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?

Friday, April 1, 2005

Crossing the Digital Divide...And Continuing the Ascent

Thursday, March 17, 2005

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

Sunday, March 13, 2005

The Hipster PDA

43 Folders has a wonderful post on a way to capture information on the go which they're calling the Hipster PDA. Now, I have tried to use all manner of PDA to keep track of info on the go at the hospital, starting with the Newton all the way up to my current Treo 610. Which one worked best? It was the system I used as an intern--3X5 index cards held together with a binder clip.

I have improved on it slightly over time, only because, as an anesthesiologist I have less stuff to remind myself about. My 'Palmster PDA' consists of the palm of my left hand on which I can conveniently write down who needs an epidural, which of my colleagues needs lunch or a break, or when I need to re-dose the antibiotic for my current patient.

Saturday, March 12, 2005

How To Use An iPod

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:

Monday, March 7, 2005

'Good guys' show just how easy it is to steal ID

'Good guys' show just how easy it is to steal ID:

" Teams of hackers surfed the Web at Seattle University yesterday, harvesting Social Security and credit card numbers like a farmer cutting wheat. In less than an hour, they found millions of names, birth dates and numbers -- cyberburglar tools for the crime of identity theft -- using just one, familiar Internet search engine: Google. "

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]

Sunday, February 13, 2005

Using Passwords? Switch to Pass-phrases, Instead.

Slashdot points to a very interesting blog entry by a Microsoft engineer in which he makes it perfectly clear how single passwords are not secure any longer:
" So with all of these highly successful, highly effective attacks on passwords (dictionary attacks, brute-force attacks, pre-computation attacks) I've come to the conclusion that there is simply too much risk associated with passwords and that users of Windows should simply stop using them to avoid this risk. "

Instead, he recommends pass-phrases:

" Pass-phrase LENGTH, not complexity defeats these attacks. Short, but complex passwords should be shunned as they are not truly secure anymore and you are deceiving yourself if you think they are. Long pass-phrases (14 characters or more) are the future (along with 2-factor or more authN, but that's another blog for another day) and are the only way to go if you want to ensure that you won't get hacked via any type of password based attack of any kind. "

Saturday, February 12, 2005

Citation Classics in Anesthetic Journals

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.

Tuesday, February 8, 2005

I want a Bluetooth pre-tracheal stethoscope

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...

Friday, January 28, 2005

BehindTheMedspeak: Pediatric MRIs will never be the same - thank God almighty!

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.


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