Going To Sleep Is Free, But

Why I'm Not Buying The (First) iPhone

• Categories: Computers, Software, Technology
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With only three weeks to go until the release of the iPhone the frenzy is peaking. What features will it have? What is the twelfth icon? Will it have a SIM tray? Where will be the best place to buy one? I decided to today that I don't care. Let me explain why I won't be buying Apple's iPhone.

I've learned not to buy the first of anything Apple puts out. Though I love the company and have been buying their computers and other devices since the beginning, I think that (especially recently) there's good reason to be patient and let other people help Apple work out the kinks.

I ordered the MacBook on the day it was announced....and had the heat-sink problem. I ordered the 24" iMac the day it was announced...and had it up and die on day four of owning it. There are other examples of released hardware that was flawed initially but improved with each revision that, thankfully, I didn't experience myself. The bottom line is that being first has a price and that it's worth giving Apple a chance to learn from the initial release and improve the hardware with subsequent revisions. That doesn't mean waiting for the next model. Apple revises hardware between new releases, too.

The second reason for waiting is that the device you really wanted is usually the second one in the model line, not the first. But you compromise, tell yourself it's still worth getting the first one, but it's not. Because as soon as the second version comes it, you decide you should have waited. That's what happened to me with the Newton. I bought each new model as it came out (and still have a 2100).

What do I expect in the second version of the iPhone that I think makes it worth waiting for? Better-than-EDGE speed, for one thing. A camera that's better than 2 megapixels for another. GPS for a third. And many fewer problems.

Today, I put down my own good money for a Nokia N95. Five megapixel camera, built-in GPS, and a mature OS that has lots and lots of third-party apps. With iSync and the release of Nokia Media Transport yesterday (nice write-up here), adding contacts, calendars, iTunes music, photos, and videos just got a lot simpler.

Acoustic Respiratory Monitoring: What Is It?

• Categories: Anesthesia practice, Technology
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An intriguing press release last week from Masimo (known for their motion artifact-resistant pulse oximeters) begins as follows:



The release then refers to "an adhesive bioacoustic sensor applied to the patient's neck and connected to a breathing frequency monitor prototype" which in turn accurately monitors respiratory rate.

If this device does what I think it does, it will become the standard of care for post-surgical patients very rapidly.  We've been looking for a way to reliably monitor respiratory rate on the floors, once patients are discharge from the recovery room.  For example, a patient may receive pain medications from multiple sources, with unpredictable onsets.  How do we know their maximum respiratory depression won't happen after they've been delivered to their hospital room?

A patient can receive oxycontin and celebrex orally from a surgeon before their knee replacement surgery, then more fentanyl, morphine, and versed from us (anesthesia).  The surgeon may then inject bupivicaine and morphine into the joint at the conclusion of surgery (without necessarily telling the anesthesiologist). I might also do a femoral nerve block to further reduce post-op pain.  All of us are trying to do right by the patient but, given the right set of circumstances, are setting them up for significant respiratory depression post-op.  The ability to reliably monitor respiratory rate with this new Masimo monitor would be a huge patient safety advance.

The Society for Technology in Anesthesia abstract is here.

Own Your Own Cable Modem? Check The Speed!

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I have cable modem service to my home via Comcast. I bought my own modem, the Motorola 4100, about three years ago so I wouldn't have to pay the cable modem rental fees. Since the modem only cost about $50, I've saved about one hundred dollars over that time period.

I had Comcast come install two CableCards in my new Tivo Series 3 and the installers commented on what an old modem I had. They went on to explain that one advantage of renting a modem is that, when the modem limits download speed, Comcast will replace it with a faster one. Having just installed a new Airport Extreme Pre-N wireless router, this seemed like something to check out.

After reading the spec. sheets on both modems it looks to me like their download speed is the same (38 Mbps). However, the Motorola 5101 I just installed is faster in my tests. Maybe it's the DOCSIS 2.0 support. Well, I'm just an unfrozen caveman anesthesiologist but I know speed when I see it...16 Mbps:

If you bought your own modem several years ago, consider upgrading it. The results might surprise you.

Send Addresses From Google Maps To Your BMW

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well, in Germany anyway...

Are Alphanumeric Pagers Obsolete? That Depends.

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Ever since I was an intern I've worn a pager while at the hospital--and at a lot of other times, too. They used to be as big as a pack of three by five cards, but now they're quite tiny (think matchbox). But it's still an item you have to remember to put on each day, an item that weighs on your waistline. Back when there were only pagers that wasn't a big deal. Wearing a pager was a status symbol.

But now that belt or waistline space is more crowded. There's probably a cell phone and a PDA. There may also be a Spectralink phone or two for in-hospital calls. If you're really important, you may have more than one or two pagers. It's enough to make your scrubs sag.

Someone explained to me once (and I don't have a reference for this) that FCC law prevents device manufacturers from integrating a digital pager into another electronic device such as a cell phone or pda and that this was done to protect the paging industry. Is that true? Does anyone know?

My group still carries pagers because we know they always work, no matter where we are. In a surgery center in the basement of a medical office building or far out of town, away from cell towers, the digital pager will let us know someone wants to talk to us.

As the Palmdoc Chronicles points out in his post titled Alternative to Paging, there are more options than there used to be: SMS/Texting, Push E-mail, IM, Push to talk. To the best of my knowledge, however, none of them offer the reliability of paging. If someone needs to be intubated, or needs an epidural, or is coding, 'Sorry, did you IM me? I didn't get it' isn't going to cut it.

The one upgrade I would love to have to our pagers is the ability to send text messages over them. For example, instead of getting paged to '3968', calling that number only to be asked to go do an epidural in labor room 8, I could just receive the message on the pager: 'Epidural labor 8.' See? Our pagers are hospital provided and the service I describe costs more. I have not been sufficiently persuasive in my appeals to get them to spring for the extra feature. When I offered to pay for the cost of the alphanumeric service over and above what regular digital paging service costs, I was told we can't do that either because they can't 'split out' a subgroup of the pagers.

Now, I realize I'm just an unfrozen caveman anesthesiologist, but if you know that 40 pagers are using a service that costs ten dollars more per month and I cut you a check for $400 each month, wouldn't that make us even?

(Another Reason Why) I Like Desflurane

• Categories: Technology, Anesthesia practice, Medical errors
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I've posted before on why I think the desflurane Tec 6 vaporizer is a good design (it doesn't need to be turned off to be refilled). I'd like to add another reason to the list: it has alarms.

The Desflurane Tec 6 has a 'low agent' alarm and a 'no output' alarm, in addition to the ability to detect when it has been tipped (and therefore shouldn't be used). The other common agent, Sevoflurane, is delivered via a vaporizer that has none of these things. I am personally aware of two cases where no volatile anesthetic was delivered despite the vaporizer being 'open'. Two cases that would have been uneventful if desflurane and a Tec 6 vaporizer had been used. I'm going to ask the Society for Technology in Anesthesia listserv if there is any reason the Sevoflurane vaporizer couldn't have these features.

DaVinci Surgical Robots. A Hospital CEO Asks Advice.

• Categories: Health Care Finance, Policy, Technology
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Running a hospital: da Vinci Uncoded -- or, Surgical Robots Unite!

I just discovered this blog today via Medgadget and am already impressed. The large health system our group works in purchased a DaVinci last year. I don't know outcomes yet but it was apparent to me before the purchase that it was largely driven by regional competition in Central Pennsylvania. I think it's telling that many of the institutions which were the early adopters no longer use the systems.

I'm hoping to pick one up cheap in a couple of years so I can do labor epidurals from home. ;-p

Bring Your Own Applications--Portableapps.com

• Categories: Technology
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PortableApps Suite | PortableApps.com - Portable software for USB drives

Hospital computers tend to have Internet Explorer as the only web browser. It works (mostly), but it's not as secure, extensible, fast, standards-compliant as, say, Firefox. Besides that, I use Firefox at home and like to have the same bookmarks available. Portableapps.com allows me to carry my own apps in on a USB thumb drive.

VeinViewer

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[Via Medgadget]

Google That Medal Count

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Just Google 'Olympic Medals' to see the top three countries in the medals race.

via [LifeHacker]

High Tech Noise Canceling Stethoscope

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Also via A Chance To Cut is a Chance to Cure, a pointer to a new stethoscope: 3M Littmann Electronic Stethoscope Model 3000

Listening to a patient's heart and lungs before anesthesia is something I don't do nearly enough. This may just be the gadget that makes it fun again...