Welcome to Grand Rounds Vol. 5 No. 44.  A Grand Rounds full of plot twists, drama, melodrama and yes, death (this is a medical blog roundup after all).

Just for fun, I am going to group the submissions under acts whose real names you’ll have to guess (pick from: The Hunt Is Afoot, The Law Gets Involved, Death Arrives, Clues Are Discovered, The Plot Thickens, and All Is Revealed). Suggestions/nominations for the acts’ titles can go in the comments and the people who get the closest to the right answers can wear their imaginary Sherlock Holmes deerstalkers with pride. The rest of us can instead wear our Doctor Watson designation (also with pride).

Why the mystery theme? First, I got the incredible honor of being a faculty member last weekend at the eye-poppingly fabulous Mystery Writers’ Conference in Corte Madera, where I met and interviewed luminaries like Jacqueline Winspear, Martin Cruz Smith, and Laurie R. King (my own role? talking about medical facts for writers, as well as the nitty-gritty of the urban human landscape). The second reason for a Grand Rounds mystery theme – well,  frankly,  every day we docs, patients, advocates, and healthcare providers of all stripes get asked to solve real medical mysteries harder and more important than in any story. This is to honor you!

To increase the drama, not everyone got the notice about a possible mystery theme due to the recent attack on the Doc Gurley blog. Fortunately the attack and subsequent issues are dealt with and the Doc Gurley blog is restored. And don’t worry – if you visited this site, you couldn’t have caught anything and are completely safe (ah, if only it were so easy to retroactively “fix” non-virtual viruses…). And, in my best Agatha Christie style, even if you didn’t know you were involved in a mystery, we’ll fit you into the plot somehow.

Act One Of The Mystery

Bongi, a surgeon in the province of Mpumalanga in South Africa, writing in the blog, ‘other things amanzi,’ contrasts the difference between pronouncing someone dead there and in the US in the post ‘Call It’.

Paul S. Auerbach Professor of Surgery at the Division of Emergency Medicine at Stanford wrote about epilepsy and drowning in the Medicine for the Outdoors blog at Healthline.

Act Two Of The Mystery

Dr. Jolie Bookspan, The Fitness Fixer wrote about running injuries and hip strengthening in her post ‘Weak Hips on Purpose?’ She regularly covers making exercise medicine healthy – moving in real life, not just a gym and here she writes about the mystery of what really causes lower leg injuries.

Jenni Prokopy at chronicbabe posts about relaxing and why it is a mystery that anyone WOULDN’T want to chill out to her Breathe playlist, a tool to help relax. She also has a mysterious new forum to look at.

The blogger at ‘How To Cope With Pain,’ a slightly mysterious Board Certified Psychiatrist, wrote about a study from U Minnesota that showed that children ages 3–17 in an acute care pediatric setting experienced significant reductions in pain levels when they worked with a dog in “animal-assisted therapy.”

Barbara Kivovitz wrote about how caretaker stress affects the health of a partner with heart failure. It might be a mystery how this fits in with our category but the hunt for connections might be right in front of you!

Act Three Of The Mystery

At the Medscape blog, On Your Meds, Barbara Olson serves up a mystery called ‘What Holds Up Med Safety Education?‘ Medication error prevention is where pharmacology meets anthropology. In the US, 1.5 million people are harmed from medication errors every year, not usually because of bad actors, but from bad processes. Part of the mystery is, “What do professionals really know about the scientific principles that inform error prevention?”

Note: accessing this blog requires Medscape registration.

Last week’s Grand Rounds host, Joseph Kim of ‘Medicine and Technology’ poses us another mildly mysterious question. How can social media improve public health? As social media outlets continue to grow, they may play a critical role in improving public health. Healthcare professionals have a tremendous opportunity to leverage social media to communicate important public health messages.

At the not-so-mysteriously-named healthblawg (the Health Care Law Blog), Marc Rodwin, Suffolk University law professor, speaks with David Harlow about his proposal for public ownership of health data published in JAMA. If de-identified health data can be bought and sold subject to restrictions on re-sharing (as is currently the case), Marc Rodwin worries that we all lose. He proposed public ownership of all de-identified health data in a recent JAMA piece, to preserve the value of this data for public health uses and EBM research.

Louise of the ‘Colorado Health Insurance Insider’ wrote ‘Eighty Eight Thousand Is A Lot Of Money’ about the mystery of the mismatch between health insurance proposals and reality. Colorado is by no means a poor state. But its median household income is more than $30,000 below the cutoff point for the proposed health insurance premium subsidies. It might make people feel good at first, but where is the money coming from?

Rita Schwab’s post at ‘Supporting Safer Health Care’ is in response to the intriguing and mysteriously-titled Wall Street Journal Article, “Why Quality Care is Dangerous.” She mentions that having been “thrown under the bus” of quality metrics a time or two in her career, she thought this a topic worthy of some discussion.

Kim at emergiblog said that she couldn’t find much mystery in her report on the Better Health “Putting Patients First” panel she spoke at in Washington, DC, but, like in all good mysteries, maybe the answer was right in front of her the whole time – the mystery of how we are going to enact real healthcare reform.

Act Four of The Mystery

Alison at Shoot Up or Put Up wrote about the science (or is it art) of diabetes management. Alison thinks she may have come up with the magic formula to deal with it.

Henry Stern at InsureBlog looked at why some cancer patients fare better than others. It remains a mystery, but a new group therapy protocol may offer a clue. And Henry Stern reported on one doctor’s efforts to help his patients find meaning in their deadly illness.

News this week at ACP Internist concerns our children. Once again we learn that the behavior of these mysterious little creatures has some connection to their parents. Making the obvious connections is a specialty of their regular ‘Medical news of the obvious’ feature.

Amy at Diabetes Mine wrote about how only us “insiders” understand the mysterious code language of living with this exasperating disease in her post ‘Diabetes, If You Know What I Mean…’

Act Five of The Mystery

Stacy at the Stacy b-log, a patient blogger, wrote about the best medical advice she ever received in her post, ‘Most Important Safety Warning Ever.’ Did her doctor lose the plot? Or was, instead, the instruction poetically perfect?

Over at Reality Rounds in a post titled ‘Bearer of Bad News‘ we hear a heartbreaking and very difficult story and an ongoing mystery with no easy solution.

Meanwhile, T. at ‘Notes of an Anesthioboist’ provides us with two fascinating and controversial posts about the mysterious topic of patient rights and an almost mysterious airway.

And Toni Brayer of Everything Health clears up the mystery of why she submitted late in her post from just after the deadline. Since we LIKE excellent posts, it is no mystery why she was happily included in our round-up.

Finally, for this act, over the past week, there have apparently been some interesting ethical and social media issues regarding Clinical Reader, a new-ish site that aggregates medical news and has an intended audience of physicians. Nikki Dettmar submits an Open Letter to Clinical Reader that sums up the situation. Because this would otherwise be too much of a mystery, here’s a more in-depth explanation: Nikki wrote a post critiquing CR’s use of copyrighted images and their display of an endorsement from the National Library of Medicine on the site. Nikki knew that NLM does not endorse, and called out CR in a post – and CR threatened to sue her (via Twitter!) if she didn’t take the post down. The situation has gotten more and more bizarre with tweets blaming the social media approach failure on a junior employee, a rogue Canadian, and an unauthorized Twitter account. The Twitter account was then changed, with previous offending tweets preserved, and then they were wiped from the new account with a claim that the old account was unauthorized. Along the way, there was false attribution of tweets and false representation as endorsements of others’ tweets (that had actually been critical). Completely noir-bizarre (hey, did I just name a new genre?).

Act Six of The Mystery

Laurie Edwards at A Chronic Dose has been writing a lot about health policy, travel, etc and mysteriously chose to go back to basics as a patient: relishing the amazing feeling of (relative) normalcy.

Catherine Busch of Child Psych proposed a mystery and then answered it. She looked at the question “What are the most common causes of child trauma” (meaning psychological/emotional trauma). The solution required considerable investigation because the available information from a wide range of sources and surveys did not have comparable statistics. The results, as with all good mysteries were a surprise.

The End – exit Holmes stage right, playing a violin.

Some of the themes of our mystery are rather broad. Some are narrow. All can fall easily under the kind of general headings you see in an avant garde play. I admit right now that one of them is a very big stretch. But stay with it, follow the clues and you should be able to get at least five of the six acts right. Put your guesses in the comments and we’ll reveal the solution. Winners will be awarded the chance to host Grand Rounds in the future!

Um, well, yes, you’re right – anyone can host Grand Rounds, but that’s beside the point…

Next week’s Grand Rounds will be hosted Down Under by Captain Atopic! (am I sensing a superhero theme in the making?…stay tuned).