Much to say — I've been idle here for a few days.
First – this paper in Mayo Proceedings provides a well done overview of the genomics research of the last few years – and how it may be relevant to real-life practicing physicians. It's a primer on genetics, and I agree that it is probably required reading for most of us.
I'll admit that I have not been blown away with the relevance of genomics to my daily life. The residency director of one of the residencies at the Academic Miracle Center here has a habit of telling anyone in the room that all of his residents are required to know genomics in detail "because it will impact their practice so much." I won't say who he is .. but I will say that his residents don't agree with either statement.
This report (RealAudio) on NPR's Marketplace yesterday, highlights a component of the current generic drug system that I wasn't aware of. This is another reminder that the laws in this country on pharmaceutical production and distribution favor the big guys .. not the little people.
bmj: The importance of patient preferences in treatment decisions and challenges for doctors. This paper provides a great overview of the complexity we encounter when trying to provide true shared decisionmaking to our patients.
Here's the result of my PubMed search on trigger thumb in kids. There remains no concensus on what is the best method of treatment. I've referred him to the local hand surgeons – who specialize in adults. They suggest no spinting and observation until at least 1 year of age. This seems fine, but several studies suggest that spinting may actually help.
In the absence of a good evidence, expert opinion may be my best bet. I think I'm going to call Boston.
Kent has updated shots again to the 2004 version. It remains free.
Ken Ong's article on Just-in-time Database-Driven Web Applications appears this month in the Journal of Internet Medical Research. It's an excellent look at how web-based applications can facilitate improved work processes in a medical setting. In the hospital and in our office, we've built many web-based applications, and I would agreee with Ken that this technology fits our needs quite well. The powerpoint presentation at the end of the paper is also an excellent overview of many of the applications they are using internally at SVCMC.
Tim's response to the post last week about e-prescribing (and duct tape) deserves a few words:
- Tim mentions that expresscrips has been doing e-prescribing for some time .. and he's right .. and in fact several other vendors have been doing things like this for a few years, but this initiative is different. Why?
- They claim that most US pharmacies will be connected.
- There will be methods for physician practices to electronically transmit prescriptions to the pharmacy directly. One EMR vendor has already announces support. More will soon follow. This thing seems to have more momentum than any previous e-prescribing initiative I've seen.
- It's not linked to one system like express scripts or PCS
- There may be methods for practices who are not "e-enabled" to transmit prescriptions to a pharmacy. we'll see who they partner with in the hand-held arena. Don't be surprised if it's epocrates or e-physician.
- Tim asks about Duct tape for warts. Sicne this post last fall, I've used duct tape in my practice many times. I can say that my results are similar to those that are reported in the study – though I'll admit that my "n" has been rather small. Probably fewer than 20 patietns in each group. One man had warts on both knees – we duct taped the left (a small square of duct tape on the wart – changed every few days – until the wart is gone – usually 3 weeks or so) .. and used cryo on the right. The result? Both warts were gone in 3 weeks, but the cryo took 3 applications. I always bring up the Duct tape option now, and will often use cryo on the 1st visit (patient is already there) .. and suggest either duct tape or one of the OTC Salicylic Acid products such as wart-off .. and if things don't improve — a return visit in about a month. For warts anywhere other than the feet, the duct tape seems to work very well. Plantar warts remaim tough to treat.