// great “Gamification” of learning about Sepsis
Compared with intakes between 600 and 1000 mg/day, intakes above 1400 mg/day were associated with higher death rates from all causes (hazard ratio 1.40, 95% confidence interval 1.17 to 1.67), cardiovascular disease (1 49, 1.09 to 2.02), and ischaemic heart disease (2.14, 1.48 to 3.09) but not from stroke (0.73, 0.33 to 1.65).
// great RadioLab episode regarding end of life wishes amongst general population vs. MDs, worth a listen
// Great project from Atul Gawande about End of Life Care
Einstein’s 10 amazing life lessons
Follow your curiosity
Perseverance is priceless
Focus on the present
The imagination is powerful
Live in the moment
Don’t expect different results
Knowledge comes from experience
Learn the rules and then play better
Moves is disrupting Fitbit, the Fuelband, and all those other nonsensical gadgets.
I’ve been using Moves for about 2 weeks now and I really, really love it. It’s an app that essentially functions as a pedometer and runs in the background tracing where you’ve been throughout the day and measuring your steps.
It is not some goofy thing I have to wear on my wrist or on your bra. It’s not something I have to remember to charge. Fire it up once, and it’s on for as long as you have an iPhone. It may not be as “good” as a Fitbit or Fuelband, but it works just fine, it’s available to everyone with an iPhone for free, and it runs in the background of your life. And, most importantly, I haven’t noticed an impact on my iPhone’s battery.
It’s a classic disruptive innovation.
I bought a Fuelband a few months ago, synced it with my iPhone, and connected it to Facebook. Facebook said “You have 37 friends with a Fuelband. Click here to see how many people have live data in the past week.” I clicked and saw 2 people. I immediately returned it to the Nike Store. I knew that goofy thing would be in some drawer in a month after the novelty wore off. And I don’t like to throw away money for gimmicks.
My iPhone is not a novelty. And Moves now runs in the background of my life letting me know how active or inactive I’ve been that day. Interesting, motivating, and exciting stuff. Congrats to the Moves team. Y’all are killin’ it.
// 2 of the 5 Bluezones were in the Mediterranean - these results are no surprise
// I’m a big fan of their high fat, high veggie diet
Damn Bed Alarms at Hospitals don’t even work…
Annals of Internal Medicine - Nov 2012
Results: Prevalence of alarm use was 64.41 days per 1000 patient-days on intervention units and 1.79 days per 1000 patient-days on control units (P = 0.004). There was no difference in change in fall rates per 1000 patient-days (risk ratio, 1.09 [95% CI, 0.85 to 1.53]; difference, 0.41 [CI, −1.05 to 2.47], which corresponds to a greater difference in falls in control vs. intervention units) or in the number of patients who fell, injurious fall rates, or the number of patients physically restrained on intervention units compared with control units.
Limitation: The study was conducted at a single site and was slightly underpowered compared with the initial design.
Conclusion: An intervention designed to increase bed alarm use in an urban hospital increased alarm use but had no statistically or clinically significant effect on fall-related events or physical restraint use.
Primary Funding Source: National Institute on Aging.
Proper use of Vancomycin
The story of vancomycin all started when a missionary from Boreno sent a sample of dirt to a friend at Eli Lilly. The compound isolated had activity against most gram positive organisms. In fact, it got its name from the word ‘vanquish.’ Vancomycin was FDA-approved in 1958. 
- Do NOT simply give 1gm as the 1st dose to everyone
- 15-20 mg/kg for non critically ill
- 25-30 mg/kg for critically ill
- Initial dose should not be adjusted for renal function (adjust later)
- For bacteremias/endocarditis: if the S. aureus MIC ≥ 1.5 mcg/mL, don’t use vancomycin!
- For all other MRSA infections: if the S. aureus MIC ≥ 2 mcg/mL, don’t use vancomycin!
Radiolab - The Bitter End
Fantastic short podcast from Radiolab of WNYC discussing research looking at what life-saving interventions doctor would want done on themselves and the gap in the public’s knowledge about the effectiveness of life-saving interventions. Take 20 minutes and listen to this podcast; it is well worth it. Here is a graph from the research they discuss:
The dermatologists correctly identified the suspicious moles 98 percent of the time. But the apps that relied on algorithms were much less reliable, missing the melanoma 30 percent of the time.
// first major publication
// For those on the Pill, Clot risk is truly minimal
Even if you take the pill or the patch, the odds are overwhelming that you’ll make it through your reproductive years without ever having a blood clot.
The risk of actually dying from a blood clot due to your hormonal birth control is about one in a million.
Three decades of mammogram screening has had only a modest impact on the incidence of late stage breast cancer, and leads to over-diagnosis and over-treatment of early stage cancers in return. Declines in mortality are modest, and can be attributed in large part to advances in breast cancer treatment - See more at: http://www.tbtam.com/2012/11/understanding-mammogram-overdiagnosis.html#sthash.RfZje4Em.efYDBEVf.dpuf
// Great 2012 NEJM Review of Mammography