Monday, September 18, 2017

A surgical resident’s legal battle with her program

My new post on Physician's Weekly is about a dispute between a resident and her surgical residency program that has escalated to court and the news media. Click here to read it.

Wednesday, September 6, 2017

The power of a photo in a tweet

Last week I did a little experiment on Twitter. No, I did not have IRB approval.

I wanted to see what the impact of attaching a photo to a tweet would be.

On August 30 at 10 a.m., I tweeted a link to a blog post I had just written about two new types of water—one that supposedly has “activated stabilized oxygen” in it and another that is “living crystal” water. Both are touted as having health benefits.

Here are the first tweet and its statistics.

Click on photo to enlarge it.
Of the 1299 impressions or unique Twitter accounts that could have been reached at 10 AM the time the tweet was posted, 11 (0.8%) people engaged with the tweet.

Three hours later I tweeted about the blog post again using similar wording but this time adding this photograph from the blog post.

Here are the tweet and its statistics. 

Wednesday, August 30, 2017

New varieties of water offer health benefits, but don't deliver

What if you could get more oxygen into your system by a method other than breathing?

A company says its oxygenated water, containing O4, also known as “activated stabilized oxygen,” can do just that. When you drink Oxigen [notice the clever spelling], O4 supposedly is absorbed under your tongue and in your stomach.

An article about this wonderful product states, “These aren’t just claims, but actual scientific processes supported by studies on stabilized oxygen.” Due to the limitations of space on the Internet, references to the studies are not provided.

The product “contains 1000 ppm of bioavailable oxygen” which is said to be about 20 times as much as the oxygen in tap water. Stabilized oxygen supposedly helps the body clear lactate and is beneficial for hangovers.

Friday, August 25, 2017

Quick takes on three recent stories


The magazine Popular Science reported on a paper which found after 20 subjects washed their hands at water temperatures of 100, 80, and 60 degrees, the temperature had no impact on bacterial counts. They also found antibacterial soap was no better than plain soap and water.

What did matter was time—10 to 20 seconds of lathering was better than 5 seconds, and 40 seconds was no better than 10 or 20.

The authors concluded that hands should be washed in water that was most comfortable for the individual.

In a blog post from last year, I pointed out that washing hands for more than 40 seconds, as advocated by a paper in Infection Control and Hospital Epidemiology, was impractical due to the excessive amount of time busy hospital staff would need to invest in doing so multiple times per day.

For example, 10 washes per hour at 40 seconds per wash is almost 7 minutes of hand washing times 8 hours equals 56 minutes.

Drivers who follow other drivers

The journal Frontiers in Psychology published a paper called “I’ll Show You the Way: Risky Driver Behavior When ‘Following a Friend.’” The authors, from the Human Systems Engineering department of Arizona State University, found that in order to keep up with the lead driver, drivers who don’t know the way took more chances when they followed someone.

The work was done by testing 16 college student subjects on a simulator. Drivers who followed were more likely to drive significantly faster, change lanes quicker, and in general “engage in riskier behaviors” than when listening to audible directions from a simulated GPS system.

The authors recommended that following another driver to a destination not be done. However if following is necessary, the driver of the lead vehicle should go slower and anticipate what the following driver might have to do to keep up.

1) I think most of us could have predicted the outcome of this research and come up with the same recommendations. 2) Does anyone who drives a car not own a smartphone in 2017?

What not to do with a hotel room tea kettle

According to the website, this is a thing that some people in China do when staying in a hotel. Whether travelers in Western nations also do so is not known.

A reporter for Gizmodo Australia asked a molecular biology professor from New Zealand’s Massey University to comment. She said, “It is super super super super gross” and pointed out that boiling does not necessarily kill spores formed by some types of bacteria.

Even if boiling killed all known living things, I still wouldn’t want to drink a cup of tea from a kettle that had contained someone’s skivvies the night before.

Wednesday, August 23, 2017

Bladder catheter + oxygen supply tubing = death

You may not be aware that I blog twice a month for the Physician's Weekly website. My latest post is called "Bladder catheter + oxygen supply tubing = death" and it can be read by clicking here.

How a pneumoperitoneum can kill.
This x-ray shows what happened to an elderly man whose oxygen tubing somehow became connected to his bladder catheter.

Tuesday, August 22, 2017

Three new studies confirm germs are everywhere

These ubiquitous germs don’t seem to be harming anyone, but reporting on the studies generates lots of clicks.

For many years kitchen sponges have been known to harbor bacteria. Now comes the news that cleaning those sponges not only doesn’t work, it may make the situation worse by promoting the overgrowth of potentially disease-causing bacteria—for example Moraxella osloensis.

The New York Times reports German researchers found kitchen sponges contained 362 different types of bacteria and as many as 82 billion bacteria per cubic inch of space. The senior author of the study said, “That’s the same density of bacteria you can find in human stool samples” [but not the same types of bacteria] and suggested replacing kitchen sponges frequently.

These revelations were based on bacterial DNA and RNA samples from 14 [yes, just 14] used sponges. Note the use of the word “potentially” to describe the pathogenicity of Moraxella. A PubMed search for this microbe back to 1968 yielded only 82 references, many of which were not pertaining to any human illnesses. The few case reports of infections involved patients who were immunosuppressed.

Wednesday, August 16, 2017

Fatal internal jugular vein cannulation by a misplaced NG tube

A case report published last month involves a 79-year-old man with multiple comorbidities including depression, alcohol abuse, hypertension, CHF, and COPD who was admitted because of abdominal pain and distention which was found to be a perforation of the right colon. 

He underwent a resection and did well until the seventh postoperative day when he became distended. A nasogastric tube was inserted. Its position was checked by injecting air through the tube and auscultating over the upper abdomen [a notoriously inaccurate method of locating an NG tube’s position].

A few hundred mL of dark blood came out. He was treated for a presumed upper gastrointestinal bleed. A chest x-ray showed the tube in good position but the tip was not seen.

When the patient’s vital signs deteriorated, a new NG tube was put in and drained 2 L of blood. The patient suffered a cardiac arrest and could not be resuscitated. At autopsy, the NG tube was found to have gone through the right pharyngeal wall and into the right internal jugular vein. The tip was in the superior vena cava.

Although I had never heard of this complication before, it has been reported in the literature at least one other time.