Going To Sleep Is Free, But

Crossing the Digital Divide...And Continuing the Ascent

• Categories: Technology
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Crossing the digital divide is a phrase often used to describe what sets apart those that have computers with internet access and those that do not. It is as if, once the divide is crossed, that's it. You've arrived. Joined the enlightened hoards in digital nirvana. You've got a Dell, a cable modem, Internet Explorer, and a Yahoo account. You can now start looking for the last page on the internet.

The far greater reward waits for those who consider crossing the Great Divide the first step in a journey, and look for ways to travel more easily and extensively (and safely). To do that, you need to read, learn from others, and explore new things. One such facet to be explored is the Firefox web browser. Once you have that, you'll need this one book: Firefox Hacks: Tips and Tools for Next Generation Web Browsing. Nine chapters. 100 Hacks. Let me give you some examples:

• Find stuff
• Identify and Use Toolbar Icons
• Flush and Clear Absolutely Everything
• Make Firefox go fast
• Play with the preference system
• Installing complementary tools
• Take Firefox with you
• Modify tabbed browsing (by Seth!)
• Govern image and ad display
• Add stuff to your toolbars
• Create your own search plugin

Learn this stuff and your own hospital IT staff will bow to your superior knowledge...and what could be better than making their smug look disappear?

DOJ Subpoenas Issued to Orthopedic Companies

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Via Medgadget: DOJ Subpoenas Issued to Orthopedic Companies:

Only the rampant attempts to influence orthopedic surgical residents and their attendings with dinners, trips to 'schools' to teach techniques, golf games, and on, and on.

Crossing the Digital Divide...And Continuing the Ascent

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Malpractice Payouts in Pennsylvania Rose in 2004

• Categories: Medical Malpractice
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Malpractice Payouts in Pennsylvania Rose in 2004:

[Via Point of Law Forum]

CMJ Review: Clostridium difficile-associated diarrhea in adults

• Categories: Medical Articles
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The Canadian Medical Journal: Clostridium difficile-associated diarrhea in adults (free full-text)

CDC: Disinfectants and Their Properties

• Categories: Anesthesia resources
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The CDC published (as an appendix to another report) a guide on which disinfectant work for what organisms:

C. difficile Outbreaks, Anyone?

• Categories: Anesthesia practice
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Our hospital has pulled all 3M Avagard hand disinfectant from the operating rooms, preferring instead that surgeons go back to the old fashioned surgical hand scrub. At the same time, we are apparently seeing more nosocomial Clostridium difficile infections. C. diff. is not a reportable pathogen, and this was felt to contribute to the outbreak Canada experienced recently. Avagard does not inactivate C. diff. spores. Co-incidence? I don't think so.

The CDC page for healthcare providers on C. diff. provides an interesting nugget:

Has anyone else seen this at their facilities?

NEJM: Two Articles On Schiavo Case

• Categories: Medical Articles
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The NEJM will publish two article on the Schiavo case in an upcoming issue. Both are online now and free without a subscription:

Perspective
Terri Schiavo — A Tragedy Compounded
T.E. Quill

Legal Issues in Medicine
"Culture of Life" Politics at the Bedside — The Case of Terri Schiavo
G.J. Annas

Take Your Web Searching To The Next Level

• Categories: Software
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There's more to search than Google--especially for medical topics. I often need to go search eMedicine, Cochrane, Pubmed, specific journals (NEJM and Anesthesia & Analgesia are two I use often) or even a Google sub-site (plain, news, images, scholar, maps) . One way to do this is to go to each home page, find their search box and, well, search! Ah, but there's a better way and it's called iSeek (MacOS X only).

What you're really doing when you use a search box on a site is submitting a search request in their syntax. If you know the syntax, you can submit a search request without actually going to the site. If you look at the address bar after you submit a search on a site, you're looking at their search syntax. For example, if I do a search on Google Scholar for 'hyperthermia,' I see the following url in the address bar:

http://scholar.google.com/scholar?hl=en&lr=&safe=off&q=hyperthermia&btnG=Search

Now, it's a bit much for us to memorize that string of text, but computers are very good at that sort of thing...and that's where iSeek comes in. Here's what iSeek looks like in my menu bar (it's the text field with the magnifying lens):

And here's what the iSeek menu looks like with all my favorite search sites:

To search at one of the listed sites, I select the site (in this case eMedicine), enter the search term in the text field, and hit 'return.' iSeek takes my search term, slaps on the right prefix and suffix to put the search term in the right format, and submits it. The results appear in a new tab in my web browser.

If the thought of figuring out the right text strings bother you, fear not. The makers of iSeek have an extensive list of search engines you can add directly from their site.

NEJM: The Serotonin Syndrome

• Categories: Medical Articles
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Boyer and Shannon's article in the NEJM The Serotonin Syndrome is an excellent review/introduction to a syndrome every anesthesiologist should be familiar with but that had not been defined when I was in training. Excess serotonergic agonism can be triggered not only by certain drug overdoses, but also by many drugs anesthesiologist give frequently (fentanyl!).

Why I'm Excited About Apple's 'Spotlight' Technology

• Categories: Software, Technology
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Rumor has it that Apple will release its next iteration of MacOS X, code named 'Tiger', in April. One component of it that is not a rumor is its new built-in search engine called Spotlight (tech preview pdf). The list of supported files types includes (but is not limited to):

• Plain text
• RTF
• PDF
• Mail
• Keynote presentations
• Microsoft Office Word documents
• Microsoft Office Excel spreadsheets
• Microsoft PowerPoint presentations
• iChat logs (if logging is enabled)

How might this be useful to a clinician? For years now, I've been dropping files onto my hard drive because they contains information I want to have access to in the future. I have an entire textbook of anesthesiology as html files. Literally hundreds if not thousands of pdf files of articles I've saved from NEJM, Anesthesia & Analgesia, and other journals. Every lecture I've ever given. All the CME I've ever done (if available electronically).

I have tried mightily to keep it all organized. Seth Dillingham actually made some software for me to be able to use a local webserver to organize, index and serve all those files on my local machine. Extended to something we called the Reference Laptop Project, we endeavored to put everything an anesthesia resident could need during their training on a $1,000 20 GB Apple iBook, complete with automatic updating of reference materials via wireless LAN. I've installed Plone and learned some Python to be able to make a system that works for me. But now, finally, coming to OS X, is the core technology that will allow me to do what I want as a feature of the operating system itself, or perhaps even as a custom application.

Underneath it all, there's even an API that lets applications access Spotlight's power. Imagine a new application that imposes a structure on the information you already have or will add! As an example, imagine an outline of relevant topics in anesthesiology. For each topic, the application would use Spotlight to create Smart Folders for, say, information on malignant hyperthermia, and airway management, and peri-operative beta blockade. I have a great deal of information on each of these topics already on my hard drive. Some in the Documents folder, some under Sites. Some exists as HTML files, some as PDF, some as powerpoint. And as I add more information, the Smart 'Chapter' will automatically update. Perhaps the very capable makers of Delicious Library will explore creating 'Delicious Reference' just for me.

The future is here. It's just not evenly distributed yet. --William Gibson

Four Drug Rep Tricks Plus One Of My Own

• Categories: Web Sites
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Polite Dissent is a blog I just discovered thanks to Grand Rounds. He/she has the same take on some of the techniques used by drug detail people as I do:

• False agreements
• Fake Thanks
• Bring the Boss
• Appeal to Authority

I'll just add my own to this very good list: use the people around you as billboards. It seems the people who make a paralytic called rocuronium have dropped off a thousand or so yellow operating room caps that say "Roc Solid" (Roc is our abbreviation for rocuronium, aka Zemuron). Many OR nurses and techs are now wearing these caps. My reaction? Even if I was planning on using rocuronium for the case, I'll draw up some tasty vecuronium or cis-atracurium instead. And besides, the vecuronium people gave me a nice nerve stimulator once...

Grand Rounds XXV: Respectful Insolence

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Grand Rounds XXV is up at Respectful Insolence. Just don't have a mouth full of coffee when you read it.