Using Brain Signals to Assist in Breaking While Driving

Is this the future of our automobile's breaking technology?  Very interesting out of Germany. Enjoy!!!!


German researchers have used drivers' brain signals, for the first time, to assist in braking, providing much quicker reaction times and a potential solution to the thousands of car accidents that are caused by human error.

Using electroencephalography (EEG) - a technique that attaches electrodes to the scalp - the researchers demonstrated that the mind-reading system, accompanied with modern traffic sensors, could detect a driver's intention to break 130 milliseconds faster than a normal brake pedal response.

Driving at 100km/h, this amounts to reducing the braking distance by 3.66 meters - the full length of a compact car or the potential margin between causing and avoiding accidents.

A detailed video of one of the subjects driving the simulator can be seen here. 

Healthy and Happy Meals from McDonalds

Is a Happy Meal still happy when it's healthy? 

Starting in September, children will get apples with their McDonald's Happy Meals -- and fewer fries at a McDonald's in Oak Brook, Illinois.

McDonald's first experimented with eliminating French fries completely from the menu, but the company says children and parents rebelled. So they brought them back, only in a smaller portion. By the beginning of next year, McDonald's will include a half-order of apples and a half-order of fries in the Happy Meal. But, customers can request a full order of one or the other.

McDonald's says the apples are currently available in Happy Meals instead of fries, but only 11 percent of people ordered them.

Under the new progam:

• McDonald's pledged to reduce sugars, saturated fats and calories through "varied portion sizes, reformulations and innovations" by 2020. By 2015, it will reduce sodium by 15 percent.
• McDonald's will introduce a new mobile app focused just on nutrition information.
• McDonald's USA president Jan Fields and other executives will go on a "listening tour" in August to hear suggestions from parents and nutrition experts. The chain will also launch a new online forum for parents.

The changes are what customers are asking for, according to Cindy Goody, McDonald's senior director of nutrition. 
"We've been in the nutrition game for over 30 years in providing nutrition information to our customers," Goody said. "Now what we're doing is we're adding more food groups and ... creating nutritional awareness."

Do you think your kids will still want Happy Meals???

Back to School Health for Children

Parents should keep in mind three key routines as they track their children's health over the school year, says Randall Cottrell, a University of Cincinnati professor of health promotion and education. In addition to physical activity, children need a good night's sleep and a proper breakfast before they head to school.

Cottrell, who has evaluated school health programs for the Ohio Department of Health, says the school year can cause children to decrease their physical activity in order to increase their study time. "All children need to maintain some level of physical activity when they go back to school. The mind works best when it's physically stimulated." Cottrell says that activity could be as simple as playing an hour of hoops with the neighborhood kids after school, rather than an hour of computer games. When it gets too cold to play outdoors, recreational leagues can offer activities that range from basketball to swimming and wrestling. "When the snow falls, children can go sledding as they continue to stay physically active through the school year."

A proper diet will lower the risk of childhood obesity and increase the likelihood of academic success. Cottrell says it all begins with a proper breakfast. Without it, the blood sugar level falls, making children fatigued and less able to concentrate. "All children should have breakfast. If they don't like cereal, they can have yogurt and toast, but they must have those calories. Studies have shown breakfast benefits learning." Cottrell also suggests sending children to school with healthy snacks and if they pack their lunch, keep it healthy, avoiding high fat, high sugar and high salt foods.

An earlier nighttime routine is often a source of conflict between kids and parents, but Cottrell says proper rest impacts learning. "Students should get a minimum of eight hours of sleep and it's better if they can get between nine and 10 hours," says Cottrell. Because their bodies are still growing, he says children need more rest than the average adult. That can be a challenge for teens who wish they could "sleep in." Studies have shown teenagers have a harder time waking up because of their changing biological clocks.


What do you do differently when the school year starts back?

Robo-Doc...Can Computers Replace Your Physician?

Automation in Medicine: Humans vs. Machines

Robots don't need vacations. Unlike humans, they don't get tired. Whether serving as a robotic scrub nurse, a miniature mobile sewing machine, or a remotely controlled surgical arm equipped with a high-speed CT scanning eye, bots offer some real advantages over humans. They can maneuver into tight anatomical spaces, require only small keyhole incisions for access, and are less likely to contaminate the field. Robots are also less likely to complain about bad lighting, table height, and room temperature. Unlike most humans, they have no life at all outside the hospital (although this is true for some physicians).

Newer cameras allow robotic assistants to respond to hand gestures. Surgeons can use hand signals to bring up an imaging study or electronic medical record data into view, without touching a thing. Similar gesture-sensing technology is available in consumer electronic games that track hand movements in 3-D space. 

Have You Met Dr. Watson?

Robots are not the only high-tech newcomers to medicine. Enter Watson, the artificial intelligence supercomputer from IBM. It processes natural-language questions and scours massive databases looking for answers. After beating uber-contestant Ken Jennings at Jeopardy , Watson went to medical school at both Columbia and University of Maryland. Watson will spend a few years learning about the types of diagnostic and therapeutic questions that arise in clinical practice. Is it possible that unearthing facts buried within massive volumes of medical journals and other data can support tailored clinical decision-making for an individual patient? Maybe we will find out in a few years. 

Humans Behind the Machines

Famed heart surgeon Michael DeBakey (who is from my hometown) learned to stitch from his mother, a seamstress and sewing teacher. He described the thrill of sewing his first synthetic bypass grafts by hand. He went on to invent dozens of machines and surgical instruments that are now commonplace in medicine. I am reminded that behind all these great mechanical and electronic innovations are real human beings. When it comes to beside manner-actively listening, expressing genuine caring, and delivering encouragement—the vast majority of human clinicians have the clear advantage over robots, hands down. Don't you think?

What is the Best Hospital In the U.S.?

The title of "Best Hospital" in the United States goes to ... The Johns Hopkins Hospital. Again.

The Baltimore-based Johns Hopkins earned the top spot among about 5,000 hospitals in the United States for the 22nd year, according to U.S. News and World Report's 2011-2012 rankings released on Tuesday. It has earned the top spot every year since the U.S. News Media Group began publishing the annual list in 1990.

The latest report recognized 720 hospitals of 4,825 nationwide that rank among the best in their metro area or in at least one of 16 medical specialties.

This year only 140 of the total number of hospitals evaluated performed well enough in even one medical specialty to earn a national ranking, according to the U.S. News media release Tuesday.

The list covers all 94 metro areas that have a minimum of both 500,000 residents and one hospital that performed well enough to earn a place, as well as 16 medical specialties, from cancer and heart disease to urology and respiratory disorders.

The rankings derive from statistics in these specialties, such as fatality rates, patient safety and volume of procedure. They also rely on a national survey in which physicians named the hospitals they consider best in their specialty for the toughest cases.

Johns Hopkins earned the top spot of 17 "Honor Roll" hospitals given the distinction for "rare breadth and depth of medical excellence," according to U.S. News.

In 2010-2011, 152 hospitals made the rankings cut but only 14 placed on the honor roll for high scores in six or more of the total 16 specialties.

This year Massachusetts General Hospital in Boston overtook the Mayo Clinic for the number two spot with the Rochester, Minnesota-based clinic taking third.

Brigham and Women's Hospital, also in Boston, traded places with Barnes-Jewish Hospital at Washington University Medical Center of St. Louis, moving up three spots to eighth while Barnes-Jewish dropped to 11th.

Vanderbilt University Medical Center in Nashville, Mount Sinai Medical Center in New York, and Stanford Hospital & Clinics of California all joined the 2011-2012 honor roll list.

The mission of "Best Hospitals" is to serve as a guide for patients in need of a high level of care, according to the U.S. News report. 

"These are referral centers where other hospitals send their sickest patients," Avery Comarow, U.S. News Health Rankings Editor said.

"Hospitals like these are ones you or those close to you should consider when the stakes are high."

Gotcha! When Malpractice Plaintiffs Fake or Exaggerate Injuries

A video presented at a malpractice trial showed a pitiful 56-year-old man grimacing in pain, hobbling on crutches, unable to even brush his teeth without his wife's assistance. His sex life was over. His disabilities were caused by a botched back operation, he testified.

The defendant neurosurgeon and his insurer were convinced the man was lying. But how to prove it? Investigators with video cameras staked out his house for 3 days, but the man stayed inside. The investigators were about to quit the surveillance when the man finally emerged, jauntily carrying a hydraulic jack and cinder blocks to prop up his car. He then changed the shock absorbers and performed other tasks with the dexterity of a pit crew at the Indianapolis 500.

The surgeon's attorney presented the video to a judge who promptly dismissed the malpractice case. Prosecutors then charged the man with perjury. He was convicted and sentenced to 30 days in jail.

In malpractice cases, it's almost expected that plaintiffs will "gild the lily" by exaggerating their disabilities. However, even the most egregious examples of fraud generally go unpunished -- unlike the case mentioned.

In many cases, searching through public records and databases can turn up phony claims without the expense and uncertainty of video surveillance. A check of motor vehicle records showed that one plaintiff had several speeding tickets issued 90 miles from the home he claimed he couldn't leave because of his "injury."

When his employment records were subpoenaed, it turned out he worked as a long-haul trucker, shifting gears in an 18-wheeler all the while claiming that his left leg was immobile as a result of a physician's negligence. In a case that involved a claim for loss of consortium, a check of divorce records found that the couple had broken up several years earlier but supplied false information about their marital status to boost the value of the lawsuit.

Finding the Fakes

How can doctors and their attorneys confirm suspicions that a plaintiff is faking? "The first tip often comes from the doctor who says the patient is acting or moving in ways that are inconsistent with the allegations," says James Lewis Griffith Sr., an attorney in Philadelphia who represents both patients and physicians. "A careful reading of the medical record can lead you to investigate further. At depositions, you develop a sixth sense about whether someone is telling the truth, often when they act too smart for their own good. Outright fraud may occur in 1% of cases and it's difficult to prove. But exaggeration is pretty common."

"We look for red flags, especially if the claimed injury doesn't follow the typical pattern," says Peter Leone, New Jersey program director for Academic Insurance in New York, which insures almost 3000 physicians. "Whenever the plaintiff says there's something he can't ever do again, especially if he's a young man, that's suspicious and we dig deeper."

Shortage of Healthcare Professionals Predicted by 2025

 Advanced practice nurses (APNs) and physician assistants (PAs) are frequently touted as the solution to the physician shortage, but there will not be enough of all 3 professionals combined to meet the nation's healthcare needs in 2025, according to a study published in the June issue of theJournal of the American College of Surgeons.

Lead author Michael Sargen, a medical student at the University of Pennsylvania in Philadelphia, and coauthors write that although the United States needs to expand the workforce of these 3 types of "advanced clinicians," healthcare personnel with less training must assume more patient care responsibilities, especially as more Americans gain insurance coverage under the Affordable Care Act.

Right now, the nation fields close to 300 advanced clinicians for every 100,000 Americans. That number is roughly 7% less than needed, based on the demand for services, which the authors extrapolate from healthcare spending. The authors write that if training programs for PAs and APNs — which include nurse practitioners — grow as currently projected while physician residency programs fail to expand, the per capita supply of advanced clinicians in 2025 will resemble the current level.

However, the workforce of 2025 in this scenario will be 20% less than needed because of burgeoning demand for services. The authors cite government studies that forecast a 65% increase in healthcare spending from 2009 to 2025 based on its historic growth rate of 2.5% above the growth of the gross domestic product (GDP).

The healthcare reform law aims to reduce that growth rate to 1% above GDP, the authors write, but even if reformers hit this target, demand for services will still outstrip the supply of advanced clinicians.

Coauthor Richard Cooper, MD, an authority on physician workforce issues and a professor at the Leonard Davis Institute of Health Economics at the University of Pennsylvania, chalks up the continued rise in spending not only to costly technologies but also to the sheer proliferation of new therapies.

"Research is finding ways to treat diseases that were once untreatable," Dr. Cooper told Medscape Medical News. "We once didn't treat lung cancer. Now we do. We don't treat Alzheimer's disease now, but we will in the future."

"Everyone Should Work to Their Level of Education"

A 20% shortfall in the advanced-clinician workforce in 2025 is the study's worst-case scenario. The nation will more likely face a 15% shortage that year, the authors write, given the pressure to add more first-year slots to residency programs.

The study authors mention several wild cards that were not factored into their analysis but that could aggravate the shortage. Physicians, they write, are working fewer and fewer hours. And all clinicians are increasingly pulled away from patient care by chores such as documenting what they do for the sake of getting paid. These factors could increase unmet demand for advanced clinicians by an additional 10% to 15%, according to the authors.

Wild cards aside, even under the rosiest scenario for advanced-clinician head counts, the nation still "must broaden the spectrum of healthcare workers who can assist in delivering services," write the authors. That means advanced clinicians must learn to delegate responsibilities that can be performed by personnel with less training and to focus on the services that only they can provide, said Dr. Cooper.

"Everyone should work to their level of education," he said. "This is easy to talk about when you work in a hospital with a lot of people [to delegate to]," he said. "It's more difficult when you're a solo practitioner."

The need to spread out the work, he predicts, will drive more physicians to join larger, more organized systems, such as hospitals and large group practices.

Medical DIagnosis Via Facebook-Who Would Have Thought It?

Facebook Helps Solve Child's Disease 

One desperate mom, through a series of photos, used Facebook to reach out and eventually figured out what her son's medical condition was and how to treat it.  Kawasaki Disease (KD) is rare, but the social network might have saved the child's life.

So, virtual friends looked at her posted photos, and simply commented on them. She rushed her son to the hospital.

An unofficial Facebook blog stated: 

"There is no virtual in feelings of that magnitude. Perhaps just as in the real world, with your real life, and quote-unquote real friends, your Facebook friend network is what you make it. Accordingly, old adages apply: Choose your friends wisely. Put in as much as you expect to get out."

So what is Kawasaki disease? 

The disorder, first described in 1967 by Dr. Tomisaku Kawasaki in Japan, often begins with a high and persistent fever that is not very responsive to normal treatment with paracetamol (acetaminophen) or ibuprofen. The fever may persist steadily for up to two weeks and is normally accompanied by irritability.

Kawasaki published the first English language report of 50 patients with Kawasaki disease in 1974. Since that time, KD has become the leading cause of acquired heart disease among children in North America and Japan. Although an infectious agent is suspected, the cause remains unknown. However, significant progress has been made toward understanding the natural history of the disease and therapeutic interventions have been developed that halt the immune-mediated destruction of the arterial wall.

Inflammation of the mucous membranes in the mouth, along with erythema (redness), edema (swelling) with fissures (cracks in the lip surface), desquamation (peeling) and exsudation of the lips become exceedingly evident. Rashes occur early in the disease, and the cutaneous rash observed in patients with KD is non-specific, polymorphic, non-itchy and normally observed up to the fifth day of fever.

Some of these symptoms may come and go during the course of the illness. It is a syndrome affecting multiple organ systems, and in the acute stage of KD, systemic inflammatory changes are evident in many organs.

If left untreated, some symptoms will eventually relent, but coronary artery aneurysms will not improve, resulting in a significant risk of death or disability due to myocardial infarction. If treated in a timely fashion, this risk can be mostly avoided and the course of illness cut short.

Children with Kawasaki disease should be hospitalized and cared for by a physician who has experience with this disease. When in an academic medical center, care is often shared between pediatric cardiology and pediatric infectious disease specialists (although no specific infectious agent has been identified as yet). It is imperative that treatment be started as soon as the diagnosis is made to prevent damage to the coronary arteries. 

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As stated this is not a common diagnosis, however, every physician treating children should know the symptoms like the back of their of hand.  In fact, every medical student in their second year or beyond should also know this disease well as it is very high yield on every board exam.  

Please feel free to email or comment about anything you'd like to see included in my blog.  

Thanks for reading!!!!!

Should Doctors Apologize for Being Late?

Fortunately in my specialty I don't have to worry about this too much.  However, if your physician believes his time is more valuable than yours, you may want to consider finding a new more considerate physician.

Being Late -- Should Doctors Apologize?

No one can be perfectly punctual all the time. The question then is how doctors should handle their own lateness, especially when patients become upset or critical in the face of a delay.

In a recent discussion on Medscape's Physician Connect (MPC), an all-physician discussion group, a general practitioner asked for advice on dealing with the "rudeness" of a patient who "scolds me for being 20 minutes 'late.'"

Many responses suggested that the original poster had it backward: A doctor who does not arrive on time for a scheduled appointment is the one who has committed the discourtesy.

"Wait--you were 20 minutes late, and she was rude? Place yourself in her shoes. She does not know what you were doing before you entered the room. All she knows is that she had to wait 20 minutes. To her, you were the one that was rude by making her wait," wrote a neurologist.

"We have a responsibility to respect the patient's time as it is as valuable as ours. Apologizing if I am late is the first thing I should always do," a public health specialist added.