Wednesday, April 6, 2005

Dear Journal Editor

Orac has written a public letter to scientific journal editors that is a must read for anyone who has ever published (or tried to publish and been rejected--me!). The post is part of Tangled Bank XXV (Like Grand Rounds, but with an emphasis on science):

"We have again rewritten the entire manuscript from start to finish. We even changed the goddamned running head! Hopefully we have suffered enough by now to satisfy even you and your bloodthirsty reviewers. Besides the fact that we included five new figures of brand new data (with six panels each, yet), we still cannot believe that you were unable to see the merit of our work..."



Saturday, April 2, 2005

Crossing the Digital Divide...And Continuing the Ascent

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

Via Medgadget: DOJ Subpoenas Issued to Orthopedic Companies:

" A press release by Stryker

Stryker Corporation (NYSE: SYK - News) announced today that it has received a subpoena from the United States Department of Justice requesting documents for the period January 2002 through the present as follows: "any and all consulting contracts, professional service agreements, or remuneration agreements between Stryker Corporation and any orthopedic surgeon, orthopedic surgeon in training, or medical school graduate using or considering the surgical use of hip or knee joint replacement/reconstruction products manufactured or sold by Stryker Corporation."

Based on an initial conversation with a Department of Justice representative, the Company understands that similar requests have been or will be directed to other companies in the orthopaedics industry. Stryker intends to fully cooperate with the Department of Justice regarding this matter.
Something major is going on. Any ideas?"

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.



Friday, April 1, 2005

Crossing the Digital Divide...And Continuing the Ascent



Thursday, March 31, 2005

Malpractice Payouts in Pennsylvania Rose in 2004

Malpractice Payouts in Pennsylvania Rose in 2004:

"In 2004, insurers reported paying out $448 million, a 13.5 percent jump from $394.5 million reported in 2003, according to the U.S. Health Resources & Services Administration. The 2004 figure broke the previous record, which had been set in 2001.

The increase in 2004 came after two years of decline. One researcher said he thinks payouts are climbing steadily, but that the steep increase in 2004 also was bumped up by delayed reporting of some payments made the previous year."

[Via Point of Law Forum]



Saturday, March 26, 2005

CMJ Review: Clostridium difficile-associated diarrhea in adults

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



Thursday, March 24, 2005

CDC: Disinfectants and Their Properties

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

"All surfaces should be cleaned thoroughly before disinfection. For basic disinfection, a 1:100 dilution of household bleach (i.e., 2.5 tablespoons/gallon) or a 1:1,000 dilution of quaternary ammonium compounds (e.g., Roccal-D® or Zephiran®) may be used. This appendix includes instructions for disinfection when a particular organism has been identified. All compounds require a contact time of >10 minutes."



Wednesday, March 23, 2005

C. difficile Outbreaks, Anyone?

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:

"If your institution experiences an outbreak, consider using only soap and water for hand hygiene when caring for patients with Clostridium difficile-associated disease; alcohol-based hand rubs may not be as effective against spore-forming bacteria."

Has anyone else seen this at their facilities?



Tuesday, March 22, 2005

NEJM: Two Articles On Schiavo Case

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



Sunday, March 20, 2005

Take Your Web Searching To The Next Level

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.



Thursday, March 17, 2005

NEJM: The Serotonin Syndrome

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

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)
In other words, all the file formats in which clinical reference information might exist on my computer hard drive will be searchable by content, not just by title.

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

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