Patients can chew gum immediately before surgery I guess

A study presented at the American Society of Anesthesiologists (ASA) meeting in October of this year found that patients who chew gum in the immediate preoperative period may safely undergo surgery.

The authors, based at the University of Pennsylvania, found that gum chewing increases saliva production and the volume of fluid in the stomach, but stomach acidity was equivalent to that of non-gum chewers. An article about the study said The mean gastric volume, or total amount of liquid in the stomach, was statistically higher in patients who chewed gum before their procedure (13ml) versus those who did not (6ml). A 7 mL difference might be statistically significant, but surely is not clinically important.

The research differed from previous studies because it involved patients who underwent upper gastrointestinal endoscopy, which enabled the investigators to recover all of the fluid in the stomach for testing. Prior studies had been done using nasogastric tubes, and it was impossible to determine whether all gastric fluid was recovered when the tubes were suctioned.

The study involved 34 gum chewers who were allowed to chew any type or any amount of gum compared to 33 patients who did not chew gum.

Another article quoted its lead author.

"We found that although chewing gum before surgery increases the production of saliva and therefore the volume of stomach liquids, it does not affect the level of stomach acidity in a way that would elevate complication risks," explains Dr. Goudra.

He says patients shouldnt be encouraged to chew gum before procedures involving anesthesia, but the habit shouldnt necessitate the cancellation or delay of scheduled cases if other aspiration risk factors arent present.

There has been long-standing debate about the subject of whether using gum and hard candy should be treated the same as ingesting a regular meal.

I wrote about this on my blog back in January 2014 and pointed out that the ASA guidelines do not address the issue.

In an effort to do due diligence, I was able to locate the abstract of this paper on the ASA website. Im glad I did because the abstract came to the opposite conclusion.

When the abstract was submitted, it included fewer patients—24 who chewed gum and 23 who did not.

The average gastric volumes were 9.78 mL for the gum chewers and 24.08 mL for the non-gum chewers (p = 0.027), and pH values were not significantly different (p = 0.094). It looks like regression to the mean occurred as the number of subjects increased.

In the original abstract, the authors concluded the following: Chewing gum in the preoperative fasting period leads to significant increase in the residual gastric volumes, with no difference in pH. We recommend that patients who have inadvertently chewed gum in the fasting period should be treated as full stomach and management modified accordingly. [Emphasis added]

So what is going on here? This would not be the first time that an abstract differed from the final paper. Actually, this sort of thing happens quite frequently. However in this case, the conclusions of the two versions are diametrically opposed to each other.

The study was presented at a meeting. Lets see what happens when it is submitted to a journal for peer review.

The correct way to have done the study would have been to calculate the number of patients needed to be studied (power analysis) beforehand.

Since this was not done, I recommend we go with the conclusion of the larger number of patients studied because it agrees with my bias that chewing gum is not potentially harmful.

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Why I Decided to Get Involved in Shows

"Egotism is the drive to maintain and enhance favorable views of oneself, and generally features an inflated opinion of ones personal features and importance."

I think its safe to say that we have all known someone who was an egotist. Sadly, in the world of costuming more and more egotists are popping up. Some people believe that they are better than others, certain costumers are competing with each other and many are caught up in racking up the most "likes" on Facebook as if their very lives depended on it. Ive personally known people who got involved with conventions for one reason and one reason only; to see their names on the Guest List and brag about it to high hell. It has nothing to do with helping the show as a member of the staff or meeting with people interested in our craft. Its to be a "Cosplay Celebrity" or a "Professional Cosplayer." Because of the behavior Ive personally seen live and in person, I had sworn off getting involved with shows in an effort not to be like the Cosplay Egotists but all of that changed at the 2013 Pittsburgh Comic Con.

Im going to be blunt; there is no such thing as a "cosplay celebrity" or a "professional cosplayer". Every time I see or hear that term, I laugh myself silly. I truly believe that that is the most idiotic term I have ever heard. Cosplay is a hobby, not a profession. If you make and sell your own costumes and props, then you are a costume maker/seamstress/designer or a prop maker. Would you put "Professional Cosplayer" on a job application? If you did, Im sure you would be laughed out of the office or they would look at you like you had three heads. And what makes a person a "professional or expert cosplayer"? If you have experience then you can just as easily say "veteran cosplayer". Throwing in "professional" or "expert" is just a BS way of making someone appear glamorous and important. Now comes the title of "cosplay celebrity". True, there are certain costumers who are more well known than others but that doesnt necessarily mean that they are the best or celebrities.



A cosplayer is a cosplayer. Plain and simple. The fancy titles are smoke and mirrors.

I never wanted to become a costumer who sought the spotlight. I got into costuming to express my fandom, not to seek fame. Ive seen people change in their search for cosplay stardom and I was afraid I would be following down the path of egotism if I got involved with shows. But then I was asked last minute to be one of the judges at the Costume Contest at the 2013 Pittsburgh Comic-Con along side Freddie Nova. Although I was bewildered, I accepted. It was truly a learning lesson for me and completely changed my perspective. A lot of that has to do with the gracious Freddie Nova. Freddie is beautiful and very talented. Her liquid latex Venom photos went viral and she has an enormous fan base. Everyone from comic creators to comic fans and cosplayers knows who she is and yet she is very humble. She treats everyone with respect and was incredibly encouraging to every person who took the stage. I saw for the first time someone use their position to spread positivity and it was beautiful. I learned from her shining example and was sure to smile at all of the contestants, encourage them and even spoke to a few of them afterwards and online. Many were first timers in costuming who had many questions. It felt wonderful to help others and I want to continue that.



Im currently scheduled for 2 more local shows. Im not doing it to see my name in lights and I actually make it clear that I do not want to be credited as a professional cosplay celebrity". Im simply a cosplayer who wants to reach out and support the community. So think of me as a Goodwill Ambassador of Cosplay, if you will. But never a professional cosplayer. *laughs*

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Why I blog and tweet

I have reached a new milestone. My work has been published in a a real journal, the Canadian Journal of Anesthesia. I was asked to write an editorial about social media--"Why I blog and tweet."

If you would like to read it, the full text is available here.

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Antibiotics for appendicitis No thanks

The long-awaited Finnish randomized controlled trial of antibiotics vs. surgery for appendicitis was just published in JAMA. Depending on your perspective, 73% of patients were successfully treated with antibiotics or 27% of patients failed antibiotics and needed surgery.

The good news is that it was a large multicenter study involving 273 patients randomized to surgery and 257 to antibiotics. Patients included in the study had uncomplicated appendicitis as diagnosed by CT scan.

The bad news is that the paper has many limitations.

Of the patients who underwent appendectomy as the primary treatment, only 15 (5.5%) had laparoscopic surgery. The authors state that open appendectomy was selected as the protocol operative technique because laparoscopic instruments may not be available worldwide and apparently many surgeons in Finland are not experienced in performing laparoscopic appendectomies.

In most Western countries, laparoscopic appendectomy is the procedure of choice. In the United States, at least 80% of all appendectomies (not just those done in patients with early or simple appendicitis) are done laparoscopically. Laparoscopic appendectomy has a much lower complication rate than open. This renders the comparison of complications of surgery (20.5%) and antibiotics (2.8%) in the Finnish randomized trial meaningless. The Finnish authors did not consider failure of antibiotic treatment a complication. Had they done so, the complication rate would have been higher for the antibiotic group.

The hospital length of stay for the surgery patients in the JAMA study was a median of three days. A paper from Texas published last year found that of 345 patients who had laparoscopic appendectomies for uncomplicated appendicitis, 88% were managed as outpatients. They spent a total of about eight hours in the hospital from admission to discharge and had a complication rate, including readmission, of 2.8%.

The antibiotic chosen for the in-hospital treatment in the JAMA study nonoperative group was ertapenem—a once-a-day drug that costs $80 per dose. How available is ertapenem in low- and middle-income countries?

The follow-up in the current paper was only one year. Is it realistic to expect that no more patients will have recurrences of appendicitis in the following years?

The inconvenience and costs of the extra hospitalization for the 27% of patients who failed antibiotic therapy were not addressed.

The stated goal of the trial was to prove the noninferiority of antibiotic therapy for appendicitis. By the authors own admission, the result failed to meet their prespecified criterion for noninferiority. In plain English, this means the trial showed antibiotic therapy is inferior to surgery for the treatment of uncomplicated acute appendicitis.

Early last year, I blogged about the potential problems with this study and said, "A randomized trial of antibiotics vs. surgery for uncomplicated appendicitis is underway in Finland. Judging from the wording of the abstract describing the trial, the authors are markedly biased toward the use of antibiotics. Despite this, lets hope it sheds some much needed light on this subject." Too bad that did not happen.

Other than Dr. Edward Livingston, a surgeon who wrote a favorable editorial accompanying the paper in JAMA, I do not know of any surgeons who would opt for antibiotics to treat appendicitis for themselves or their family members.

A more realistic randomized trial is planned by surgeons in Washington State. Until that study is published, I’ll stick with surgery for uncomplicated appendicitis.

Addendum: The spelling of ertapenem was corrected on 6/18/15.

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Why Charity Work Matters to Me

Charity Work is something that I have been interested in for quite some time. My interest reached a new level after discovering that many people I knew were in the Heroes Alliance. The Heroes Alliance is a nationwide non-profit organization of  volunteers who give back to the community by making super hero appearances at child-related charities and events. I had seen many wonderful photos and spoke to the charity workers about their mission and how they used their skills in costuming to brighten a childs day. They became real life heroes to children (and their families) who desperately needed hope and I wanted to become a part of it.



I wanted to get involved for many reasons. First and foremost, I know what its like for your life to suddenly change. In 1999 I went from able -bodied teenager to being in a wheelchair in a blink of an eye. One moment I was carefree and the next, I was bleeding and broken, trapped in a car. Words cannot describe how shattering it is for your life to suddenly change. You experience shock, depression, anger, exhaustion, hopelessness and a whole other truck load of emotions. And then theres your family and what they are experiencing. It is not easy. The world goes dark and during these times it is so important to let any amount of love and light in. It does make a difference. It can help you heal. I was so happy after months of being in the hospital, when I was finally taken to the art room to do a craft project. That memory stands out. That happy moment. If Superman or Wonder Woman came to visit me, I can tell you right now that would have made all the difference in the world.

When I got the process moving on creating and running a Heroes Alliance branch in Pennsylvania, the unthinkable happened. My grandmother had fallen ill. My beautiful green-eyed grandmother was always there for her family. If someone needed a place to sleep, she offered her couch. If they needed a meal, she cooked for them. She swept the sidewalk of her neighborhood and always loved telling people that God loved them. She was a good, loving woman and sadly in late 2013, I had to gather up the strength to say good-bye to her on her deathbed. That was the hardest thing I have ever done. Emotionally and mentally I was a mess and then my body shut down. I broke out in hives that spread throughout my body and came down with a cold. I was in bed and on medication for days and yet, I did not want to stop the process on creating a Heroes Alliance branch. Although I was terribly sick, I felt my grandmothers strength with me and knew proceeding with this would be the best way to honor her memory.

My grandmother and my accident is why charity work matters to me. I know what its like for your life to change and I know what its like to lose someone you love. My grandmothers kindness and generosity inspired me to help others like she once did.


I cant speak highly enough about the Heroes Alliance organization. It truly is a beautiful concept to give back and an added bonus that we are dressed as super heroes. Everyone has a big heart and they are just as passionate as you are to make the world a better place. We are making a difference and spreading love, support and positivity.  And everyone within the organization supports one another in their mission 110% all throughout the United States. We all have a story on why super hero charity work means so much to us. Now you know mine.

Dedicated to Virginia
I love you

                                                             

                 
                                                   

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I can date a poor man Ani Amatosero

Effixzzy Magazine publisher/CEO Effixzzy Production, Ani Amatosero, is back on the block and she is poised to release two new movies entitled Guy Next Door and Edge of Darkness. Read her recent interview after the cut...

Describe your ideal man?

"I don’t have any perfect description of my ideal man. All I know is that there is a man God has made to be my husband. The mistake most women make is that they see their boyfriends as husbands and husbands as boyfriends. He doesnt have to be rich, so long he has a vision that he is working towards. Most women marry the wrong men because of what they look out for in marriage, things like money, security, fame and so on. They forget that when you finally settle into the marriage and you don’t see all these things, the love simply fades; it is good for a woman to be hard working. When you do that, your husband will be your supporter and not an access to riches. I don’t want to be a woman saved by a prince, I want to be a queen that is an asset to her king.

Can you date a poor guy?

Yes, why not? I can date a poor guy. Any hard working woman will not look at the pocket of any man; you don’t marry a man’s present but his future. For such women, the mantra is it can only get better. Like I said earlier, my ideal man must have a vision and must be hard working. And let me add, a man with a vision is not a poor man. Wealth is not how much you have, but rather, how many lives that you can touch. Do you agree with her?

Meanwhile her two movies will be released this March.

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Awesomecon 2014 Coverage

The Awesomecon 2014 show took place April 18th-20th at the Walter E. Washington Convention Center in Washington, D.C. Guests in attendance included Doctor Who actress Billie Piper, Lord of the Rings Star Sean Astin, The Walking Deads Danai Gurira, Once Upon A Time star  Raphael Sbarge and many more. Comic guests included the legendary George Perez, Dan Parent and Jamal Igle. For a complete guest list, please check out the Awesomecon official website. The show offered exclusives such as t-shirts and exclusive issues of My Little Pony, Skullkickers, and Monster & Madman. Photo Ops with celebrities were offered as well as plenty of panels and an official after party Saturday night.

My photographer (Brian Green of Green House Photography) and I attended the show Saturday and Sunday. After arriving at the nations capital in the mid afternoon, we checked into our hotel. We were booked for a Superman/Lois Lane photo shoot so I immediately changed and we headed to the lobby to meet our Superman (who bears a strong resemblance to Christopher Reeves). We walked to a small courtyard in the back of the hotel where we conducted our shoot and the images came out stunning. After the session was over, we made our way back to our room where I changed into Ariel (Kiss the Girl variant) and headed to the convention center. After picking up our passes, we made our way to the convention floor with a group of friends.



The crowds were massive on Saturday. There was a large number of impressive cosplayers portraying everything from Comics, Disney, Video Games and Anime. Many vendors were there and the celebrity signing areas were located in the back. Artist Alley (my favorite area of any con) featured many talented artists with beautiful artwork. During Saturdays show, we squeezed in an Ariel/Ursula photo shoot. We ended the day with a group dinner where George Perez joined us.

On Easter Sunday I dressed as the Disney version of Snow White. We attended a church service performed by Fans for Christ in one of the panel rooms with our friend Cosplay Jesus. After the service, we went to the con and immediately noticed a difference in the crowd. Whereas Saturday was wall to wall people, Sunday was very laid back and had less attendance, most likely due to the Easter holiday. I met up with my friend Jacky of Evil Queen Cosplay who was dressed as the Once Upon A Time version of Snow White (yes, we planned it that way).  We went to say hello to actor Raphael Sbarge who gushed over our costumes and asked to take a photo with us. After some shopping and conversing with friends, we did a joint Snow White photo shoot before saying goodbye and making the long drive back home.




This was the first time I cosplayed Disney Princesses all weekend at a show and I absolutely loved it. The reaction from kids and adults was wonderful and princess costumes are much more comfortable than super hero gear. I think in the future I am going to be leaning towards more characters from the fairy tale world.

I was very impressed with the Awesomecon Show. For an event that was only in its second year, it was well organized and had plenty to offer in terms of shopping, exclusives, comic talent and celebrity actors. Now there has been some complaints regarding ticket lines and Saturdays crowds. First I want to address the Saturday crowds at Awesomecon. Based on observation and my 11 years experience going to conventions all around the country, I know and am always fully prepared for Saturday crowds at any show. Thats con life and thats the way its been for several years. Its never going to change. In fact, now that comics and geek culture are mainstream, you can expect more people to be in attendance. I find that the people who complain about crowds are the ones who are new to conventions and who quite frankly, dont know any better. I feel that it is unfair criticism in Awesomecons case.

In regards to ticket line complaints, that is something that I did not experience but I am happy to report that the president of Awesomecon released a statement via their official website and Facebook Page addressing fan concerns. This move is to be applauded; whereas most cons just shrug off their fans, Awesomecon is reaching out and is striving to make next years show even better. The statement can be read HERE.

Next years show will be taking place May 29th-31st, 2015 and I look forward to returning. My thanks to everyone at the Awesomecon convention for a great show.

Please be sure to check out images from official shoots on Green House Photographys Awesomecon 2014 Folder.  For my complete gallery, check out my folder on my Official Facebook Page.

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A medical riddle Where do incident reports go

Incident reports are frequently submitted by hospital personnel. Did you ever wonder what happens to them? I have.

Over the years, I estimate that I’ve heard of hundreds of such reports being filed, but rarely have I heard of a problem being solved or for that matter, any action being taken at all.

In fact, I don’t even know where they went or who dealt with them. When I was a department chairman, I sat on quality assurance and risk management committees. Yet we never discussed individual incident reports.

The original intent of incident reports was to identify patient harms and increase patient safety.

According to a 2009 post by patient safety expert Dr. Bob Wachter, hospital incident reports are a spinoff from the Aviation Safety Reporting System which had successfully used them for identifying potential safety issues such as near misses.

At Dr. Wachters hospital, San Francisco General, about 20,000 incident reports were filed every year. That is about half of what the Aviation Safety Reporting System receives per year, and San Francisco General Is only one of about 6000 hospitals in the United States.

Dr. Wachter feels that analyzing incident reports is not worth it. He estimates that each incident report creates about 80 minutes of work times 20,000 reports, which equals about 26,600 hours of wasted time. He also estimated that about one fourth of US hospitals do nothing with incident reports. That saves time but renders the reports useless.

He says an even bigger problem is that incident reports in his hospital fail to capture most events that harm patients.

That has also been my experience. I think most incident reports were filed by people wanting to "cover their asses" and most of the reported incidents were minor. A reference in Wachters article states that most incident reports are submitted by nurses with only about 2% by doctors.

Incident reports can backfire too. From a 2002 Medscape article: "In some states, under certain conditions, the incident report is considered confidential and cannot be used against the nurse practitioner in a lawsuit. However, if copies are made or the chart reflects that an incident report was completed, the incident report can then be subpoenaed by the patient and used against the defendants in court."

And from the Louisiana State University School of Law: "The nonjudgmental nature of an incident report is very important because in most cases the incident report will be discoverable in litigation. An accusatory remark in an incident report may gain unintended weight in a legal proceeding."

Since incident reports generate a massive amount of wasted time, fail to identify most events that harm patients, are frequently ignored, and can possibly have a negative effect on lawsuits, why are they still being filled out by the thousands?

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What about activity restrictions after surgery

Although, uncommon, bleeding after surgery is the most common potential post-operative complication. To minimize the chances of this occurring, patients are advised to be as minimally active after surgery as possible. This includes activity restrictions such as:
No bending or heavy lifting
No rigorous exercise or exertion
Do not make important plans in the days immediately following your surgery

The above instructions appear on the website of a medical school department. The operation in question is

A. Cholecystectomy
B. Partial mastectomy
C. Inguinal hernia repair
D. All of the above
E. None of the above

Answer: E. None of the above. While all three of the operations mentioned could have been the subject of these activity restrictions, they were taken from a dermatology services description of the aftercare of Mohs surgery, which is a way of exercising skin cancers—not exactly major surgery.

This topic was suggested to me by a Twitter follower.



I told him that as far as I knew, there is no evidence basis for any of the activity restrictions we tell patients.

When I was a resident in the early 1970s, we kept patients who underwent inguinal herniorrhaphy in bed for no fewer than five days, and nephrectomy patients were bedbound for a week.

For the former, the theory was that early activity might disrupt the repair—implying that many repairs were tenuous in those days. Regarding nephrectomy, the prevailing wisdom was that the tie or ties on the renal vein could be dislodged by increased pressure in the inferior vena cava from something as trivial as a Valsalva maneuver. Following this logic, we should have prevented nephrectomy patients from coughing or having bowel movements too.

Since then, progress has been made. Hernia patients are discharged on the day of surgery, and nephrectomies are not kept in bed.

What is the definition of "heavy lifting"? It is usually described as lifting more than 10 lbs. Where did that come from? Other than 10 being a nice round number, I cant think of another reason.

A far-from-exhaustive literature search revealed no evidence-based studies and nothing at all pertaining to general surgery.

A 2008 opinion paper suggested that cardiac surgery patients who have excessive limitations on their activities might suffer excessive anxiety and depression leading to poor outcomes. They recommended that patients be given "personalized activity guidelines developed by an exercise specialist to help them resume their presurgical lives."

Activity restrictions after gynecologic surgery are also not evidence-based. A review from the University of Utah found no studies relating postoperative activity and surgical success. A previous survey had found "Depending on the surgery, 88-99% of surgeons restricted lifting for mean of 5–7 weeks (range 1–26 weeks and up to forever [?] after vaginal hysterectomy with vaginal repairs)."

In 2011, an expert panel said patients undergoing laparoscopic supracervical hysterectomy should avoid lifting more than 10 kg, bicycle riding, and vacuum cleaning [?] for two weeks.

At the other extreme is the story of Ryan Callahan, a forward for the Tampa Bay Lightning of the National Hockey League. Last May, he began practicing three days after a laparoscopic appendectomy and played in a playoff game two days later.

To put it mildly, the topic of postoperative activity restrictions is long overdue for prospective study.

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Should I go to med school

A young man writes

I am thinking about pursuing medicine as a career. However, it is not something that I am entirely sure of because of the changing healthcare landscape.

Suppose I enter medical school at age 26. Four years later I have my MD. Five or six years later I will be done with a surgery residency and two years after that with my fellowship. I will 37-38 years of age with kids, a wife, and most likely a home. My kids will be around 9-11 years of age. In addition, I will be near $250K in debt from medical school because of interest accumulated throughout my residency and fellowship. This is of course not including retirement, car, house, investment, and kids’ college savings.

My friends tell me not to think about it, but if I don’t, I can end up in a position that I don’t want to be in. Even if I pay off my debt at age 50, I still have all those other things to address. And even if I do, when will I enjoy my money? What is perhaps most important though, is the time component. I am essentially giving up my entire life to a profession that will not allow me to transfer laterally to other professions if I choose to. I can be pursuing my other interests in the time that I would be becoming a surgeon such as business or engineering.

Lastly, I grew up in poverty and have no financial assets. It will take me years to accumulate wealth. And once I do (at around age 60), that wealth will be passed down to my children.

Did I miss something? What are your thoughts? 

While rereading and editing your email, I realized you did miss something. Whats missing is enthusiasm for becoming a doctor. You listed several reasons not to go to med school, but nothing about why you want to do it. If you don’t truly love the idea, you will be very unhappy.

I think you need to reassess your future.

For those who want more information, I have written a couple of posts about questions related to this one [links here and here.] The comments on the more recent post are worth reading..

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Whats The Best Tools For Adfly Which One Should I Use

Whats The Best Tools For Adfly Which One Should I Use?

Goodmorning, well for me it is here 4:07am and me here drinking coffee and uploading this post for you guys. But let me say i love it , this job is the best job you could ever have! BELIEVE ME ON THAT!!

Whats the best tools to use for adfly:

Adf.ly has many features and tools which can help you to make even more money.

Mass Shrinker: Mass Shrinker is a tool which allows you to shrink up to 20 URLs at a time. It is a good tool if you want to shrink many URLs at a time.

Multiple Links: This allows AdFly to convert ALL of the links on a page into Paid Links. You simply cut & paste the HTML of a page into the HTML box of the tool and it will generate a new page for you.

Easy Link: If you don’t need a short URL and you just want to make money from your blog or website, Easy Link provides you the quickest and simplest possible way to earn with adf.ly:

Bookmarklet: It is toolbar that you can install in your browser. Whenever you visit a page online you just simply click Shorten with adf.ly! button in your tool bar and you will get shortened adf.ly link for that URL.

API Documentation: This tool you everything you need to integrate adf.ly links in your applications.

Google Analytics: You can use this tool to see your adf.ly statistics in google analytics.

Full Page Script: If you have a blog or website and you want to convert all your links into adf.ly links, this tool gives you the code for that.

Website Entry Script: This tool allows you to make money every time someone enters your blog or website. First the visitor had to see advertisement for 5 seconds and then he will be allowed to visit your site.

Export Links and Stats: This tool allows you to export your shortened links and statistics so that you can have a backup of them.

Domains: This tool allows you to use your domain or subdomain names with adf.ly service. 

Pop Ads: If you have a website or blog and wish to earn money when a visitor simply enters your site (even without clicking an AdFly link!), you can use this tool to display Pop Ads.

Mass Delete: Recently adfly added this tool which allows you to delete your links that were created in a given data range. uou can select data range and delete your links at one click.

Dont forget to check out my other posts! So you can make tons of money online with adfly.

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Those who can publish Those who can’t blog

What’s your view on social media and science? For example, the role of science blogs in critiquing published papers? "Those who can, publish. Those who can’t, blog," says Jingmai OConnor.

According to Cell.com, Dr. O’Connor is a professor at the Institute of Vertebrate Paleontology and Paleoanthropology of the Chinese Academy of Sciences, and her comment was part of an interview published last month.

Dr. OConnor says, "It often seems those who criticize or spend large amounts of time blogging are also those who don’t generate much [sic] publications themselves." She thinks comments should be peer-reviewed and published only in journals. She worries about the public who may not realize "a published paper passed rigorous review by experts, which carries more validity than the opinion of some disgruntled scientist or amateur on the internet." She adds, "criticism in social media is damaging to science, as it is to most aspects of our culture."

Apparently she isnt aware that peer review is under fire from a number of respectable sources.

"If peer review was a drug it would never be allowed onto the market," said Drummond Rennie, a contributing deputy editor of JAMA. Richard Smith, former editor of the BMJ agrees "because we have no convincing evidence of its benefits but a lot of evidence of its flaws."

In 2015, 107 scientific papers were retracted by several journals because their authors, nearly all of whom were Chinese academics, had performed fraudulent peer review by creating fictitious names and email addresses of suggested reviewers so they could write glowing reviews of their own work. Some of these charlatans are from Beijing, where Dr. OConnor is based.

Australian bloggers found an error that had somehow been missed during "rigorous review by experts" regarding the number needed to treat in a New England Journal of Medicine paper on targeted vs. universal decolonization to prevent ICU infection. They contacted the papers corresponding author who acknowledged the mistake within 11 days. It took five months for a correction to appear online in the journal.

Whether Dr. OConnor likes it or not, the future will involve more immediate feedback about research papers. For example, PubMed and PubPeer already allow comments, and the BMJ also has a section for online rapid responses.

Blogger Marc Bellemare, an associate professor of economics at the University of Minnesota, cites David McKenzie, an economist/blogger at the World Bank who thinks that blogs play an important role in disseminating information to the public and "raise the profile of bloggers and their institution."

But Bellemare feels blogging might not be for every academic He quotes Tyler Cowen of George Mason University, who when asked why dont more economists blog replied, "I believe it is because they can’t, at least not without embarrassing themselves rather quickly, even if they are smart and very good economists. It’s simply a different set of skills."

Maybe Dr. OConnor doesnt have the skill set to blog. I say, "Those who can, blog. Those who cant, insult those who can."

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How Can I Make A Living With Adfly Is It Possible

How Can I Make A Living With Adfly? Is It Possible?

Do you believe in yourself? If so , then yes it is possible.

Let me tell you something.. I always tell everyone that if they want something they can always get it , it is up to you really. So if you do want to make a living doing adfly what is holding you? I can give you some tips, but it is up to you to keep it up and make the money!

I can show you so many ways for you to make a living with adfly (yes it is possible) and you still wont make it to work. So should i start then?

First: Lets take a look at my referrals

As you can see, i have 230 to be honest to make a living here in adfly i would have to need at least 500 to 600 referrals is it possible? Well let me tell you "YES!!!" i have a friend , he has 1,439 referrals and he is making alot of money monthly. 

I am not going to lie i do receive an amount every single month from adfly but the thing is , is not an amount that i would want to receive so what should i do ? 

I have to work hard to make that 230 to at least 330 can i do it? YES!

How can i make a living with adfly? 

You going to need a blog... Yes make a blog it is for free a blog like this that gives you alot of information a blog that will help people!! You have to be consistent with the blog and update it at least once a day.!

Why? So your  blog can be on google ALOT! so once you put "how to make money with adfly" my blog should pop up , why? Because i am consistent with this blog. I have more but i am going to work harder on this one.!

The best thing about all this is that i am making money with this FREE blog!! And i am proud about that... Make a website a blog for free about something that you wont have alot of competetion! Go to google and search.

Make a website about something you would love to talk every single day and would enjoy to write on your blog like i am doing right now. Is is possible? it is up to you!

Once you have that blog, put adfly around your blog, even put the banner around! Make a subject sometimes about let me introduce you to adfly this and that.! You get the point!

Everything is UP TO YOU! make it happen!!!

Godbless.

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The Worst Cosplay Questions I Have Been Asked

Over the course of 8 years I have been interviewed by many websites regarding costuming and other hobbies that I enjoy. During this time I have been asked the absolute worst questions that are rude, invasive to my privacy or flat out dumb. I dont understand how anyone (mostly men) think its appropriate to speak to a woman like this but then again, thats the problem isnt it? These guys forget that I am a woman. I am a person. Im someones daughter, sister, aunt and girlfriend. Would you ask your daughter these questions to post on the world wide web? Probably not particularly when most of these questions are resulting in information that will bring a crazed fan boy right to your front door step. Thanks for trying to risk my safety, pal. Below are examples of the worst questions I have ever been asked.

#1. My Phone Number: This is always a nice excuse "Can I have your phone number so I can do an over the phone interview with you? Its easier."  Actually, no its not. I use to write for a comic website and conducted two over the phone interviews with artists and trust me when I say, its a bitch playing back the audio and typing it up word for word. Why do these guys think its appropriate to ask for my number? Youre a stranger. Why the hell would I give you my number so you can abuse it later? Nice try. Just email me the damn questions.

#2. My weight: Its never okay to ask someone how much they weigh. Ever. And how is that relevant to cosplay?

#3. Photo of me without makeup: Why the hell do you want to see what I look like when I wake up in the morning? I get asking for a "normal" photo but without makeup? Really? For what?!

#4. Can I take you out for dinner sometime? Wait; what?!

#5. Family questions: What does my family have to do with cosplay? Why do you want to know how they reacted to me wanting to dress as a superhero? Perhaps you think theres a story there? Maybe you think they tried to ship me off to the Betty Ford Clinic cause they thought I had a "problem"?

#6. Can you give me your full name?: Obviously Sherlock, "Cosplay" isnt my last name but I think its also obvious that if Im using a stage name, its because I dont want my full legal name out there. No you may not have my full legal name. Its none of your business.

#7. Can you tell me your city and state?: This is usually the follow up to the "Can you give me your full name?" question and is a great stalker tactic. If they have your full legal name and city and state, all they have to do is jump on Goggle and BAM! They can find out where you live. And Im sure my boyfriend will be more than happy to make street meat out of you while I call the cops. Seriously, have a little respect. I always answer with "The Philadelphia area" which is true and vague enough because there are dozens of townships in the area but you dont need to know which one I live in.

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OR tech How do I deal with an abusive surgeon

Have you ever come across problems with rage and temperament issues in the OR. I have been an operating room tech for many years and have been in a variety of surgical settings.

A certain surgeon brings in a lot of money to the hospital, but he is terrible. I have been called things no one has ever called me. He throws instruments on my table and mayo stand, screams, and implies that I and my colleagues have no idea what we are doing. I have reported him to my manager and the OR director, but nothing ever comes of it.

Other surgeons have witnessed his behavior and have said something, but nothing was ever done. I understand the OR is a beast of its own, but the culture has to change with these newer guys coming out of residency. The mindset of the surgeon being our customer, which is being rolled out to us now, is not reason for us to put up with abuse. What have you encountered on a peer-to-peer level on how to handle such demeaning behavior? I trained and worked at a level 1 trauma center with emotions that constantly ran high, and still it was less stressful than this particular surgeon. Thank you for your advice. 

A recent paper in the American Journal of Surgery addressed this topic. The authors interviewed 19 OR personnel including nurses, medical students, surgical residents, anesthesiologists, and 2 scrub technicians. Dr. Amalia Cochran, the papers lead author, told me the reason there werent more scrub techs was that they were reluctant to participate.

This figure, modified slightly from the paper, describes the harm that disruptive surgeons can do and suggests some coping strategies.

Italicized items are discussed in the paper

I suggest you read the entire paper. Your hospitals medical librarian should be able to obtain a copy for you without difficulty.

Its a tough situation. When I was a surgical chairman, I had some experience with surgeons behaving badly. I always had trouble getting the nurses and techs to go on the record with their complaints.

If your immediate boss cant help, maybe you could try your hospitals risk management department. A surgeon who bullies the staff is a patient safety risk. Some hospitals have anonymous hotlines where complaints can be lodged.

The only other thing I can suggest is to get several other staff to join in the complaints. Administration can ignore one or two people but not eight or ten.

Can anyone else comment?

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Problem with my blog I need your help

I have a big problem.

For the last 10 days, Twitter has been blocking me from tweeting any links to my blog.

This is the message I get whenever I try to send a tweet with "skepticalscalpel.blogspot.com" in it.

I have tried to contact Twitter through @twitter and @support four times and have received no reply, nor have they replied to numerous ticket requests through the Twitter Help Center.

I discovered a site called virustotal.com which compiles reports from 63 different programs that detect viruses, worms, trojans, and malware.

Originally a site called BitDefender claimed my site was malicious. The next day, BitDefender declared my site was clean, but AutoShun, which previously had no problem with my site, said it was malicious. The following day, AutoShun said my site was unrated and Clean MX said "malicious." But the day after, AutoShun went back to calling it malicious and Clean MX said my blog was clean. At no time, did more than one of the 63 detection programs identify my blogsite is being malicious.

You would think that if my blog contained any suspicious programs, more than one of the 63 virus detection organizations would have come up with a positive result on the same day.

None of the programs saying my blog was malicious gave me any clue as to what part of my site was supposedly creating the problem.

I attempted to get some help from Blogger, which hosts my blog. Although one person on a forum responded with some advice, it wasnt enough for me to solve the problem.

My blog is averaging 1600 page views per day. Not one person has contacted me to complain that I am harboring viruses or any other malicious software. That is because, to the best of my knowledge, no such malicious software exists on my blog.

Maybe it would help if you would go to the results section of the virustotal website and cast your vote in favor of my site as not being malicious. In the upper right-hand corner of the site you will see this cartoon.



 Please click on the green face to support my blog.

Meanwhile, I have discovered an interesting workaround which enables me to tweet links to my blog, but visitors to the site will still be blocked by Twitter from tweeting links.

If you consider yourself computer-savvy, maybe you can figure out how I did it. If you think you know the answer, please submit a comment.

I also would welcome any comments or suggestions that could help to resolve my problem. If anyone knows a way to contact a human at Twitter, please let me know.

Thanks.

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Should I become a general surgeon

One of the rewarding things about blogging is receiving many emails from high school, college, and medical students asking about general surgery as a career.

I try to answer every one of their specific questions and direct them to posts that Ive written on the subject.

A recent inquiry stimulated me to review all of my posts and put most of the questions about becoming a general surgeon in one place. They are about 500 words each. I hope you enjoy them. Here they are.

Is the solo general surgeon a dying breed?

What is the future of open surgery?

In what specialties can a surgeon be autonomous?

An applicant worries about the future of general surgery

Will automation affect surgeons skills?

Going to medical school and becoming a surgeon when you are older

A medical student from the UK discovers surgery and has questions

Is it possible to live a full life as a surgeon?

Choosing a medical specialty is difficult

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What are the chances of international medical grads matching in surgery

Anyone considering attending a Caribbean or any foreign medical school should do due diligence. An Internet search is step one. If the school does not list residency match statistics, that could be a red flag. It would not be easy to accomplish, but try to speak with some current students or recent graduates of any schools you are thinking about.

If the school wont give you any names, use caution, and remember, they are not likely to give you the names of dissatisfied students or alumni.

If a school does not require Medical College Admission Test (MCAT) scores, I would advise extreme caution. That suggests they probably take all comers.
Heres a look at some match data from offshore schools. The list of schools is by no means comprehensive as there are about 25 med schools in the Caribbean area. I attempted to find results from the 2015 match for the following schools: Ross, St. Georges, American University of the Caribbean, Caribbean Medical University, St. James University, University of Medicine and Health Sciences, and American Global University.

I used the word "placed" because that term is what one of the schools used, and I believe students who obtained positions in the Supplemental Offer and Acceptance Program (SOAP) after the main match are included.

The orthopedic results are shown to give you an idea of the chances to find a surgical position in any surgical specialty other than general.

For all of the schools that published lists, the overwhelming majority of students obtained positions in family medicine and internal medicine.

The number of unmatched students is not stated, but US schools dont publish that information either.

It is not completely hopeless because if you look at the NRMPs Advance Data for the 2015 match, you can see that 243 (20%) of the general surgery positions and 40 (5.7%) of the positions in orthopedics were filled by non-US grads.

Finally, heres a portion of an email I received last week.

I am a US-IMG who recently matched into a categorical surgery residency at a university program. I graduate in a few weeks from a school in the Middle East. I rotated in my 4th year at some really prominent institutions that many foreign grads dont have access to, and I believe this helped tremendously.

I was definitely on the high end for a foreign grad in terms of interviews in my class. I was very lucky. A lot of people told me I would have to look into other things or didnt believe in me, but in the end, I took a risk for something I love.

Unless you want to be an internist or a family doctor, you will have to decide if you want to risk not being the lucky one.

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