Automatic chest compressions

Automatic chest compressions? For a second there I thought I was reading the Mad Engineering blog. But no, according to Medgadget, this is in fact a very real product from swedish company Jolife AB. Apparently the device can deliver chest compressions for up to 45 minutes while paramedics are loading patients, transporting, charting and reporting and other stuff. Incredible.

Firstborns first pass at the Linux shell

As any parent will tell you, you should never turn your back on a toddler. They grab stuff, stick it in their mouths and/or pour milk on it. It's a fact of nature.

Firstborn got his hands on the Linux laptop earlier today. Now, you'd probably expect he'd throw it around (he's 20 months old) or pull out keys from the keyboard and eat them, but it turns out he just typed away at it. Here's what the backlog looked like when he was finished:

imitari:~# mk
-bash: mk: command not found
imitari:~# io
-bash: io: command not found
imitari:~#
imitari:~#

Well, okay, he obviously hasn't got a clue about bash, but "mk" and "io" are actually reminiscent of actual commands. It makes a geek dad so proud I almost want to cry! :)

Listening Is Powerful Medicine

Each story is different. Some are detailed; others are vague. Some have a beginning, middle and end. Others wander without a clear conclusion. Some are true; others not. Yet all those things do not really matter. What matters to the storyteller is that the story is heard — without interruption, assumption or judgment.

Read the rest of dr. Alicia Conill's essay on listening over at This I Believe.

Mostly harmless?

Head over to vitum medicinus and read the post The tragic outcome of a homeopath treating his daughter's eczema. Then return here and tell me that alternative medicine is completely harmless. Anyone who manages to remain a shruggie after reading a story like that will completely lose my respect.

As a future doctor and scientist, my mind is raging, orac style. As a parent, my stomach is churning and my heart is crying out at the thought of that little 3rd percentile body ravaged with infection.

The SMS story

How did SMS come about? Why are SMS messages limited to 160 characters? Did German GSM committee chairman Friedhelm Hillebrand basically invent Twitter in 1985, before the web was even born, and while Twitter founders Dorsey, Williams and Stone were still playing with Matchbox cars? Check out the story in LA Times. (H/T Ves Dimov)

The dangers of importing data into personal health records

Garbage in, garbage out... Image credit:
Jan's Illustrated Computer Literacy 101

Via RISKS Digest, an article from The Boston Globe about how 59 year old Dave deBronkart, a survivor of kidney cancer, erroneously got billing data imported into his Google Health clinical history. Billing data are not meant to precisely describe clinical conditions, but are often used as approximations when coding reimbursements, which is why deBronkart got a chilling scare when Google Health suddenly informed him that he had diagnoses like brain metastasis and an aortic aneurysm. Blogging about his experience over at e-Patients.net, deBronkart also describes how, presumably through the same mechanism, a diagnosis like optical migraine had been transmogrified into plain old migraine headache and year-old diagnoses of hypokalemia and anxiety were revived and flagged as medical alerts.

How could this have been avoided? For starters, by having aligning data models on both ends of the export/import pipe. Standardization bodies like HL7 have been working since the early eighties to providing standardized methods for information exchange, but still Personal EHR providers are reinventing the wheel, leading inevitably to errors like these. Who's to blame? Beth Israel Deaconess Medical Center's PatientSite, or Google Health? Who would be sued if these runaway billing data imposing as real clinical data had led to medical errors somewhere down the chain? deBronkart makes no conclusion, but calls for patients to claim ownership and responsibility for their own data. He also calls for vendors and the open source community to start making standardized systems.

Looking at it from another angle — who's liable if users themselves enter erroneous data into personal health records? Most doctors are familiar with patients who come to appointments with huge stacks of printouts from various sources, and most are wary in trusting these data. Are personal health records doomed to fail? The answer of course depends on the condition. Headache or allergy diaries can be immensely useful, but a patient presenting an PHR record claiming and inexplicable and intractable pain condition and paracetamol and NSAID allergies... Well, I guess you all know where I'm headed.

Personal health records — a blessing or a curse? I guess it remains to be seen. Stories like these don't exactly inspire confidence, though.

An ethical dilemma

Image credit: 2create@Flickr

A man in his seventies is diagnosed with metastatic prostate cancer, and is enrolled in a palliative chemotherapy program. As the man's primary care physician you're having a hard time getting the man to cope with his situation. He has not informed his family about his diagnosis. He has confined himself to his home, refuses to come to you for consultation, and only rarely answers the phone. You've started making weekly home visits to check up on his well-being, which he begrudgingly accepts. He complains that his family doesn't care and expresses the wish to "just die in peace".

The last two weeks he has stopped answering his door. You confer with the man's oncologist, which tells you that the he still shows up for chemotherapy at the local hostpital, but that they have not heard from him in a couple of weeks. The oncologist suggests that "someone" should break the man's door down and see if he's still alive. Not wanting to disrespect a dying old man's privacy and wish to be left alone, you struggle with what to do.

Thoughts?

Living Arrhythmias

I know, I know, here I go again with the video posts, this time even shamelessly stolen from another blogger (Pharmamotion). I'll try to find the inspiration for self-produced material soon. In the meantime this one was just too good to pass up. There's something special about watching a cardiologist (trying to) balance on one leg while simulating right bundle branch block with the other.

The Great Sperm Race Game

British Channel 4 have created a cute little flash game that lets you play the role of one of 250 million sperm competing for the privilege of fertilizing the egg. Sounds lame, I know, but it was actually kind of fun. Kind of like OB/GYN rotation.

Linky: The Great Sperm Race

HIV T-cell transmission captured on video

Image credit: Science Magazine

MIT Technology Review reports on another nail in the coffin for HIV/AIDS denialists. For the first time, researchers have created footage of virus transmission in live cells. The above image is a screenshot from one of the videos. The study was published in the March 27 edition of Science.

HIV/AIDS denialists are a shady bunch. Hopefully none of my readers need convincing that the HIV virus is real.

¹ Quantitative 3D Video Microscopy of HIV Transfer Across T Cell Virological Synapses. Wolfgang Hübner, Gregory P. McNerney, Ping Chen, Benjamin M. Dale, Ronald E. Gordon, Frank Y. S. Chuang, Xiao-Dong Li, David M. Asmuth, Thomas Huser, Benjamin K. Chen.
Science vol. 323. no. 5922, pp. 1743 - 1747 DOI: 10.1126/science.1167525

Brief intermission

Hiya! Just dropping by to apologize for the lack of posting recently, and to wish everyone a happy Earth Hour.

I for one don't think it's just a feeble gesture. I do believe it's important to raise awareness. I also disagree with the people who mock Earth Day for being pointless — at least it's doing something. I'm not sitting around waiting for the one solution that will fix everything in an instant to come along before I act.

Request for comments

Image credit: CrimethInc

Dear readers, I need to hear your thoughts on an issue.

Say you were the doctor of an 83 year old, pleasantly senile diabetic lady, with whose husband you have regular meetings about her care. Let's describe the husband as, well, a bit anal and somewhat argumentative, but mostly pleasant and cooperative. Lately he's been giving you a hard time over her insulin regime, saying she needs five daily measurements of blood glucose, while you're arguing that her HbA1C levels are fine and have been stable long enough that two daily measurements will suffice. This has been the topic of your last three or four meetings. After the last meeting, in which the husband's temper got pretty high over a sporadic, mildly raised glucose level, the patient's nurse pulls you aside and tells you that he has been secretly recording your meetings. Let's say the laws of your country don't forbid anyone from taping a conversation in which they themselves take part, provided that they inform the other parties.

What thoughts would you have? Why would he possibly need to tape your conversations? Would you feel silly for being paranoid?

What would you do? Ignore it? Confront him about it? Take offense? Press charges? Refuse to cooperate further unless he refrains from taping?