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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_473"
                     title="AAN: High Intake of Vitamin D Linked to Lower MS Risk (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAN/tb/18406?impressionId=1265817357305"
                     
      &lt;p&gt;TORONTO  --  Women whose mothers consumed high levels of vitamin D during pregnancy have a lower risk of developing multiple sclerosis, a large, observational study confirmed.&lt;/p&gt;
&lt;p&gt;Mothers who reported the highest intake during pregnancy were 45% less likely to have a daughter who subsequently developed the disease than those who consumed the least vitamin D (RR 0.55, 95% CI 0.35 to 0.88), according to Fariba Mirzaei, MD, MPH, a doctoral student at the Harvard School of Public Health.&lt;/p&gt;
&lt;p&gt;Mirzaei is scheduled to report the findings at the American Academy of Neurology (AAN) meeting in April.&lt;/p&gt;
&lt;p&gt;Lily Jung, MD, a neurologist at Swedish Medical Center in Seattle, said in an interview that the study &quot;adds more fuel to the fire that low vitamin D is important in the genesis of MS,&quot; which has been demonstrated in previous studies. (See &lt;a href=&quot;http://www.medpagetoday.com/Neurology/MultipleSclerosis/4738&quot; mce_href=&quot;http://www.medpagetoday.com/Neurology/MultipleSclerosis/4738&quot; target=&quot;_blank&quot;&gt;High Blood Levels of Vitamin D May Lower MS Risk&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;She said it&apos;s unclear why vitamin D is associated with risk of multiple sclerosis.&lt;/p&gt;
&lt;p&gt;&quot;There&apos;s an idea that perhaps there might be receptors that are turned on by vitamin D levels that give some form of protection, but that is very preliminary information and we&apos;re still learning a lot about that,&quot; said Jung, who is also a spokeswoman for the AAN.&lt;/p&gt;
&lt;p&gt;Although the link between vitamin D and risk of multiple sclerosis has been demonstrated before, gestational exposure to the vitamin has not been studied.&lt;/p&gt;
&lt;p&gt;To fill that gap, Mirzaei analyzed data from the Nurses&apos; Mothers&apos; Study, which includes a subcohort of the two Nurses&apos; Health Studies that was restricted to nurses whose biological mothers completed a questionnaire in 2001 about their diet during pregnancy.&lt;/p&gt;
&lt;p&gt;The current analysis included 35,794 nurse-mother pairs.&lt;/p&gt;
&lt;p&gt;During the 16-year study period, 199 of the nurses were diagnosed with multiple sclerosis.&lt;/p&gt;
&lt;p&gt;In addition to a lower risk of disease among those whose mothers consumed the largest amounts of vitamin D, those whose mothers had the highest predicted serum 25-hydroxyvitamin D levels also had a reduced risk of having a daughter with the disease (RR 0.58, 95% CI 0.37 to 0.90).&lt;/p&gt;
&lt;p&gt;In an analysis of milk drinking alone, mothers who drank at least four glasses a day had a nonsignificant reduced risk of having a daughter who would develop multiple sclerosis compared with those who drank less than three glasses a month (RR 0.44, 95% CI 0.16 to 1.23).&lt;/p&gt;
&lt;p&gt;However, there was a significant trend for lower risk of multiple sclerosis with increasing milk consumption (&lt;em&gt;P&lt;/em&gt;=0.001).&lt;/p&gt;
&lt;p&gt;Jung noted that the study was limited by the use of questionnaires decades after a pregnancy to determine dietary intake of vitamin D.&lt;/p&gt;
&lt;p&gt;Nevertheless, she said, &quot;this is very consistent with what we&apos;re seeing elsewhere in terms of vitamin D in moms and the risk of MS in kids.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Mirzaei did not make any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_472"
                     title="Test Allows LMW Heparin Monitoring in Cath Lab (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Cardiology/PCI/tb/18403?impressionId=1265817357305"
                     
      &lt;p&gt;A novel point-of-care anticoagulation test not yet available in the U.S. allowed more accurate dosing of enoxaparin (Lovenox) prior to cardiac catheterization in a clinical trial, researchers said.&lt;/p&gt;
&lt;p&gt;Patients in whom anticoagulation was insufficient with standard enoxaparin doses were identified with the Hemochron Jr. Hemonox test at a sensitivity of 94.9% (95% CI 91.1% to 97.4%) and specificity of 73.3% (95% CI 67.6% to 78.5%), allowing for needed dosage adjustments before undergoing catheterization and coronary revascularization, reported Johanne Silvain, MD, of Piti&amp;#233;-Salp&amp;#234;tri&amp;#232;re Hospital in Paris, and colleagues.&lt;/p&gt;
&lt;p&gt;&quot;In daily practice, the Hemonox test may be used in the catheterization laboratory to assess the appropriate level of anticoagulation therapy in patients undergoing percutaneous coronary intervention and to avoid the use of unfractionated heparin in addition to enoxaparin, as is still done by some interventionists,&quot; the researchers wrote in the Feb. 16 &lt;em&gt;Journal of the American College of Cardiology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Normally, anticoagulant therapy is started in patients scheduled for catheterization to minimize the risk that the procedure will trigger a thrombotic event.&lt;/p&gt;
&lt;p&gt;Silvain and colleagues explained that low molecular weight heparins such as enoxaparin appear to be safer and at least as effective as unfractionated heparin, but are not widely used.&lt;/p&gt;
&lt;p&gt;&quot;The inability to rapidly monitor the anticoagulant effect of enoxaparin in a similar fashion as the activated clotting time with unfractionated heparin has limited the use of enoxaparin in interventional cardiac procedures,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Past clinical studies have found that most but not all patients achieve target levels of anticoagulation using standard doses of enoxaparin, Silvain and colleagues noted. Excessive anticoagulation increases risk of bleeding, whereas shortfalls raise the likelihood of periprocedural&lt;strong&gt; &lt;/strong&gt;myocardial infarction, pulmonary embolism, and stroke.&lt;/p&gt;
&lt;p&gt;According to Silvain and colleagues, there are currently no good ways to measure the adequacy of enoxaparin dosing at bedside. Activated clotting time is too imprecise with enoxaparin, and chromogenic anti-factor Xa activity requires a laboratory-performed assay, they wrote.&lt;/p&gt;
&lt;p&gt;They evaluated the Hemonox test in 296 unselected patients undergoing catheterization because of cardiac symptoms, of whom 169 went on to percutaneous revascularization or bypass graft surgery.&lt;/p&gt;
&lt;p&gt;The Hemonox test delivers results as a clotting time.&lt;/p&gt;
&lt;p&gt;Enoxaparin was given intravenously in 211 patients, in combination with subcutaneous enoxaparin in 21, only subcutaneously to 64 patients, and the route was unrecorded in the remaining 14.&lt;/p&gt;
&lt;p&gt;Blood samples were drawn immediately after sheath insertion and again 10 minutes later. Samples were tested with Hemonox, a standard assay for activated partial thromboplastin time, and the lab assay for anti-factor Xa activity. The latter served as the &quot;gold standard&quot; reference in the study.&lt;/p&gt;
&lt;p&gt;Insufficient anticoagulation  --  defined as an anti-factor Xa level of less than 0.5 IU/mL  --  was found in 14 patients at the second blood draw. Excessive anticoagulation occurred in only three patients, all of whom had anti-factor Xa levels of 1.9 IU/mL (upper level cutoff 1.8 IU/mL).&lt;/p&gt;
&lt;p&gt;Silvain and colleagues found that the area below the receiver operating characteristic curve for the Hemonox test, for discriminating those individuals with inadequate anticoagulation, was 0.95 relative to the anti-factor Xa assay (95% CI 0.93 to 0.97).&lt;/p&gt;
&lt;p&gt;Using a cutoff of 120 seconds for the Hemonox clotting time to identify inadequate anticoagulation, which maximizes the sensitivity, the results produced a positive predictive value of 73.9% (95% CI 68.7% to 79.0%) and a negative predictive value of 94.8% (95% CI 91.8% to 97.8%).&lt;/p&gt;
&lt;p&gt;A cutoff of 80 seconds reversed the Hemonox test&apos;s performance almost exactly  --  it produced a sensitivity for detecting inadequate anticoagulation of 74.5% and a specificity of 98.5%. Silvain and colleagues explained that, in patients undergoing interventional procedures, &quot;the sensitivity of the bedside test is critical.&quot;&lt;/p&gt;
&lt;p&gt;Activated partial thromboplastin time correlated much more poorly with anti-factor Xa results, the researchers said.&lt;/p&gt;
&lt;p&gt;The Hemonox results paralleled those of the anti-factor Xa assay in important subgroups, including obese patients and the elderly, the researchers reported.&lt;/p&gt;
&lt;p&gt;Two major bleeding events were observed in the study, both in patients with anti-factor Xa levels well within the target range.&lt;/p&gt;
&lt;p&gt;Silvain and colleagues noted that the lack of clinical outcomes as a study endpoint was a limitation, as was the lack of sufficient data to assess the Hemonox test&apos;s effectiveness in measuring excessive anticoagulation.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by International Technidyne Corp., which developed the anticoagulation test.&lt;/p&gt;&lt;p&gt;Study authors reported relationships other than research funding with Pfizer, sanofi-aventis, Astellas, Eli Lilly, Bristol-Myers Squibb, The Medicines Company, Schering-Plough, Merck Sharpe &amp;amp; Dohme, Cordis, and GlaxoSmithKline. They also reported research funding from Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, sanofi-aventis, Eli Lilly, Guerbet Medical, Medtronic, Boston Scientific, Cordis, Stago, and Centocor.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_471"
                     title="Early Pregnancy Determines Late Outcomes (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/OBGYN/Pregnancy/tb/18405?impressionId=1265817357305"
                     
      &lt;p&gt;Growth of the fetus during the first trimester  --  when essential organ development is completed  --  lays the foundation for important outcomes in pregnancy and early childhood, Dutch researchers found.&lt;/p&gt;
&lt;p&gt;Restricted first-trimester growth appeared to more than double the risk of preterm birth, low birth weight, and small size for gestational age at birth in a prospective study led by Vincent W.V. Jaddoe, MD, PhD, of Erasmus Medical Center in Rotterdam.&lt;/p&gt;
&lt;p&gt;Infants who didn&apos;t grow as much as expected during the first trimester also showed accelerated &quot;catch-up&quot; growth up to their second birthday  --  a well-established risk factor for later metabolic and cardiovascular disease.&lt;/p&gt;
&lt;p&gt;&quot;It could be that growth as early as in the first trimester of pregnancy is associated with disease in adulthood, although longer follow-up studies are necessary to examine this relationship,&quot; the researchers wrote in the Feb. 10 &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;This and prior studies suggest that women at high risk of problems late in pregnancy could be identifiable in the first trimester, with the potential for trials of screening and early intervention, according to an accompanying editorial by Gordon C.S. Smith, MD, PhD, of the University of Cambridge, England.&lt;/p&gt;
&lt;p&gt;The challenge, Smith wrote, will be to &quot;produce robust screening tests with acceptable levels of detection and prediction, and to identify interventions that are effective in improving outcome when a pregnancy has been identified as high risk.&quot;&lt;/p&gt;
&lt;p&gt;The researchers&apos; population-based, prospective Generation R Study included 1,631 pregnant women in Rotterdam with a known and reliable first day of their last menstrual period and a regular menstrual cycle.&lt;/p&gt;
&lt;p&gt;Fetal crown-to-rump length, measured by ultrasound between the gestational age of 10 weeks 0 days and 13&lt;/p&gt;
&lt;p&gt;weeks 6 days, is typically used to determine gestational age. But in this study it served as the main parameter of first-trimester fetal growth.&lt;/p&gt;
&lt;p&gt;Predictors of restricted fetal growth in multivariate analyses included the following (given as standard deviation growth score): &lt;ul&gt; &lt;li&gt;Younger maternal age (0.10 per 4.68-year standard deviation increase, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) &lt;/li&gt; &lt;li&gt;Higher maternal diastolic blood pressure (&amp;#8722;0.05 per 9.52-mm Hg standard deviation increase, &lt;em&gt;P&lt;/em&gt;=0.03) &lt;/li&gt; &lt;li&gt;Higher hematocrit level (&amp;#8722;0.07 per 2.50% standard deviation increase, &lt;em&gt;P&lt;/em&gt;=0.02) &lt;/li&gt; &lt;li&gt;Smoking (&amp;#8722;0.13, &lt;em&gt;P&lt;/em&gt;=0.03)&lt;/li&gt; &lt;li&gt;Folic acid supplement use (0.17, &lt;em&gt;P&lt;/em&gt;=0.03) &lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;After adjustment for multiple testing, only hematocrit and maternal age remained significant factors, but smoking and nonoptimal use of folic acid supplements together produced a significant reduction in first-trimester fetal growth (SD score &amp;#8722;0.52, 95% CI &amp;#8722;0.78 to &amp;#8722;0.25, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for interaction).&lt;/p&gt;
&lt;p&gt;Higher hematocrit levels may indicate lower circulating plasma volume. That in turn could lead to suboptimal placental perfusion, the researchers suggested as a possible explanation for the importance of this factor.&lt;/p&gt;
&lt;p&gt;The impact on pregnancy outcomes was significant for all adverse birth outcomes assessed. Compared with normal first-trimester fetal growth, growth restriction was associated with the following risks: &lt;ul&gt; &lt;li&gt;2.12-fold higher adjusted odds of preterm birth before 37 weeks&apos; gestation (4.0% versus 7.2%, &lt;em&gt;P&lt;/em&gt;=0.006).&lt;/li&gt; &lt;li&gt;2.42-fold higher adjusted odds of low birth weight, defined as less than 2,500 g or 5 lb 8 oz (3.5% versus 7.5%, &lt;em&gt;P&lt;/em&gt;=0.001).&lt;/li&gt; &lt;li&gt;2.64-fold higher adjusted odds of being small for gestational age at birth, defined as in the lowest 20% (4.0% versus 10.6%, &lt;em&gt;P&lt;/em&gt;=0.001). &lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Independent of birth weight, fetal growth restriction in the first trimester accelerated postnatal growth until age 2 years (0.139 standard deviation score increase over two years per standard deviation fetal-crown-to-rump length decrease, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Even though they included only women with reliable menstrual cycles, the authors noted, misclassification of gestational age might still have been an issue, depending on timing of ovulation and implantation.&lt;/p&gt;
&lt;p&gt;&quot;Further studies are needed to assess the associations of first-trimester growth variation on the risks of disease in later childhood and adulthood,&quot; they concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The first phase of the Generation R Study was financially supported by the Erasmus Medical Center, the Erasmus University Rotterdam, and the Netherlands Organization for Health Research.&lt;/p&gt;&lt;p&gt;Jaddoe reported receipt of funding from the Netherlands Organization for Health Research.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;Smith reported having been a member of preterm labor advisory boards for GlaxoSmithKline. He also reported funding from Cambridge National Institute for Health Research Biomedical Research Centre, Cambridge University Hospitals, NHS Foundation Trust.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_470"
                     title="For-Profit Hospitals Most Likely to Overtreat Dementia Patients (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Geriatrics/Dementia/tb/18402?impressionId=1265817357305"
                     
      Tube-feeding patients with advanced dementia  --  a practice whose effectiveness has been questioned by two widely cited literature reviews  --  is most common in larger hospitals and those run for profit, researchers said.&lt;br&gt;
&lt;br&gt;The odds of a feeding-tube insertion in a hospitalized patient with advanced dementia were about 50% greater when the hospital was larger than 310 beds than in facilities with 100 beds or less, and it was 33% more common in for-profit versus government-owned facilities, reported Joan M. Teno, MD, of Brown University in Providence, R.I., and colleagues.&lt;br&gt;
&lt;br&gt;Hospitals that frequently admitted elderly patients in the last six months of life to their ICUs  --  signifying a pattern of aggressive end-of-life care  --  were also substantially more likely to use tube feeding, the researchers wrote in the Feb. 10 &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;At some 12% of the 2,797 acute-care hospitals included in the analysis, which covered an eight-year period ending in 2007, feeding tubes were never used in patients with advanced dementia.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;In others, however, such patients were intubated for feeding at rates of up to 38.9 per 100 hospitalizations.&lt;/p&gt;
&lt;p&gt;Teno and colleagues suggested that many of these insertions reflect overtreatment. They cited previous research showing that tube feeding &quot;does not improve survival, prevent aspiration pneumonia, heal or prevent decubitus ulcers, or improve other clinical outcomes.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Feeding tube insertion in persons with advanced cognitive impairment demonstrates a disconnect with the existing evidence of their effectiveness,&quot; Teno and colleagues commented. &quot;Many experts have expressed concerns regarding the overuse of feeding tubes.&quot;&lt;/p&gt;
&lt;p&gt;They called for more research into the decision-making processes that produce such variations among hospitals and interventions to reduce unnecessary insertions and those that conflict with patients&apos; preferences.&lt;/p&gt;
&lt;p&gt;Teno and colleagues analyzed data on some 163,000 patients included in the U.S. Nursing Home Minimum Data Set whose records indicated an age greater than 65, advanced cognitive impairment, lack of prior tube feeding, and an acute-care hospitalization from 2000 to 2007.&lt;/p&gt;
&lt;p&gt;They also had data on the size and business structure of the hospitals to which patients were admitted.&lt;/p&gt;
&lt;p&gt;The researchers found the following adjusted odds ratios for hospital characteristics associated with feeding tube insertions: &lt;ul&gt; &lt;li&gt;Business model: 1.33 (95% CI 1.21 to 1.46) for for-profit versus government owned.&lt;/li&gt; &lt;li&gt;Size: 1.48 (95% CI 1.35 to 1.63) for more than 310 beds versus less than 101 beds.&lt;/li&gt; &lt;li&gt;ICU use in failing elderly patients: 2.60 (95% CI 2.20 to 3.06) for highest decile of ICU care in the last six months of life versus the lowest decile.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The adjustments included age, gender, race and ethnicity, medical history, degree of cognitive impairment, advanced care directives, and durable power of attorney.&lt;/p&gt;
&lt;p&gt;The differences were much greater before the adjustments. For example, the raw data showed a rate of 8.0 feeding tube insertions per 100 hospitalizations at large facilities compared with 4.3 per 100 in small hospitals.&lt;/p&gt;
&lt;p&gt;Similarly, hospitals with the most aggressive ICU use in elderly patients had an insertion rate of 10.1 per 100 hospitalizations, while those with the lowest ICU use in such patients had a mean rate of 2.9 per 100.&lt;/p&gt;
&lt;p&gt;Teno and colleagues also found that some other hospital factors  --  such as the ratio of specialists to general medicine physicians and the use of hospice services  --  did not significantly predict feeding tube use.&lt;/p&gt;
&lt;p&gt;On the other hand, indicators of advanced care planning were significantly associated with reduced feeding tube insertions, although perhaps not as much as would be expected.&lt;/p&gt;
&lt;p&gt;Expressed as adjusted odds ratios, the rate reductions were: &lt;ul&gt; &lt;li&gt;Living will: 0.75 (95% CI 0.70 to 0.79)&lt;/li&gt; &lt;li&gt;Durable power of attorney: 0.88 (95% CI 0.84 to 0.91)&lt;/li&gt; &lt;li&gt;DNR orders: 0.65 (95% CI 0.62 to 0.67)&lt;/li&gt; &lt;li&gt;Orders to forgo artificial hydration and nutrition: 0.73 (95% CI 0.67 to 0.80)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;&quot;These results raise more questions than answers,&quot; Teno and colleagues noted in calling for additional research into the reasons for the trends they identified.&lt;/p&gt;
&lt;p&gt;&quot;Future research to examine these reported variations should focus on decision making for feeding tube insertion in hospitalized nursing home residents with dementia. Additionally, the role that hospitals and nursing homes have in advance care planning is critically important,&quot; they wrote, noting that advanced care planning is often neglected in nursing homes.&lt;/p&gt;
&lt;p&gt;Teno and colleagues noted some limitations to the study, notably the reliance on administrative records for most data, as well as the lack of information on physician counseling and patient preferences beyond the orders recorded in the database.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The National Institute on Aging funded the study.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_469"
                     title="BLOG: Linkfest Today"
                     score="0.01"
                     href="http://www.medpagetoday.com/Blogs/18401?impressionId=1265817357305"
                     
      Test scores have historically been important for prospective medical students.  But sometimes, those who score highest don&apos;t necessarily make the best doctors.  In a &lt;i&gt;New York Times&lt;/i&gt; column, surgeon Pauline Chen discusses a study looking at whether &lt;a href=&quot;http://www.nytimes.com/2010/01/15/health/14chen.html?partner=rss&amp;emc=rss&quot; target=&quot;_blank&quot;&gt;personality traits&lt;/a&gt; would make better predictors.  For instance, according to the study&apos;s author, &amp;quot;If I know someone is not just stress-prone, but stress-prone at the 
95th percentile rather than the 65th. I would have to ask myself if that
 person could handle the stress of medicine.&amp;quot;&lt;br&gt;
&lt;br&gt;
The interview portion of the application process is one way to gauge an applicant&apos;s personality.  But requiring students to take personality tests can standardize this measure, and better predict success.&lt;br&gt;
&lt;br&gt;
***&lt;br&gt;
&lt;br&gt;
More doctors are splitting their time between clinical duties and writing a book.  Surgeon Atul Gawande comes to mind, for instance.  In a guest post, fellow &lt;a href=&quot;http://www.kevinmd.com/blog/2010/02/telling-patient-story-issues-facing-physician-writers.html&quot; target=&quot;_blank&quot;&gt;physician-author&lt;/a&gt; Danielle Ofri talks about some of the issues facing doctors who take up the pen.  &lt;br&gt;
&lt;br&gt;
When talking about how she recounts patient stories, she writes, &amp;quot;I want to give a respectful rendering of my patient&apos;s story, one that
 I hope would honor them and what they&apos;ve endured. Of course this is 
necessarily a subjective decision, but it is the only internal ethic 
that I can live with. My patients have entrusted me with their stories, 
and I need to respect that. If a particular story can edify future 
doctors, or educate the public, there might be value in publishing it.&amp;quot;  &lt;br&gt;
&lt;br&gt;
Great advice, which can also be applied to physician-bloggers as well.&lt;br&gt;
    </recommendedItem>
</recommendedContent>
