BehindTheMedspeak: Pediatric MRIs will never be the same - thank God almighty!
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My fellow blogging anesthesiologist Book Of Joe posted BehindTheMedspeak: Pediatric MRIs will never be the same - thank God almighty! and points to new motion-correction software available for MRI's.
" "I was quite dismayed when I read on and learned that, though the software and hardware upgrades required for MRI machines to create acceptable images with a moving patient have been available for a year, 'they are not used in all hospitals and clinics.'
It is inconceivable that any institution doing MRIs wouldn't immediately buy these upgrades.
The cost of a medical negligence suit resulting from a dead or brain-damaged child is astronomical, running into the millions of dollars; it dwarfs whatever G.E.'s charging for Version 2.0.
Talk about penny-wise and pound-foolish..." "
I agree whole heartedly.
RSS for PubMed Searches
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Orac Knows points to a really nifty use of rss for those of us that use PubMed for literature searches called HubMed and use RSS. HubMed offers 'RSS feeds of literature queries - updated daily'. For example, I can enter a search string like 'liver transplant anesthesia' and get a nice list of hits on a web page. Encoded in the html of the page is the url for the rss feed of this search. Handing the html page url to your news reader/aggregator allows it to 'discover' the rss url for you. After that, your news reader will highlight any new references the search turns up.
New Genetic Test May Prevent Drug Interaction
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New Genetic Test May Prevent Drug Interaction:
A new DNA microarray test called the AmpliChip Cytochrome P450 Genotyping Test analyzes abnormalities in the gene coding for Cytochrome P450, the liver enzyme involved in metabolizing many drugs. The hope is that testing for the abnormality will allow better use/selection of drugs in these patients. As the list of cytochrome P450-metabolized drugs is long and includes NSAID's, inhaled anesthetics. Are we looking at a standard pre-op test? Perhaps. Polymorphism at this gene may explain some of the bell-shaped curve we see in responses not only to anesthetics, but to many commonly prescribed drugs. What we need now are outcome studies...and to be patient.
More information about genotyping in general is here (thanks, Google).
[Via WebMD Health Headlines]
Charite Artificial Intervertebral Discs--ready for prime time?
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DePuy Spine/J&J are marketing Charite artificial discs as an alternative to spinal fusion. A recent New York Times report, though pointing out that long term evidence is lacking, was basically positive and contained the following quote from a company representative:
" "Some of the anecdotal evidence for the Charité is impressive." "
Some of the anecdotal evidence? What? This device has been in use in Europe for two decades and that's the best they can do? The Charite web site with information for physicians has results but no references. None.
The one study I did find via PubMed concluded:
" "In this prospective randomized study, both surgical groups improved significantly. Complications of total disc replacement were similar to those encountered with anterior lumbar interbody fusion. Total disc replacement appears to be a viable alternative to fusion for the treatment of single-level symptomatic disc degeneration unresponsive to nonoperative management." "
It may be a 'viable alternative', but there's no data on long term results. Here's what I bet will happen. The FDA will approve the device and ask for long term followup, which is actually done by a company in fewer than half the cases where it is requested by the FDA. (I don't know J&J's record specifically, though.) Patients will read about it and find a surgeon that does the Charite procedure (even if it means going to someone who is not their normal orthopedic surgeon)...and resort to the legal system if their expectations are not met or their long term results are disappointing.
[Via Medgadget]
Radiologists Use iPod for Image Storage
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Via Medgadget:
" "
Radiological Society of North America reports:
The iPod is not just for music any more. Radiologists from the University of California, Los Angeles (UCLA), and their colleagues at other institutions from as far away as Europe and Australia are now using iPod devices to store medical images.
'This is what we call using off the shelf, consumer market technology,' says Osman Ratib, M.D., Ph.D., professor and vice-chairman of radiologic services at UCLA. 'Technology coming from the consumer market is changing the way we do things in the radiology department.'
Dr. Ratib and Antoine Rosset, M.D., a radiologist in Geneva, Switzerland, recently developed OsiriX, Macintosh-based software for display and manipulation of complex medical image data.
Dr. Rosset set up the OsiriX software to automatically recognize and search for medical images on the iPod. When it detects the images, they automatically appear on the list of image data available - similar to the way music files are accessible by the iTune music application.
'It's easy to use and you don't have to worry about how to load and unload it from the iPod,' Dr. Ratib says. 'But the real beauty of it is that I can use the images directly on the iPod. I don't have to take the time to copy them to my computer. The iPod allows me to copy data from work to my laptop, but I don't have to do it if I don't want to.'
Dr. Ratib sees the iPod as a kind of giant memory stick, 'The performance is amazing.'
" "
Safe Personal Computing--Lessons for Safe Hospital Computing?
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Bruce Schneier has updated his list of a dozen things Internet users can do to protect themselves. There's no particular reason I can think of that these shouldn't also apply to hospital IT. Does your hospital still use Internet Explorer as its default web browser and Exchange for e-mail? Here are a few of his recommendation that I think should be applied in the hospital setting.
"
"Operating systems: If possible, don't use Microsoft Windows. Buy a Macintosh or use Linux. If you must use Windows, set up Automatic Update so that you automatically receive security patches. And delete the files 'command.com' and 'cmd.exe.'
Browsing: Don't use Microsoft Internet Explorer, period. Limit use of cookies and applets to those few sites that provide services you need. Set your browser to regularly delete cookies. Don't assume a Web site is what it claims to be, unless you've typed in the URL yourself. Make sure the address bar shows the exact address, not a near-miss.
Passwords: You can't memorize good enough passwords any more, so don't bother. For high-security Web sites such as banks, create long random passwords and write them down. Guard them as you would your cash: i.e., store them in your wallet, etc.
E-mail : Turn off HTML e-mail. Don't automatically assume that any e-mail is from the 'From' address.
Delete spam without reading it. Don't open messages with file attachments, unless you know what they contain; immediately delete them. Don't open cartoons, videos and similar 'good for a laugh' files forwarded by your well-meaning friends; again, immediately delete them.
Never click links in e-mail unless you're sure about the e-mail; copy and paste the link into your browser instead. Don't use Outlook or Outlook Express. If you must use Microsoft Office, enable macro virus protection; in Office 2000, turn the security level to 'high' and don't trust any received files unless you have to. If you're using Windows, turn off the 'hide file extensions for known file types' option; it lets Trojan horses masquerade as other types of files. Uninstall the Windows Scripting Host if you can get along without it. If you can't, at least change your file associations, so that script files aren't automatically sent to the Scripting Host if you double-click them.
Firewall : Spend $50 for a Network Address Translator firewall device; it's likely to be good enough in default mode. On your laptop, use personal firewall software. If you can, hide your IP address. There's no reason to allow any incoming connections from anybody.
Encryption: Install an e-mail and file encryptor (like PGP). Encrypting all your e-mail or your entire hard drive is unrealistic, but some mail is too sensitive to send in the clear. Similarly, some files on your hard drive are too sensitive to leave unencrypted."
"
Recent developments in non-invasive cardiology -- Prasad et al. 329 (7479): 1386 -- BMJ
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Recent developments in non-invasive cardiology -- Prasad et al. 329 (7479): 1386 -- BMJ:
"Current clinical applications of cardiovascular magnetic resonance imaging
- General--measurement of cardiac volume and function; if echocardiography is unsatisfactory
- Great vessels--accurate sizing; detection of dissection, coarctation, stenosis; anomalous vessels
- Congenital heart disease--check for concordance of atrioventricular or ventriculoarterial connections; check for great vessels connections; assessment of conduits; assessment of complex anatomy
- Ischaemic heart disease--detection of regional wall motion abnormalities or infarction; assessment of viability
- Cardiomyopathy--identification of hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy; detection of fibrosis or scarring; risk stratification; quantification of iron overload in thalassemia
- Left ventricular mass--accurate assessment in hypertension; assessment of response to therapy
- Valvular disease--quantification of regurgitation
- Pericardium--assessment of thickening
- Cardiac masses--characterisation of tissue; assessment of extent of tumour
"
Public Service Announcement: Firefox 1.0 is out
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The mozilla foundation has released version 1.0 of Firefox--their small, speedy, secure, highly configurable web client that should take the place of Internet Explorer wherever possible. It's available for all platforms at http://www.getfirefox.com/ and it's FREE!
CME Watch
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CME Watch:
""Now there's a freebie, CME Watch v0.4, to help you keep tgrack of your CME activities!
![]() Description:
Introducing CME Watch - Track your CME Hours Easily on your Palm.
No more worrying about whether you've accumulated enough hours.
Use the summary function to add up all the CME hours!
Useful for : Physicians, Nurses, Respiratory Therapists....anyone who needs to attend and keep track of Continuing Medical Education Time!
Featuring:
- Automatically Adds and Summarizes Total CME Hours
- Ability to also track days for CME Allowance.
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""
[Via The Palmdoc Chronicles]
T-Line Tensymeter Instead of Arterial Lines
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I remember seeing this product at an anesthesiology meeting last year and thinking how great it would be for bariatric surgery (gastric bypass operations on the morbidly obese). It's an external device which, when strapped to the wrist and calibrated, can give a very accurate blood pressure reading. Depending on their upper arm morphology, a non-invasive blood pressure cuff may not work reliably in morbidly obese patients if the upper arm is cone-shaped. I used to start arterial lines on these patients, but this device, would be an alternative.
As almost all gastric bypass operations I give anesthesia for are done laparoscopically, this is less and less of an issue for me personally.
[Via EchoJournal]
How Technology Failed In Iraq
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MIT Technology Review: How Technology Failed In Iraq
" “Next to the fall of Baghdad,” says Marcone, “that bridge was the most important piece of terrain in the theater, and no one can tell me what’s defending it. Not how many troops, what units, what tanks, anything. There is zero information getting to me. Someone may have known above me, but the information didn’t get to me on the ground.” Marcone’s men were ambushed repeatedly on the approach to the bridge. But the scale of the intelligence deficit was clear after Marcone took the bridge on April 2." "
