todorov, head of the Social Perception Lab at Princeton University, discusses his new book, “Face Value: The Irresistible Influence of First Impressions”:

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The Mistakes You Make in a Meeting’s First Milliseconds - WSJ

Adolescents' circadian clock and the vicious circle of media use, exposure to light at night, sleep loss and risk behaviors

Thu, 01 Feb 2018 06:00:48 PST

Sleep is a key element in adolescent development. However, teens are spending increasing amounts of time online with health risks related to excessive use of electronic media (computers, smartphones, tablets, consoles, etc.). This excessive use is negatively associated with daytime functioning and sleep outcomes.

Adolescent sleep becomes irregular, shortened and delayed in relation with later sleep onset and early waking time due to early school starting times on weekdays which results in rhythm desynchronization and sleep loss.

In addition, exposure of adolescents to the numerous electronic devices prior to bedtime has become a great concern because LEDs emit much more blue light than white incandescent bulbs and compact fluorescent bulbs and have therefore a greater impact on the biological clock.

A large number of adolescents move to evening chronotype and experience a misalignment between biological and social rhythms which, added to sleep loss, results in:

- fatigue
- daytime sleepiness
- behavioral problems (problematic media use, alcohol consumption, binge drinking, smoking habits, stimulant use)
- poor academic achievement

The permanent social jet lag resulting in clock misalignment experienced by a number of adolescents should be considered as a matter of public health.


Disruption of adolescents' circadian clock: The vicious circle of media use, exposure to light at night, sleep loss and risk behaviors. - PubMed - NCBI

"The health system cannot sustain current rates of clinician burnout and continue to deliver safe, high-quality care". What to do?

Wed, 31 Jan 2018 05:57:21 PST

From the NEJM:

More than half of U.S. physicians report significant symptoms of burnout — a rate more than twice that among professionals in other fields. Medical students and residents have higher rates of burnout and depression than their peers who are pursuing nonmedical careers. Physicians with symptoms of burnout are twice as likely to leave an organization as those without such symptoms

"The health system cannot sustain current rates of clinician burnout and continue to deliver safe, high-quality care". What to do?

Here are some examples (more reading available at the reference links below):

- To prevent burnout, Mayo Clinic has leadership-effectiveness scores for every division head and department chair.

- University of Colorado health uses medical assistants to set the agenda for patient visits and write the notes (almost 3 assistants per physician)




The key to digital media use and happiness is limited use: less than 1 hour per day plus exercise and real-life interaction

Mon, 22 Jan 2018 12:49:02 PST

In a recent study, playing computer games, using social media, texting and video chatting were all associated with less happiness.

“The advent of the smartphone is the most plausible explanation for the sudden decrease in teens’ psychological well-being.”

The happiest teenagers were those who used digital media a little less than an hour a day.

The key to digital media use and happiness is limited use.

Here is the 2-step solution:

1. Aim to spend no more than one hour a day on digital media
2. Increase the amount of time you spend seeing friends face-to-face and exercising – two activities reliably linked to greater happiness

Prof Jean Twenge has made a whole career of this topic ( Here is a recent interview: Are smartphones making a generation unhappy?

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Teenage screen addicts lose out on happiness, study shows

In-person clinic visits are being replaced with virtual visits at a rapid pace

Tue, 16 Jan 2018 06:07:42 PST

From the NEJM:

What if health care were designed so that in-person visits were the second, third, or even last option for meeting routine patient needs, rather than the first?

At Kaiser Permanente, 52% of 100 million patient encounters each year are now “virtual visits”. It spends 25% of its annual $3.8 billion budget on information technology.

"Payment models are an obvious barrier to deemphasizing in-person visits, but every provider’s business success depends on market share. The best way to win market share is to design and deliver better care, then modify the payment system to support it. Moreover, payment systems are already evolving to support nonvisit care. For example, use of bundled payment programs and accountable care organizations — which reward nontraditional care delivery models that reduce spending and meet patients’ needs — is growing."

Patients are increasingly asking, “Isn’t there a way to do this without my having to drive to your office?”


In-Person Health Care as Option B — NEJM
NEJM Interview — In-Person Health Care as Option B
5% of patients account for 50% of healthcare costs

Smartphone and Social Media Use in Lectures Makes Your Learn Less

Mon, 15 Jan 2018 05:46:19 PST

Several studies have shown that problematic smartphone use (PSU) is related to detrimental outcomes, such as:

- worse psychological well-being
- higher cognitive distraction
- poorer academic outcomes

Problematic smartphone use (PSU) is strongly related to social media use.

The study participants were 415 Estonian university students aged 19-46 years (79% females).

Problematic smartphone use (PSU) and the frequency of social media use in lectures were negatively correlated with a deep approach to learning (defined as learning for understanding) and positively correlated with a surface approach to learning (defined as superficial learning).

Mediation analysis showed that social media use in lectures completely mediates the relationship between PSU and approaches to learning. These results indicate that the frequency of social media use in lectures might explain the relationships between poorer academic outcomes and PSU.


Problematic Smartphone Use, Deep and Surface Approaches to Learning, and Social Media Use in Lectures. Int J Environ Res Public Health. 2018 Jan 8;15(1). pii: E92. doi: 10.3390/ijerph15010092.

How to treat dry eyes

Tue, 02 Jan 2018 07:38:00 PST

How common are dye eyes?The prevalence of dry eyes has been estimated to be 5-30% percent in persons aged 50 years and older, 7% of US adult population has been diagnosed with dry eye disease. The prevalence increases with age (2.7% in those 18 to 34 years old vs. 19% in those aged 75 years and older). Prevalence is higher in women than men (9% versus 4%).What are the risk factors for dry eye disease?- Advanced age- Female gender- Hormonal changes (primarily due to decreased androgens)- Systemic diseases (eg, diabetes mellitus, Parkinson disease)- Contact lens wear- Systemic medications (antihistamines, anticholinergics, estrogens, isotretinoin, selective serotonin receptor antagonists, amiodarone, nicotinic acid)- Ocular medications (especially those containing preservatives)- Nutritional deficiencies (eg, vitamin A deficiency)- Decreased corneal sensation, for example, after Laser-assisted in situ keratomileusis (LASIK)- Ophthalmic surgery (especially corneal refractive surgery)- Low humidity environments- Sjögren's syndromeWhat are the treatments for dry eyes? Tear conservationThe use of medications that may worsen symptoms of dryness should be avoided. Moisture-conserving eyewearPhysical barriers, such as large-frame glasses to minimize tear evaporation, can be helpful. Moisture-conserving eyewear can be employed to conserve the tear film. These may be most helpful in particular situations, such as when traveling into dry and/or windy environments such as airplanes or long air-conditioned car rides, during which humidity is low; and while exercising, especially jogging or biking, during which increased air movement on the ocular surface and decreased blink rate are encountered.Examples of moisture-conserving eyewear include:- Side shields, which can be fitted to glasses, reducing the evaporation rate of normal or artificial tears- Wraparound sunglasses, which are more socially acceptable to many patients than are side shields or goggles- Ski or swim goggles, which also reduce evaporationEnvironmental managementArtificial tears should be used regularly to help prevent complications and to increase comfort before entry into dry environments.The following environments may be problematic:- Dry or windy outdoor environments- Dry indoor environments- Areas with polluted air and other irritants, including the presence of smokers- Hospital operating and recovery roomsComputer use is associated with a decreased blink rate, and extended computer use can be especially problematic and may worsen dry eye. Frequent, short breaks and additional longer breaks may be beneficial.The use of humidifiers is helpful in bedrooms and other rooms in which the patient spends a lot of time. Here is the best seller from Amazon: frameborder="0" marginheight="0" marginwidth="0" scrolling="no" src="//®ion=US&placement=B013IJPTFK&asins=B013IJPTFK&linkId=cc969a6de35705628b7881e7df90c749&show_border=true&link_opens_in_new_window=true&price_color=333333&title_color=0066c0&bg_color=ffffff" style="height: 240px; width: 120px;">Warm compressesHow to use warm compresses:- boil water and leave it to cool to a warm temperature- soak a clean flannel or eye pad in the warm water and gently place this over the eyes for around 10 minutes- reheat the compress periodically by soaking it in warm water, ensuring the flannel doesn't become cold- You can also buy a special microwaveable compress for your eyes to use instead of a flannelThe regular use of warm compresses over the eyes can also provide symptomatic relief by impr[...]

Media Files:

Major Success for Gene Therapy for Factor IX Deficiency: near elimination of bleeding and factor use

Mon, 01 Jan 2018 03:00:32 PST

Hemophilia B Gene Therapy with a High-Specific-Activity Factor IX Variant: the researchers infused a single-stranded adeno-associated viral (AAV) vector consisting of a bioengineered capsid, liver-specific promoter and factor IX Padua (factor IX–R338L) transgene in 10 men with hemophilia B who had factor IX coagulant activity of 2% or less of the normal value.

They found sustained therapeutic expression of factor IX coagulant activity after gene transfer in the 10 participants with hemophilia who received the same vector dose. Transgene-derived factor IX coagulant activity enabled the termination of baseline prophylaxis and the near elimination of bleeding and factor use.

More info here:

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The large mouth of largemouth bass is of interest to scientists trying to understand how joints work

Sat, 30 Dec 2017 04:30:23 PST

Inside the bass’s mouth is a system of linked muscle and bone that resembles the mechanism of an oil rig. NYTimes:

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Read more here:

Fremanezumab for Preventive Treatment of Migraine

Fri, 29 Dec 2017 03:30:28 PST

Fremanezumab is a humanized monoclonal antibody targeting calcitonin gene–related peptide (CGRP). It is administered monthly via SQ injection.

In this NEJM study, fremanezumab was effective as a preventive treatment for chronic migraine:

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Genetics-based app could help you find true love

Wed, 27 Dec 2017 06:44:21 PST

The first genetics-based dating app, called Pheramor, is expected to launch in 2018. The name is based on pheromones:

The founders say: "Genetic-based human attraction has to do with pheromones. And when we smell pheromones, what we're actually smelling is how diverse someone's immune system is compared to our own."

"Evolution is very strong. So we're smelling each other, trying to figure out who is the best person to mate with. And that's what love at first sight actually is. It's smelling someone's pheromones from across the room, and your brain says, "That's the most perfect pheromone profile I've ever smelled in my entire life. I love them."

Human chromosomes (grey) capped by telomeres (white). Image source: Wikipedia, public domain.

When someone swabs their cheek with a Pheramor kit, the lab scans for 11 genes, which scientists have linked to attraction.

Read more here: Genetic-based dating app works to find true love using your DNA

BMJ study: Patients treated by older physicians (60 and older) had higher mortality vs. younger physicians (39 and younger)

Wed, 13 Dec 2017 10:53:06 PST

From BMJ:The researchers evaluated a 20% random sample of Medicare fee-for-service beneficiaries aged 65 and older admitted to hospital with a medical condition in 2011-14 and treated by hospitalist physicians. Main outcome measures 30 day mortality and readmissions and costs of care.The study included 700,000 admissions managed by 18,800 hospitalist physicians (median age 41).Patients’ adjusted 30 day mortality rates were:- 10.8% for physicians younger than 40- 11.1% for physicians aged 40-49- 11.3% for physicians aged 50-59- 12.1% for physicians aged 60 and olderSee the figure here: Among physicians with a high volume of patients, however, there was no association between physician age and patient mortality. Within the same hospital, patients treated by older physicians had higher mortality than patients cared for by younger physicians, except those physicians treating high volumes of patients. The calculated "number need to harm (NNH)" was 77.Patients treated by physicians aged younger than 40 had 0.85 times the odds of dying or an 11% lower probability of dying compared with patients cared for by physicians aged 60 and older. This difference in mortality is comparable with the impact of statins for the primary prevention of cardiovascular mortality on all cause mortality (odds ratio of 0.86) or the impact of β blockers on mortality among patients with myocardial infarction (incidence rate ratio of 0.86), thus indicating that the observed difference in mortality is not only statistically significant but arguably clinically significant. The adjusted risk difference of 1.3 percentage points suggests that for every 77 patients treated by doctors aged 60 and older, one fewer patient would die within 30 days of admission if those patients were cared for by physicians aged 39 and younger.Though clinical skills and knowledge accumulated by more experienced physicians could lead to improved quality of care, physicians’ skills might become outdated as scientific knowledge, technology, and clinical guidelines change.Older physicians might have decreased clinical knowledge, adhere less often to standards of appropriate treatment, and perform worse on process measures of quality with respect to diagnosis, screening, and preventive care.References:Physician age and outcomes in elderly patients in hospital in the US: observational study. BMJ 2017; 357 doi: (Published 16 May 2017)Cite this as: BMJ 2017;357:j1797Image source: OpenClipArt, Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.[...]

Surgeon grows vegetables across from his hospital to cope with stress and burnout

Wed, 22 Nov 2017 05:15:42 PST

(image) From this Reuters/Yahoo article:

"Dr. Brian Halloran, a vascular surgeon at St. Joseph Mercy Ann Arbor, starts planning his garden long before spring arrives in southeast Michigan. His tiny plot, located in the shadow of the 537-bed teaching hospital, helps Halloran cope with burnout from long hours and the stress of surgery on gravely ill patients. "You really have to find the balance to put it a little more in perspective," he said.

Hospitals such as St. Joseph Mercy Ann Arbor have been investing in programs ranging from yoga classes to personal coaches designed to help doctors become more resilient. But national burnout rates keep rising, with up to 54 percent of doctors affected."

Burnout as a syndrome is marked by emotional exhaustion, cynicism and decreased effectiveness. A 2015 Mayo Clinic study found that more than 7% of 7,000 doctors had considered suicide within the prior 12 months, compared with 4 percent of other workers.

Some blame the way medicine is practiced in the United States since the introduction of EMRs, fueled in part by growing clerical demands that have doctors spending two hours on the computer for every one hour they spend seeing patients.

It can cost more than a $1 million to recruit and train a replacement for a doctor who leaves because of burnout.

Atrius Health, Massachusetts' largest independent physicians group, is aiming to cut 1.5 million mouse "clicks" per year.

Tips for managing stress (watch the 2-minute BBC video embedded below)

- Take a few deep breaths
- Get plenty of exercise
- Socialize - don't stress alone, talk to someone and have a laugh
- Get out - go to the park

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Read more: 


Counting the costs: U.S. hospitals feeling the pain of physician burnout(image)

How to fight physician burnout - KevinMD shares his personal experience

Tue, 26 Sep 2017 12:31:10 PDT

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Mosquito controls with AGO bucket traps, Autocidal Gravid Ovitrap (AGO), tested by CDC

Sun, 24 Sep 2017 15:08:44 PDT

Autocidal Gravid Ovitrap (AGO) bucket trap is a standard 5-gallon bucket adapted in a specific way to capture mosquitoes.AGO traps are available for purchase online from Springstar. Two traps cost $75, free shipping: Autocidal Gravid Ovitrap (AGO trap), was developed by the Center for Disease Control (CDC) and has been proven to reduce populations of Aedes mosquitoes by over 80%. It is effective for the mosquitoes that transmit Zika, dengue, chikungunya, and yellow fever. No pesticides or pheromones required. Just add water and a little hay. frameborder="0" marginheight="0" marginwidth="0" scrolling="no" src="//®ion=US&placement=B0741FP1WK&asins=B0741FP1WK&linkId=388b761aa66fc468b9afe726ecc0a9c4&show_border=true&link_opens_in_new_window=true&price_color=333333&title_color=0066c0&bg_color=ffffff" style="height: 240px; width: 120px;">From Springstar website: "The Trap-N-Kill® Autocidal Gravid Ovitrap is an 18 liter black bucket fitted with a “capture chamber” on the top. The capture chamber allows you to swap out the sticky board without having to pull off the whole lid. Twist the top half of the chamber and you'll have access to where the sticky board rests. The bucket itself is filled with water up to a specific depth that is controlled by a series of slots which are machined into the bucket sides. Gravid female Aedes mosquitoes are attracted to the hay-infused standing water and seek to lay their eggs on a hard surface right at the water line. They try to do that by entering the capture chamber through the top screen. They can get through that screen with ease but other critters, like squirrels or birds can't. The capture chamber, a cylinder, contains a replaceable glue board that covers the entire inside portion of the cylinder. The mosquitoes cannot get to the water surface because the bottom screen is made of a finer mesh than the top one -- too fine for a mosquito to get through. As they keep trying to get to the water, they tire and may need to rest. When they choose to rest on the glue surface, that will be their final resting place, so to speak. No pesticides or pheromones required. Just add water and some grass clippings or hay."The "stickies" are the sticky issue here, as the replacements are not readily available for purchase. Pest management company Catchmaster lists "AGO Trap Replacement Glue Boards" on its website but there is no link to purchase them online.References: Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.[...]

Media Files:

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

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. neuroticism2. extraversion3. agreeableness4. openness to experience5. conscientiousnessThere 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 Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.[...]

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.


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.


A platinum age for rheumatology - The Lancet

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?

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.:

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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.


Short Term Use of Oral Corticosteroids and Related Harms

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)