Grand Rounds, Vol. 3 No. 12
> 12/12/2006

We've been blogging in earnest for quite a while now. While it seems much more recently, it was six months and over 400 posts ago that we last hosted Grand Rounds. It's surprising how much has changed in that time, but also how much has stayed the same. We had a number of submissions from bloggers we featured last time around, along with a number of new faces. It seemed too that the quality of blogging has only continued to rise. Maybe it's simply a factor of writers becoming more comfortable with the medium. Or maybe it's a function of medical bloggers pushing each other to excel. Whatever it is, one thing is for sure: we the readers are the ones who truly benefit.

We received many great submissions for this edition of Grand Rounds, and we apologize that we didn't have room for everyone. We've done our best to break things up into some hopefully self-explanatory categories, and while often it was difficult to put every entry into a group, we sucked it up and did our best. Thanks again to everyone who sent in their posts. A special thanks also goes out to Grand Rounds coordinator extraordinaire, Dr. Nick Genes. Finally, we'd just like to mention that we found the comic below on Steve Pashley's blog, which appears below, and just fell in love with it. Call it nerdy blog humor. You can find more off-the-wall work by the same humorist at

Editors’ Spotlight
The submissions this week were all top-notch, but as we did last time around, we’d like to spotlight a couple of posts that deal with issues close to our hearts, as well as a few that just knocked our socks off (which, collectively, is pretty hard to do!).

The first anorexic patient that Nurse Ratched worked with provided an experience and an education not soon to be forgotten.

It’s not only psychiatrists that know and use “the mask,” and as Dr. Dork writes, learning to wear it isn’t the problem, it’s learning how and when to take it off.

We’ve long been a proponent of informational therapy, and in this post Diabetes Mine provides an outstanding overview of just what that concept means in the grand scheme and also more specifically for those dealing with diabetes, “the ultimate self-managed disease.”

Big tobacco has been on a lot of physician’s hit lists for a long time. As the resident physician at Wandering Visitor points out, if their product hasn’t outraged you yet, then their marketing techniques definitely should.

Establishing healthy eating habits, especially for children, is an issue that we’ve addressed here, but never as well as it is taken up at Junkfood Science. This extensive post about how the marketing of fear, combined with good intentions, can lead to unhealthy options in schools is just one example of the great information to be found on this blog.

Nurses are an indispensable, well-educated pieces of the health care puzzle, so why the lack of respect? In a well-written and organized post, Emergiblog lays out the changes that she’ll be making in how she goes about her business. We applaud vigorously!

Parallel Universes explains that not everyone who looks thin is healthy, and not everyone who looks over-weight is headed for disaster. Like you hopefully learned in kindergarten, it’s what’s inside that counts.

Nuts and Bolts
Blogging is an important part of creating collective knowledge. By sharing our experiences, opinions and ideas, we pool our knowledge in a way that enriches the entire community. These posts relate information about specific areas of expertise or interest.

A lot of people would probably blush upon hearing the words “Skin to skin,” but as we learn at Surgeonsblog, those words have a more important meaning to those who work in the OR, and they can often separate the fast from the slow and the good from the great.

In this post we get the answer to a question of intestinal obstruction at Odysseys of George. And for those of us in the mental health field, we also get some instructive pictures.

Could the beloved Saint Nick be in danger of a sleep disorder? Breath Spa for Kids says it’s highly likely.

It can be difficult for those who make medical decisions to turn over the decision-making about their own health to another physician, but as Scalpel or Sword? relates, it eventually becomes necessary, and the decision shouldn’t be made lightly.

Last week, Inside Surgery wrapped up a nine-part series about the importance of hand washing in hospital settings and proper techniques for ensuring cleanliness.

Those of us who spend a lot of time surfing the web, and in particular, fans of the technology site C-Net were stunned to learn of the death of James Kim, one of the site’s editors. At Medicine for the Outdoors the tragic incident served as a jumping off point for a discussion of wilderness safety and survival tips.

AIDS, as Digital Doorway describes, can lead to dementia, and for patients at various stages of treatment, therapy and other alternatives can be powerful weapons in battling back the effects of the disease. In these situations, love itself can be a powerful weapon.

Two separate articles provide a foray into alternatives to prescription drugs, specifically to treat mild depression and ear infections, at Colorado Health Insurance Insider. While they’re correct (at least in the case of mild depression) that some alternative strategies can prove very efficacious, it’s still important to discuss all treatment options with your physician.

As she points out, “Our days and nights are filled with stress,” so Chronicbabe’s post offering tips from one of her readers for de-stressing is particularly functional.

Ethical Issues
Posts arising from ethical issues are often some of the most probing and personal that one will find. Each of these submissions wrestles with the difficult questions, and each arrives at a conclusion, if not a solution.

In this post, Signout ponders some tough questions regarding happiness, quality of life and family, each viewed through the lens of experiences in the neonatal intensive care unit.

For Dr. Logan, the OBGYN resident from OB-log, HIPAA compliance and the FBI’s wanted listed recently came into conflict. While the specific case awaits an outcome, he has decided what course of action he’ll take.

Pregnancy can be a challenge for even the most healthy individuals, but as A Chronic Dose writes, for a young women dealing with chronic disease the question of “can I” versus “should I” must also be considered.

A recent AAP report on advertising and children drew our ire. It also drew the ire of Doctor Anonymous, and he discussed his reactions in a great post that led to some healthy comment discussion.

Personal Reflections
Sometimes the most powerful stories are the ones that we share from personal experience. In these posts, writers leverage autobiographical inspiration to great effect.

Many fail to understand the dangers of Acetaminophen, and in his post at Musings of a Distractible Mind one writer recounts his difficult night when one young girl’s naiveté regarding those dangers ended her life.

Fat Doctor’s recent run in with one of her favorite patients reminded her that more kissing might not be a bad thing.

One ER chaplain found that a magic shirt, stumbled upon at a scrubs sale, has an effect on those she encounters. She describes a few of the more interesting reactions at Rickety Contrivances of Doing Good.

For many, a light box can bring immediate results and noticeable improvements. Rachel from Tales of My Thirties discovered that first hand.

Six Until Me shares an intimate look at how the quiet of a morning interacts with the seemingly deafening noises of managing diabetes.

December 1st was World AIDS Day, and for the occasion, Fruit of the Womb remembered a special patient from his past.

Clinical Cases and Images – Blog posted a short but sweet little film this week about one man’s typical home hemodialysis day.

GruntDoc has some thank you’s and some lessons to pass on from his experiences on the night shift.

It has become the bane of Urostream’s existence, much like it is the bane of many other intern’s existence: The Pager!

Questions of Policy
Medicine is also a business, and that means that it often becomes the center of debates on policy. No matter how you feel about that fact, these posts prove that questions of policy make for compelling reading.

In this post about the “criteria” that insurers use, Dr. Hébert’s Medical Gumbo also includes a healthy serving of the absurd. Maybe Camus should be required reading at U.S. medical schools.

It is always fascinating to read about the NHS for the similarities and differences from the problems we find in our own healthcare system. The Changing NHS is a nice place to do that.

The folks at Health Business Blog are always thought provoking, and that is especially true in this post where they discuss the lack of insulation for the rich and powerful when it comes to health care.

The legal and medical fields often come together in the most contentious and emotional debates. NHS Blog Doctor examines how past legislation regarding abortion might inform present discussion around a bill that deals with euthanasia.

Many people are content to have a working grasp of today’s medical technologies, but the docinthemachine has his eye to the future. In this excellent post he discusses how cuts in military research will impact new medical technologies currently in development.

Once you break down the changes to Medicare, InsureBlog wants to know: “Why do folks think a universal health care system is a good idea?”

Shrink Wrap offers three posts, one from each contributor, which cut across a range of issues in the field of mental health including government legislated screenings and new research on antidepressants and suicide.

Next week's Rounds will be appearing at Nurse Ratched's Place.

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