Scientists Create the Definitive Flu Killer

Had to brag about my school a little…

Guest Post: Some Radiology Perspective

When physicist Wilhelm Röntgen documented the bones of his wife’s hand using x-rays, he could not have imagined how profoundly his discovery would continue to impact the medical profession more than a hundred years later. He could not have predicted his Nobel Prize or the element that would be named in his honor, Roentgenium (Rg). Today, electromagnetic radiation is used for an abundance of medical processes, from traditional skeletal analysis to more complex tumor diagnosis procedures. The x-ray breakthrough inspired a generation of medical imaging technologies like MRIs and ultrasound that are so heavily relied upon in obstetrics and cancer screening, and which continue to save lives. And of course, more than a century after the initial discovery, engineers and doctors are still finding clever ways to use radiologic devices for the benefit of mankind.

Everyone knows that yearly mammograms for women, starting between 40-50 years of age, are a good idea. In fact, a new, large-scale Swedish study claims to confirm the benefits of this procedure. How does a mammographic test work? Well, it uses x-rays to create an image of the breast, illuminating potential abnormalities and supposedly boosting breast cancer survival rates. But this technology still has a long way to go, and its effectiveness is actually still under question by a lot of people. There have been numerous cases of false positives and even entire tumors going completely undetected in women, so-called “false negatives.” The technology isn’t perfect and it still has a long way to go before it is universally accepted, but x-rays made it possible to begin with. The x-ray has spawned an entire diagnostic niche that continues to get better and that, in time, will save more and more lives.

As with any fatal disease, the early detection of lung cancer–and preventative screening–continues to help in the fight against mortality rates. A recent decade-long study has revealed that low-dose computed tomography (CT) chest scans contributed to a 20% decrease in lung cancer mortality as compared to people screened with chest x-rays. What’s important to note here, of course, is that both of the techniques use x-rays as the electromagnetic source to generate images. What this appears to show is that the CT process, which is a much more sophisticated and refined version of the traditional x-ray, is more effective at actually detecting the cancer. This is good news for the radiologic industry in general and will help pave the way for more advanced and creative use of the technology, but there are still people who dispute the fact that these procedures can actually cause cancer, since they expose the body to limited amounts of radiation.

And how about those NFL players who are constantly butting heads and breaking bones? Sports, which is a huge industry both in the US and around the world, relies on radiological technology more than most people probably imagine. Recently, a group of 75 ex-professional football players decided to sue the NFL after a recent paper in the Journal of Radiology revealed disruptive brain connectivity in post-concussive patients. In a profession where sports players are expected to recover quickly and get back in the game as soon as possible, health can sometimes seem secondary. The ex-players alleged that the NFL was purposefully concealing the negative effects of concussions, and that they had been doing so for many years. Imagine that: a potentially major lawsuit built entirely on a study created from x- ray images. Indeed, radiology is far-reaching and will continue to find more intriguing use over time.

Most CT scanners are enormous cylindrical machines that occupy an entire room of a hospital, but this is changing. The Ceretom is the only portable CT technology of its kind in North Jersey, and Valley Hospital has been using it in the operating room during surgery. While Ceretom can only be used to scan specific body parts at this time, it can be transported to any part of the hospital, increasing its versatility. It’s a great example of the direction in
which radiologic technology is heading: towards more diversified use and more compact transportation.

These days, preventative medicine is gaining a lot of momentum in health care. As it continues to do so, it’s always valuable for doctors–and medical students!–to have a perspective on how creative uses of x-ray technology will continue to change their day-to-day routines. Radiologic technology is a cornerstone of the medical profession. The prospect for improvement is great. People are finding new uses for CT technology in gunfire trauma. The ultrasound is becoming increasingly more universal. The list goes on.

It will only be a matter of time before more novel uses crop up, and often it is doctors who help inspire and generate these new ideas. Remember that without radiologic technology it would become much more difficult, neigh impossible, to detect certain cancers of the brain and in the lungs. The doctor’s life would become increasingly more difficult, and indeed health care would, too.

This is a guest post written by Anderson Hawthorne, a biomedical engineer and contributor at x ray tech, a radiology technology resource site.

The first day of the rest of our lives

Tomorrow we will enter the hospital in a brand new role. As third year medical students. For once, we won’t be following attendings in packs, imposing on patients to let us poke and prod them one after another, with no responsibility except for our own learning. When I ask members of my class how they feel about tomorrow I’ve gotten a lot of similar answers. Excited. Scared. Nervous. And every once in awhile, Dread. Fear of the unknown. Insecurity. And Self-doubt.

We have spent the past two years sitting in the library, listening to lectures in class (or at home), studying. We were responsible for our grades but nothing else. No one else depended on us. Well, in our school lives at least. While we have no real power as MS3s, I have been reassured over and over again by attendings that we really are vital to how the hospital is run. We have more time with our patients than anyone else. We are the ones who can sit and talk to them, get to know them, maybe pick up on the random fact that they forgot to mention to anyone else but actually ends up being crucial to their treatment. We are the ones who have time to do research on our patients and their ailments. We’re more likely to pick up the zebras.

While many of my classmates feel these various feelings about tomorrow I hope that we soon overcome our fears. We are important and we really can have some good ideas every once in awhile. Recently while talking with Dr. Jones (an internal medicine faculty member at UTSW), he told a very interesting story. He had a student who was presenting a patient and stated that he believed the patient had Budd-Chiari syndrome and went on to explain his reasoning. No one else had thought of that. The resident hadn’t thought of it and Dr. Jones, even after decades of experience, hadn’t thought of that. Turns out, Budd-Chiari syndrome is exactly what the patient had. That third year medical student was not only smart enough to come up with the right answer but also confident enough to present it.

So to all the new MS3s, good luck tomorrow! Be confident, work hard, and always think about what’s best for your patients and you can’t go wrong.

Introducing- ScrubSmarts Consults!

Consult: to ask the advice or opinion of

Here at ScrubSmarts we are so excited to announce the launch of our new feature on our blog. ScrubSmarts Consults is a place for UTSW students to post advice and tips about the different clerkships we will be rotating through during our third year of medical school.

You must have a valid UTSW e-mail address to post and must input your graduation year but all posts are completely anonymous. Posts must also be approved before they will be displayed but posts will only be denied if they are deemed inappropriate. To view Consults, just click on the “Consults” link at the top of the page next to the “Home” button.

So keep Consults in mind during your rotations and check back often!

Hope you all had a good fourth of July and good luck tomorrow!

- Brielle

The Times They Are A-Changin’…

Changes are happening here at ScrubSmarts so we just wanted to give you a heads up! First of all, we will be launching a new area of our site (very soon!) that all of you new UTSW MS3s are going to love- but we’re keeping it a surprise until it launches.

Second of all, the focus of ScrubSmarts is going to change a little.

• As we move in to the hospital, there will be more personal experience posts (since I’ll finally have more to talk about than studying).
• We are also hoping to add in some interviews with physicians about their specialties to help us all figure out what we want to do when we grow up.
• And last, but not least, we are looking to start adding some guest posts! If you have a personal experience you would like to share or an opinion about a recent article or some new research you would like to talk about please submit a guest post! We will be adding a “Submit a Guest Post” button soon but if you would like to submit one sooner, just e-mail us at 

Don’t worry, we will still be sharing interesting news articles, medical technology news from Samer, and linking to our favorite medical blogs. If you have any suggestions or want to let us know what YOU would like to see on ScrubSmarts, please don’t hesitate to let us know!

Have a great fourth of July weekend!

Airlines Relying on Traveling Doctors to Aid in Mid-Air Emergencies

Today the New York Times published an interesting look at doctors coming to the rescue (or something like that) when there are medical emergencies mid-flight. Many doctors don’t answer when there is a call for a physician because their specialty probably wouldn’t help (who needs a Pap smear mid-flight? a psych consult? a mole examined?). And if they do answer, they often feel unsure about what their doing- and with dozens of eyes watching. The resources on a plane can be troublesome as well- what is in the medical emergency kits varies and often does not contain what is necessary.

I was very impressed by Dr. Paul Abramson, a primary care physician in San Francisco. He carries medications with him when he flies (antihistamines, prednisone, sedatives, and painkillers) in case they are not available on the plane. He books his flights using “Dr.” in front of his name so they’ll know he’s a doctor. And he actually enjoys answer the call for a doctor mid-flight. “Because it’s what I do, and it seems helpful, and it’s interesting to make do with whatever minimal resources you have,” he says.

I have to admit, one of my biggest fears is that in 20 years I’ll be the only doctor on a plane and I’ll be so specialized that I won’t remember how to do anything useful in an emergency. I remember reading this article a few months ago that made that fear even a little worse.

Once while on a plane, a physician responded to the call for a doctor to learn that another doctor had already volunteered and he was not needed. However, the flight attendant came back to get him because the first doctor who volunteered was having a little, well, trouble. The “patient” had a history of asthma and was having trouble breathing but was afraid to take more of her Albuterol because she had been told to take it sparingly. The first doctor was unsure of what to do.

The doctor already tending to her had not yet checked her vital signs, listened to her lungs, or administered a treatment other than oxygen. I wondered why, and then learned that the doctor was a radiologist (from Germany, as it happens). She seemed – what’s the word I’m looking for – yes, elated, to hand over the reins to me.

I really hope that one day I’m more like Dr. Abramson and less like that radiologist.

Break from Hiatus…

So I know just yesterday I said we were going on a Step 1 hiatus but I just had to share this…

The CDC has released a statement about what you should do in the case of a zombie attack. Yes, zombies.

David Daigle, a CDC spokesman, took the idea to Dr. Ali Khan, the agency’s director of preparedness, after the CDC received a question about zombies during an online chat about radiation leaks at Japan’s Fukushima Daiichi nuclear plant.

Then the CDC got a question about zombies during an online chat about radiation leaks related to the meltdown at Japan’s Fukushima Daiichi nuclear plant in March, and they saw traffic spike.
Khan and his communications team knew they’d found a way to get the public interested in disaster preparedness, he said.
“You have a ‘Resident Evil’ movie coming out, ‘Shaun of the Dead,’ ‘World War Z.’ It’s a good metaphor for where you have complete disruption,” he said.
So they posted the advice on Monday. Their website crashed on Wednesday. (from CNN)

Interestingly, the advice is basically the same thing the CDC recommends for most natural disasters. So maybe this is just a really clever marketing tool to get you to actually listen to what the CDC has to say… It also probably has nothing to do with the fact that “Resident Evil” is Dr. Khan’s favorite movie.

A Spotlight on Public Health, Invaded by Zombies- NYTimes
Ready for a zombie apocalypse? CDC has advice.- CNN

Step 1 Hiatus

ScrubSmarts will be on temporary hiatus while I study for Step 1. We’ll be back after June 18!

Be nice to your patients- or Medicare might not pay you

Medicare reimbursements could be tied to patient satisfaction surveys. As required by last year’s health care law, the Centers for Medicare & Medicaid Services is finalizing details for a new reimbursement method.

Under CMS’s “value-based purchasing” proposal, Medicare will begin withholding 1 percent of its payments to hospitals starting in October 2012. That money — $850 million in the first year — will go into a pool to be doled out as bonuses to hospitals that score above average on several measures. The agency’s final rule is due out soon.

This policy is terribly misguided. I understand the goal of trying to increase patient satisfaction but the truth is, patient satisfaction does not always correlate with the best care. Maybe their nurse was in a bad mood and while she still did everything she was supposed to do, she just didn’t do it with a smile. Perhaps money is spent to actually treat patients instead of for more aesthetically pleasing hospital rooms. Maybe a patient received news that they did not want to hear- who would rate a hospital has “highly satisfactory” when they were just told they were dying from lung cancer?

Tying reimbursement with patient satisfaction could even lead to worse medical care. In order to “satisfy” their patients, doctors might go against their medical judgment to order an unnecessary test or prescribe a medication not because it is the best option but simply because the patient wants it. Not to mention that this could cause even more physicians to stop accepting Medicare patients which is already a huge problem. The Centers for Medicare & Medicaid Services need to find a way to incentivize doctors to take Medicare patients and take good care of them- not drive them away from taking care of some of the patients that are most in need.

Dallas Doctors’ Toughest Cases

Some really cool stories about some tough cases here in Dallas. It’s no surprise that most of these physicians are at UTSW…

Dr. Alex Eastman: Operating on a Friend at Gunpoint
Dr. D. Rohan Jeyarajah: Removing a Woman’s Stomach
Dr. Robyn Horsager: Saving Twin Babies
Dr. David C. Smith: Fixing a Man Cut in Half by a Train
Dr. Michael DiMaio: Performing Surgery With a Robot
Dr. James McCulley: Giving A Man Back His Sight