I've lectured on a variety of topics. I've been asked to give inservices to OR nurses and anesthesia techs alike. No topic is more frequently requested than how to use an iPod. Honest. iPods are becoming more commonplace in the operating room all the time. I've finally found a nice demo on the web of how to operate an iPod which allows self-paced learning:
'Good guys' show just how easy it is to steal ID:
The problem is not Google. The problem is the sites that allowed these documents to be indexed. I wonder how successful we would be finding protected health information?
[Via HIPAA Blog]
Instead, he recommends pass-phrases:
I was listening to some friends talk about taking a large set of information and making it more useful to the user when I thought about a project I helped with to try to remedy this with regard to the body of published literature in medicine. PubMed is the National Library of Medicine's big online database of medical articles (no, I didn't help with that). Searching for a term on PubMed usually gets lots of results but doesn't necessarily get you any closer to finding that key reference that people consider the classic or definitive paper in the field.
As a teacher in academic anesthesia, I saw residents (note the past tense) had little hope of finding the 'right' paper to read unless I gave it to them. If I said 'read about airway management' they would no doubt find some things about airway management, but probably not the paper on airway management. Unless of course they were able to search a subset of articles in PubMed defined in advance to be especially relevant to their field of study. That's how we conceived of the idea of 'Key References'--make it easy to assemble a list of references for whatever purpose. To make it easy, we used a unique identifier for each article called the PubMed ID Number (PMID). Seth Dillingham then wrote a plugin for Conversant that could take that PMID and go to the PubMed system and (politely) request information about the reference such as title, authors, citation, and even the abstract.
'Citation classics in anesthetic journals' by Baltussen and Kindler is comprised of 'seminal advances in anesthesia' which give 'a historic perspective on the scientific progress of this specialty'. The advantage of having them available online as a compilation lies in the fact that they 1) are searchable and 2) linked to related articles in PubMed (something which even the online version of the original article even does not do).
See for yourself: Citation Classics in Anesthetic Journals
After looking up all 100 PMID's for these articles I wrote to the journal editors and suggested they require authors to include PMID's for references they cite in each article but (apparently) failed to make a convincing enough case. Sort of like in, oh, 1995 when I suggested to the editors of another journal that they could put their articles online using Highwire Press and was told that they had their hands full putting back issues on CD.
During my anesthesiology training, attendings encouraged me to use a pre-tracheal stethoscope--basically a metal bell that rested on the base of the patient's neck over the trachea which could be used to listen to breath sounds during general anesthesia. This usually involved a hollow tube running from the stethoscope to an earpiece in the anesthetists ear. FM transmitter were available for wireless monitoring.
I still think this is usefull, especially for cases using a laryngeal mask airway (LMA). Trouble with an LMA is usually preceded by 'crowing'--a high pitched noise caused by the passage of air over partially closed vocal cords. This can progress to frank laryngospasm, airway obstruction, and the generation of very large negative intra-thoracic pressures and negative pressure pulmonary edema.
What would the modern equivalent be like? Bluetooth transmitter. Wireless ear phone. I wonder if I can do this with my PowerBook somehow? I'd need a box to convert the sound from the stethoscope to a digital signal (and amplify it), then run it into the PowerBook. On a PowerBook with built-in bluetooth, can I send the sound-in signal out via bluetooth? Sounds like a weekend project, to me...
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 agree whole heartedly.
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:
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]
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? 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:
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]
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.'
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."
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