Tuesday, February 8, 2005
I want a Bluetooth pre-tracheal stethoscope
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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...
medmusings: Grand Rounds XX
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All the way from Singapore......medmusings: Grand Rounds XX
Monday, February 7, 2005
More than 80 Prominent Leaders Endorse Special Health Courts
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Common Good has kicked off a national education campaign about special health care courts with a brochure titled An Urgent Call for Special Health Courts: America needs a reliable system of medical justice. (pdf also available).
I've posted about special health courts before here and support them in principle We have special courts for workman's compensation--we need special courts for malpractice issues. The proposal includes:
- Full-time judges
- Neutral experts
- Speedy processing at lower cost
- Schedule for non-economic damages
- Liberalized standard for patient recovery
Wired Magazine: Pain Management in Iraq
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The Painful Truth: The Iraq war is a new kind of hell, with more survivors - but more maimed, shattered limbs - than ever. A revolution in battlefield medicine is helping them conquer the pain.
" For soldiers evacuated from the battlefield, the advantages of nerve blocks over traditional methods of pain control are clear. The wounded troops flying in and out of Landstuhl are often in misery or a narcotized stupor, while those treated with blocks remain awake and pain-free despite massive injuries. "
A great story about how military anesthesiologists are making a big difference for our wounded.
Kaiser Daily Health Policy Report Highlights News of State Medical Malpractice Developments
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Summarizes recent developments in tort reform in Georgia, Maryland, Missouri, Nevada, North and South Carolina, and Wyoming.
[Via UK Medical News Today]
Friday, February 4, 2005
Site Update: Trackbacks Are Live
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My content management system, Conversant, now fully support Trackback as detailed here. To see the trackbacks, you'll have to look at the 'discuss' link that follows each post.
Thursday, February 3, 2005
PA State Medical Society Frivolous Lawsuit Project
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In 2004, the Pennsylvania State Medical Society began a project to support physicians who chose to countersue lawyers who brought frivolous malpractice lawsuits under the Frivolous Lawsuit Project. A recent newsletter gave the following update:
" In May of 2004, the Society settled its first frivolous case, resulting in an apology from the offending attorney and an agreement to make an undisclosed monetary payment.
The countersuit was brought by Charles Dunton, MD—a gynecological oncologist from Delaware County—against Diane Rice, Esq., of Bucks County.
Ms. Rice had filed a medical malpractice action on behalf of her client in which she accused Dr. Dunton of providing inadequate care. That action was eventually resolved in Dr. Dunton’s favor when Ms. Rice was unable to produce an expert to support her allegations.
In her apology, Ms. Rice admitted she did not obtain an opinion from a qualified medical expert prior to filing the suit... "
Wednesday, February 2, 2005
FDA Approves Generic Fentanyl Patch
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FDA Clears the Way for Generic Versions of Transdermal Patches to Treat Chronic Pain
" The Food and Drug Administration (FDA) has granted approval to Mylan Technologies, Inc., for the first generic version of Alza Corporation's Duragesic Patch (Fentanyl Transdermal System) used to treat patients suffering from severe chronic pain that cannot be managed with alternative analgesics. When applied to the skin, this patch technology delivers fentanyl, an opioid pain medication that is slowly absorbed into the body through the skin providing pain relief for up to three days (72 hours).
The agency's approval is expected to provide patients with access to a lower cost alternative of this pain management system. At the same time that FDA approved Mylan's generic product, it acted on several citizens' petitions requesting that FDA deny or delay approval of the product." "
[Via Science Blog - Science News Stories]
Medical Bills, Lost Income Due to Illness, and Bankruptcy
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Health Affairs: MarketWatch--Illness And Injury As Contributors To Bankruptcy:
" "In 2001, 1.458 million American families filed for bankruptcy. To investigate medical contributors to bankruptcy, we surveyed 1,771 personal bankruptcy filers in five federal courts and subsequently completed in-depth interviews with 931 of them. About half cited medical causes, which indicates that 1.9-2.2 million Americans (filers plus dependents) experienced medical bankruptcy. Among those whose illnesses led to bankruptcy, out-of-pocket costs average $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness. Medical debtors were 42 percent more likely than other debtors to experience lapses in coverage. Even middle-class insured families often fall prey to financial catastrophe when sick." "
[Via Science Blog - Science News Stories]
Caffeine, Why Do We Love Thee?
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I spotted this National Geographics cover about my favorite drug while browsing ScienceBlog :
Tort System Costs
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I'm posting these data mainly so I'll be able to find them again at a later date, but others might find the numbers useful as well.
" The tort system now costs every man, woman, and child in America an average of $845 a year, almost 10 times the inflation-adjusted $91 per capita it cost in 1950. The $246 billion-a-year total comes to 2.2 percent of America's gross domestic product -- more than triple the 0.6 percent in the United Kingdom and more than double the 0.8 percent in Japan, France, and Canada. And as of 2002, only 22 percent of all tort costs went to compensate alleged victims' out-of-pocket losses; 24 percent went to pay for non-economic losses such as pain and suffering; 19 percent went to plaintiffs' lawyers; 14 percent went to defense costs; and 21 percent went to insurance overhead. "
I found this section in Better Justice: Bush's Missed Opportunity, which is quoting U.S. Tort Costs:2004 Update Trends and Findings on the Cost of the U.S. Tort System.
FactCheck: MoveOn.org Social Security Ad
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FactCheck.org got its start during the presidential election cycle and aims to "reduce the level of deception and confusion in U.S. politics." A project of the Annenberg Public Policy Center of the University of Pennsylvania, it periodically published 'fact checks' when it feels facts need to be checked (obviously). Their latest analysis is titled 'MoveOn.org Social Security Ad: Liberal group's ad falsely claims Bush plan would cut benefits 46 percent'.
" Summary
MoveOn.org launched a false TV ad in the districts of several House members, claiming through images and words that President Bush plans to cut Social Security benefits nearly in half. Showing white-haired workers lifting boxes, mopping floors, shoveling and laundering, the ad says "it won't be long before America introduces the working retirement."
Actually, Bush has said repeatedly he won't propose any cuts for those already retired, or near retirement. What MoveOn.org calls "Bush's planned Social Security benefit cuts" is actually a plan that would hold starting Social Security benefits steady in purchasing power, rather than allowing them to nearly double over the next 75 years as they are projected to do under the current benefit formula. The White House has discussed such a proposal, and may or may not adopt it when the President puts forth a detailed plan expected in late February. "
As physicians I think we need to be familiar with the facts about such major policy changes and FactCheck helps. If you like, you may sign up to receive future reports automatically.
Sunday, January 30, 2005
A Momentous Day
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The Fox News headline sums it up rather well: "A New Dawn of Democracy".
Iraq, our thoughts and prayers are with you--especially today. Let Freedom Ring!
Friday, January 28, 2005
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.
Palm Anesthesiology
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PalmSource maintains an excellent resource for anesthesiologists (thanks to Donald M. Voltz, M.D.) at Palm Anesthesiology which includes:
Software
- Medical Calculators
- Drug References
- Case-Tracking Software
- Educational Software
- Medical Billing Software
- Quality Assurance Software
- Clinical Information
E-Books
User Stories
Web Resources"
Included is some billing software I'm going to have to review...
Saturday, January 22, 2005
Unusual Venue for a Tribute: iTunes Music Store
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I ran across an unusual, but moving, tribute from a son to his mother. I say 'unusual' mainly because of where I found it--on the iTunes Music Store. I'll post it below for you to consider:
For those of you with iTunes, you can see the iMix.
Friday, January 21, 2005
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.
'X' Marks the Spot. Or Does It?
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Newsday.com has details of a recently announced jury verdict in a case of wrong side surgery:
" "A Manhattan hospital and the chief doctor for the New York Rangers hockey team were ordered Thursday to pay a dance director and choreographer a total of $450,000 because the physician operated on the man's wrong knee.
The jury awarded the money to Douglas Hall, 43, who entered St. Vincent's Hospital on Nov. 30, 2001, for arthroscopic surgery on his right knee. Despite marking that knee with an 'X,' Dr. Andrew Feldman operated on the left knee. " "
Does an 'X' mean 'operate on this one' or does it mean 'do not operate on this one--operate on the other one'? I've seen a few patients write 'No!' on the non-operative side. We all got a chuckle out of it, but it worked! Rather than an 'X', the mark should be placed on and refer to the correct side--either 'R' or 'L'.
The rest of the article points out that the OR was also set up for the wrong side. Just another example of multiple failures being needed for a medical misadventure to occur. I'm sure there was no end of the 'blame game' going on for this one.
Why I Like Being An Anesthesiologist
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I've tried to explain to people why I like being an anesthesiologist so much--with difficulty (unfettered access to narcotics, starting my work day at 07:30, having patients ask me if I'm a real doctor, oodels of respect from surgeons and nurses alike are the reasons that usually come to mind). I just ran across something on the web that really helps me understand why. Getting Back To Work: A Personal Productivity Toolkit at kuro5hin.org is an article about procrastination. Now, my favorite motto is 'hard work pays off after a time, but laziness pays off now,' so I was naturally drawn to this article.
The article describes the ideal work experience as being in a state of 'flow' and goes on to outline the kinds of tasks that make it more likely you'll be able to attain it:
"
- Variety
- Appropriate and flexible challenges
- Clear goals
- Immediate feedback
- A sense that one's skills are adequate to cope with the challenges at hand.
- A rule-bound action system
This is what the ideal job looks like. This job will resemble play, and will be addictive. As much as you can create work like this, you will be a happy person. As much as you can make your work like this, you will want to do it. "
Bingo! That's why I like being an anesthesiologist in private practice!
That's also why I like using Conversant to build web sites. When I'm working on a Conversant site, I often reach a state of 'flow.'
[Via 43 Folders]
Wednesday, January 19, 2005
Google--Preventing comment spam
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Google--Preventing comment spam:
" "If you're a blogger (or a blog reader), you're painfully familiar with people who try to raise their own websites' search engine rankings by submitting linked blog comments like 'Visit my discount pharmaceuticals site.' This is called comment spam, we don't like it either, and we've been testing a new tag that blocks it. From now on, when Google sees the attribute (rel='nofollow') on hyperlinks, those links won't get any credit when we rank websites in our search results. This isn't a negative vote for the site where the comment was posted; it's just a way to make sure that spammers get no benefit from abusing public areas like blog comments, trackbacks, and referrer lists." "
Read the rest for details of how to implement this tag
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