As you may have inferred from the dearth of timely updates, I have been quite busy with non-blogging responsibilities. Such is usually the case, but April and May have been particularly hectic months, as I am inundated with manuscript deadlines–on top of other professional and personal responsibilities. I am nevertheless pleased to have made some progress: I submitted a preliminary research draft a few weeks ago, and completed the final version of another manuscript today. There are still a few more items in the pipeline.

Naturally, On The Wards takes a back seat during these time crunches. I suspect that for the millionth-and-second time I will need to revisit my time management strategies and contemplate how On The Wards will fit into the grand scheme of life.

The Digital Pathology Blog (”a weblog for the digital pathology community and laboratory professionals”) hosts today’s edition of the Medicine 2.0 blog carnival, which derives its name from the “Web 2.0″ reference to current trends in Internet design and technologies. Not surprisingly, the carnival focuses on Internet-based technologies applied in the health care industry. On The Wards makes a brief appearance with our February report on the collaboration between Google Health and the Cleveland Clinic.

The venerable MedBlogs Grand Rounds circulates every Tuesday, which coincidentally falls on April Fools Day this year. Today’s edition (4.28) is primarily hosted by GruntDoc. As an added twist to commemorate this foolhardy occasion, GruntDoc conspired with a few other medical bloggers to scatter the featured articles among multiple sites. The purposeful chaos is reminiscent of a carnival-like atmosphere where the multitude of loud, flashy booths are scattered throughout the carnival grounds (how appropriate for a blog carnival).

Our article for this week’s Grand Rounds discusses low colonoscopy screening rates and can be found at Musings of a Distractible Mind. The distractible Dr. Rob hosts part 6 of “Mutant Grand Rounds”, where he includes pictures of oversized or overcolored mutants. He jokingly posits “the dangers these mutants pose are beyond description”. He follows …

The same can be said for insufficient screening for colon cancer. This is raised in the blog On the Wards. Who is to blame for such poor screening in our society? Katie Couric? Alan Thicke? Nick Genes? No, it is the physician who need to be identifying those at risk and encouraging colonoscopy.

This is quite an amusing yet discombobulating Grand Rounds, quite appropriate for April Fools Day. If you have no idea what I just presented above, don’t worry. I’m still left dazed and confused myself.

Earlier this month, I presented the updated colon cancer screening guidelines and commented how virtual colonoscopy may improve screening rates due to its less invasive nature than the traditional colonoscopy. My premise was that patient discomfort served as a primary deterrent to higher rates of colonoscopy use. Data from a recently published Vanderbilt study, however, beg to differ and suggest that other factors account for the inadequate rates of colon cancer screening in the United States.

The study population was derived from the Southern Community Cohort Study (SCCS), a large research endeavor to characterize cancer trends and disparities across racial and socioeconomic backgrounds. The group comprises 51,454 patients (ages 40-79 years) collected from 48 community health centers. The exclusion criteria for this particular study included the following: race other than African-American or Caucasian; uncertainty of whether the patient has had a sigmoidoscopy or colonoscopy; and, uncertainty of family cancer history. This left 41,830 participants, who were surveyed on personal demographics, personal history of colorectal polyps, family history of colon cancer, patterns of undergoing screening endoscopy, and last visit to a health care provider.

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The figurative use of the word “airhead” originated in the late 1970’s and signified a simple-minded or stupid person. But what are the characteristics of the literal “airhead” (or in medical jargon, pneumocephalus)? Does this person also exhibit similar deficits in cognitive function?

The New England Journal of Medicine recently featured the case of an Argentinian patient who spontaneously developed the so-called pneumocephalus. She is a 54 year-old woman who experienced progressive visual, auditory, and speaking abnormalities. A head radiograph demonstrated an air pocket along her left temporal region (enlarged image). A computed tomography (CT) scan revealed similar findings, with the pocket measuring 4 cm x 3 cm x 5 cm. There was no evidence of fracture or trauma.

The cause of the woman’s sensory and speech deficits can be explained by the air compressing against her brain, with indirect compromise of her brainstem. Her symptoms resolved soon after undergoing neurologic surgery to decompress the air and to repair a defect in an adjacent bone (mastoid). No tumor or infection was noted. Although most cases of pneumocephalus occur secondary to head trauma, it is possible the mastoid bone defect discovered during surgery may have been the source for air to enter the skull.

On a lighter note, the next time someone accuses you of being an airhead, you could refute him figuratively and literally with the following response: “I do not manifest the typical characteristics of pneumocephalus”.

• Sources
• Villa RA, Capdevila A. Spontaneous otogenic pneumocephalus. NEJM 2008;358:e13.
• Image Copyright: New England Journal of Medicine

Today is Residency Match Day, the moment when over 20,000 applicants learn where they have “matched” to pursue residency training come July. For the uninitiated, here are more articles on match day and the residency match process.

You can imagine the amount of jubilation surrounding this event. Stress- and anxiety-ridden medical students discover the light that follows their four years of slavery through medical school (little do they know that the slavery continues into residency, but let’s not spoil the moment). Families proudly rejoice the significant achievements of their loved ones. Friends find another reason to capture the excitement over a pint or two. And then … there are the overworked, overstressed, over-everything interns who look forward to their replacements arriving soon.

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On The Wards participates in this week’s Grand Rounds with our report on the weight loss management (WLM) clinical trial. Version 4.26 of Grand Rounds is hosted at Polite Dissent, and comes packaged with a theme of the Wild Wild West. The blog’s author is a family physician from Southwestern Illinois whose love for comics is also apparent in his other writings. Many previous posts provide excerpts of medical themes found in traditional comic book genres. This is indeed a unique and interesting feature of his blog.

It almost seems that a million-and-one books are published everyday touting the secret to rapid and sustained weight loss. But, how many of these diet schemes have been verified to produce the results they advertise? In the latest JAMA (Journal of the American Medical Association) issue, a group of academic centers involved in the Weight Loss Maintenance (WLM) initiative published their results from a three-year study comparing strategies for sustaining weight loss. The project is sponsored by the National Heart, Lung, and Blood Institute (NHLBI), and includes four clinical centers: Duke University, Johns Hopkins University, Pennington Biomedical Research Center, and the Kaiser Permanente Center for Health Research.

The design of the WLM clinical trial involves two phases. Phase 1 comprises a 6-month period where all participants undergo similar intervention to obtain weight loss. Working closely with a trained interventionist, the group strives to achieve a weekly weight loss goal of 1-2 pounds per week through a combination of strategies, such as caloric reduction, dietary modification, and increased physical activity. After having lost weight in phase 1, participants in the 30-month phase 2 trial are randomly divided into three groups, each with a different level of intervention to encourage maintenance of weight loss: 1) minimal intervention; 2) technology-based intervention, with use of an interactive website which sets personal goals, action plans, and provides an online support community; and 3) personal-contact intervention, involving monthly contact with a weight-loss interventionist.

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