• >Medical information on the web - Questions and Answers.• >Shortcuts with Powerpoint*• >Using touchscreens to speed up dictation* Computer annoyances:

Spyware, • >popups, Viruses, Worms* Managing Your Email Searching

strategies • >Robotics/artificial intelligence in medicine The Internet as the • >Megamacroscope - Microscope/Web historical analogies The

Tablet PC.• >Human based computing and medicine• >Wireless applications in medicine.• >Evidence based nephrology and clinical practice guidelines online.

>Medical information on the web - Questions and Answers.>Medical information on the web - Questions and Answers.>Shortcuts with Powerpoint*>Shortcuts with Powerpoint*>Using touchscreens to speed up dictation* Computer annoyances: >Using touchscreens to speed up dictation* Computer annoyances: Spyware, Spyware, >popups, Viruses, Worms* Managing Your Email Searching >popups, Viruses, Worms* Managing Your Email Searching strategies strategies Robotics/artificial intelligence in medicine The Internet as the Robotics/artificial intelligence in medicine The Internet as the

Megamacroscope - Microscope/Web historical Megamacroscope - Microscope/Web historical analogies The Tablet PC.analogies The Tablet PC.Human based computing and medicineHuman based computing and medicineWireless applications in medicine.Wireless applications in medicine.Evidence based nephrology and clinical practice Evidence based nephrology and clinical practice guidelines online.guidelines online.

>Medical information on the web - Questions and Answers.>Medical information on the web - Questions and Answers.>Shortcuts with Powerpoint*>Shortcuts with Powerpoint*>Using touchscreens to speed up dictation* Computer annoyances: >Using touchscreens to speed up dictation* Computer annoyances: Spyware, Spyware, >popups, Viruses, Worms* Managing Your Email Searching >popups, Viruses, Worms* Managing Your Email Searching strategies strategies Robotics/artificial intelligence in medicine The Internet as the Robotics/artificial intelligence in medicine The Internet as the

Megamacroscope - Microscope/Web historical Megamacroscope - Microscope/Web historical analogies The Tablet PC.analogies The Tablet PC.Human based computing and medicineHuman based computing and medicineWireless applications in medicine.Wireless applications in medicine.Evidence based nephrology and clinical practice Evidence based nephrology and clinical practice guidelines online.guidelines online.

Part 1Part 1

Medical information on the web - Medical information on the web - Questions and Answers.Questions and Answers.Shortcuts with Powerpoint*Shortcuts with Powerpoint*Using touchscreens to speed up dictation* Using touchscreens to speed up dictation* Computer annoyances: Spyware, Computer annoyances: Spyware, popups, Viruses, Worms* Managing Your popups, Viruses, Worms* Managing Your Email Searching strategies Email Searching strategies Robotics/artificial intelligence in medicine Robotics/artificial intelligence in medicine The Internet as the The Internet as the

Part 2Part 2

Megamacroscope - Microscope/Web Megamacroscope - Microscope/Web historical analogies The Tablet PC.historical analogies The Tablet PC.

Human based computing and Human based computing and medicinemedicine

Wireless applications in medicine.Wireless applications in medicine.

Evidence based nephrology and Evidence based nephrology and clinical practice guidelines online.clinical practice guidelines online.

Medical information on the web Medical information on the web Questions and AnswersQuestions and Answers

GoogleGoogle– ImagesImages

NewsdeskNewsdesk

PubmedPubmed

UptodateUptodate

Full Text journalsFull Text journals

Shortcuts with PowerpointShortcuts with Powerpoint

Changing backgrounds and layoutsChanging backgrounds and layouts

Add a pictureAdd a picture

Get rid of the backgroundGet rid of the background

Split the slideSplit the slide

Print – avoid the messPrint – avoid the mess

F5 – look like you know what you’re doingF5 – look like you know what you’re doing

Dual screens Dual screens

Issues inNephrology

AnimationAnimation

FAS

EPO

JAK2 JAK2

P

P

P

P

PSH2-STAT

FADD

FASL

CASPASEACTIVATION

EPO

JAK2 JAK2

P

P

P

P P

STAT

GATA-1 GATA-1GATA-1

SHP (Scr homology domain phosphatase) is a Cytoplasmic enzymeThat dephosphorylates andturns off the EPO Receptor. A congenitaldefect in this enzyme was present in Eero Mäntyranta who won a gold medal in the 1964Olympics. His hemoglobinwas 23.1 g/dL.

Src homology protein

EPO is a chemokine ligand that binds to two receptors.

Janus Kinase (JAK) Phosphorylates the receptor – docking sites.

Picture SH2-STAT (Signal transducer and Transcription) as a modem

GATA (Guanadine-Adenine-thymidine-Adenine) a transcription factor that selects the proper DNA sequence for transcription.

GATA-1 blocks apoptosis through increased BCl-cL and EPO

Fas combines with FaDD. The DD stands for “death domain”. Recruit s proteolytic caspases

The Fas ligand is upregulated by Tumor necrosis factor and interferon – hence a mechanism where inflammation blunts erythropoiesis

EPO block erythroid apoptosis

HypoxiaVHL

HIF-1

Ubiquitin induced degradation

EPO

Erythropoiesis

Normoxia

OH

NUCLEUS

PROLYL HYDROXYLASE

Fe++

O2

Proteasome

Amino Acids

NORMOXIA

HIF ASPARAGINYL HYDROXYLASE

P300 Coactivator

TRANSCRIPTIONACTIVATION

OH

OH

NUCLEUS

Fe++

O2

Proteasome

Amino Acids

P300 Coactivator

TRANSCRIPTIONACTIVATION

OH

Iron deficiency

COBALT

P300

HIFß

HNF4

CREBTranscription on EPO Gene

CADMIUM

NITRIC OXIDE, IRON DEFCIENCY AND COBALT RESCUE HIFBUT CADMIUM BLOCKS AT THE DNA LEVEL

NO

P300

NUCLEUS

PROLYL HYDROXYLASE

Proteasome

HYPOXIA

HIFß

HNF4

CREBTranscription on EPO Gene

EPO

The EPO

Receptor

The EPO

Receptor

EPO

popups, Viruses, Worms* popups, Viruses, Worms* Managing Your Email Searching Managing Your Email Searching

strategies strategies

Popups Popups

Popups are obnoxious

Popups – Worms – Viruses – Popups – Worms – Viruses – Spyware and SpamSpyware and Spam

Popups – GooglePopups – Google

Worms – Virus programs – Mcafee and Worms – Virus programs – Mcafee and NortonNorton

Spyware – Webroot and Addaware – try Spyware – Webroot and Addaware – try to prevent – check oftento prevent – check often

Spam – anti spam programs – Norton and Spam – anti spam programs – Norton and Spam Bayes. MS Outlook 2003Spam Bayes. MS Outlook 2003

E-mail filteringE-mail filtering

OrganizeOrganize– Friends, Business, Research, Humor, Friends, Business, Research, Humor,

PersonalPersonal

Setting your rulesSetting your rules

Editing rulesEditing rules

Outlook is limitedOutlook is limited

Eudora is betterEudora is better

InvaluableInvaluable

Be careful sending patients e-mailBe careful sending patients e-mail

Record – permanent – cannot be changedRecord – permanent – cannot be changed

Dated – date must be recordedDated – date must be recorded

Must be in a central recordMust be in a central record

Responsiveness – Responsiveness – – E-mail: Doc, I am having chest pain and E-mail: Doc, I am having chest pain and

shortness of breath right now. What do I do?shortness of breath right now. What do I do?

Hipaa compliant – Hipaa compliant – – Encryption algorithms, Secure serverEncryption algorithms, Secure server

The New NewsdeskThe New Newsdesk

Newsdesk 3.0Newsdesk 3.0

www.szf.comwww.szf.com

FasterFaster

Easier to executeEasier to execute

Send e-mailSend e-mail

Send to PDA Send to PDA http://www.medicalresources.net

The Renalworld FamilyThe Renalworld Family

http://www.links.nephron.comhttp://www.links.nephron.com

http://www.ifkf.nethttp://www.ifkf.net

http://www.renalworld.comhttp://www.renalworld.com

http://www.szf.comhttp://www.szf.com

http://www.medicalresources.nethttp://www.medicalresources.net

Advanced PowerpointAdvanced Powerpoint

Visual BasicVisual Basic

TestsTests

QuizesQuizes

PopupsPopups

Height

Weight

cmi

c

skgl

BMI

CalculateReset

Next Slide

Calculate your MDRD GFRCalculate your MDRD GFR

Black

White or Other

Male

Female

CalculateReset

Age

Creatinine

MDRD

SIMg

ml/min/1.73m2

MS Powerpoint slide © 2003 Stephen Z. Fadem, M.D. and Brian Rosenthal.All rights reserved

Ref: Ann Intern Med. 1999, Mar 16(6):461-70, JASN 2000, Sep (11): A0828NKF K/DOQI Guidelines – Chronic Kidney Disease

QQuizuizQQuizuiz

Question 1Question 1

Blood pressure is 120/80

BP is 120/80 in diabetes

BP is 140/90

Not until BP > 150/90

Next

JNC VII recommends medication when

Question 2Question 2

Check all that apply:Diltiazem

is a vasodilator

decreases cardiac resistance

increases cardiac resistance

increases heart rate

Question 3Question 3

True

False

True or false: A systolic increase of 20 mm or a diastolic of 10 mm doubles cardiac risk when BP > 115/75

Question 4Question 4

The following are true

1. Diltiazem in the Nordil study was not designed for nightly control

2. Diltiazem dose in Nordil was > 360 mg

3. Diltiazem decreases stroke

4. Diltiazem did not significantly increase cardiovascular risk

3

Question 5Question 5

True

False

It is normal for blood pressure to be the same in the morning and in the evening

Question 6Question 6

in the evening

in late afternoon

at high noon

in early morning

Myocardial infarctions occur most often:

Question 7Question 7

causes giraffes to talk

is designed to provide maximum concentrations in early morning hours with PM dosing

should not be given at doses > 360 mg

is a dihydropyridine

Choose the best answerChoose the best answer

Diltiazem LADiltiazem LA

Question 8Question 8

True

False

True or FalseTrue or FalseIt is recommended that we treat BP It is recommended that we treat BP of > 130/80 with medication in of > 130/80 with medication in diabetics and patients with kidney diabetics and patients with kidney diseasedisease

Your scoreYour score

You scored a 8 / 8 on this You scored a 8 / 8 on this test. Please print out your test. Please print out your certificate on the next slide.certificate on the next slide.

passed this test. 50 million Americans are hypertensive.passed this test. 50 million Americans are hypertensive.Today, I have learned more about one of the classes of Today, I have learned more about one of the classes of

therapeutic agents used to treat hypertension, and am now therapeutic agents used to treat hypertension, and am now more familiar with the new Guidelines published by the more familiar with the new Guidelines published by the

Seventh Joint National Committee on HypertensionSeventh Joint National Committee on Hypertension

Physician Signature_________________Date___________

Printed name_________

Name___________________________________

THE ENDTHE END