Medlogs, Asterisk & Earwax

Medlogs, Asterisk & Earwax: 

I did the weekly review last night and approved of another batch of medical weblogs for inclusion in  Lots of medical weblogs. Wow.  It's no secret that we've been talking with Steve about some sort of partnership.  Medlogs may have outgrown its current iteration, which is just fine.  We need to categorize things better (volunteer libriarian-types welcome to assist with this!) .. and we may use some of the cataloging tools we're developing for FMDRL to help with these functions.

I met last week with Glenn McGee who is crazy.  Reminds me of myself.  He's FULL of energy — and I think he may actually be able to accomplish his goals .. which are many.  He has ideas for Medlogs too — and how we could integrate it into  Hmmm

Speaking of crazy – I installed an Asterisk server in my basement.   I used Asterisk @ Home .. which is kinda Asterisk for dummies.

It works remarkably well, and I learned that SIP phones are oh-so-2004 and that the cool 2005 protocol for IP telephony is IAX.  It does work better than SIP and it works from behind firewalls too.  (Though I had to punch a hole in the smoothwall firewall that's runninng in the basement – for phones to get through to the server).  There's a free IAX softphone called Firefly that works on "third party networks" (including any Asterisk server).   It is the bext IAX softphone that I've found yet.  May actually buy a hard phone at some point.  The cool thing is that with either the softphone or the hard phone … if I am on the Internet .. plug it in and the thing will work as if it's local.  So calls that come in to my number just ring … and calls that I make will go out as if I was sitting there 10 feet from the server. 


What's all that have to do with earwax?  Nothing.  But Bandolier has a great little review on earwax today.  A quick read – and well done as usual. 


Medical Vocabularies, bad laptop .. ugh

It's been a hectic week. 

Went to San Antonio last week to work on the FMDRL grant.  Didn't see much of the city – but we did get some things sorted out for the project .. and I enjoyed working with our team.

The project is to create a digital library of resources for family medicine education.  Here's an abstract of the grant.

If you're building a library – you've got to catalog the resources so that people can look for stuff.  Fortunately, the good folks at NLM have built some fantastic tools that we're using to put all of this together.

How's it work? 
  — top secret (for now) ..
But here's a sample.  Pointing the "catalog engine" at this random medical blog post .. returns this:

Sample Text:

Take two ximelegatran and call me in the morning [Addendum, 2/14/05: as has been pointed out by commenters, ximelagatran was turned down for approval by an FDA panel in September, 2004, because of concerns about hepato-toxicity. Whether it will ever …


Primary Subject(s):

ximelagatran (T121:Pharmacologic Substance)
Marketing (T057:Occupational Activity)
Coumadin (T121:Pharmacologic Substance)

Secondary Subject(s):

Diaphragm (Anatomy) (T023:Body Part, Organ, or Organ Component) Hemorrhage (T046:Pathologic Function)

Cool huh? 

Using this engine – we could catalog ALL of medlogs (and therefore the "medical blogworld") .. and map the concepts to MeSH or even SNOMED ..

My laptop died yesterday .. which really stinks.  It's an enormous hassle.  I never liked it anyway … it was a Compaq N800c.  Worked very well for speech recognition .. but it was too big and heavy to work well in the office.  Charlie ordered me a replacement yesterday. 


Otitis Media: hold the antibiotics

This editorial in CMAJ is wonderful.  The authors summarize a recent paper in that jornal that found a small difference in outcomes between patients who received amoxicillin and those who received placebo.  86% of patients who received placebo – and 92% of those who received amoxicillin had resolution of disease.  The editorial appropriately points out that this small difference should not cause us to think that antibiotics are appropriate for first-line treatment of AOM.  The NNT remains ~ 11 for treatment of AOM with antibiotics.  Do we really want those 10 extra kids treated? …  No.  of course not.

CPOE causing medication errors

Yeh .. this one is old news, but I'll mention it anyway … as it was on NPR yesterday.  Where's the audio?  (if someone can find the link to it .. LMK). It's a study from JAMA that describes how bad UI can cause medical errors.   This is a no-brainer.  At this week's meeting with a rep from our not-to-be-named EMR vendor (no, it's not really Voldemort) – we learned about some of their UI improvements and I will say that they are starting to "talk the talk."  Things we talked about 3 years ago and they looked at us funny like we were speaking Turkish are now appearing in their Powerpoints.  It's certainly a welcome change.  When one of our pediatricians remarked that he had made errors in the ordering of immunizations because the UI of the immunizations screen is so bad – I wasn't surprised.  Bad UI in healthcare applications simply shouldn't be tolerated. 

The question, of course, is how we are going to get from here to there. 

Hard work.

EHR implementation, etc ..

Long time … let's see ..

  • The AAFP has released the findings of their EHR pilot project.  Not much new news there.  Bottom line: small practices will do just fine with an ASP model, and we need to re-do workflow.  Duh.  They used the Medplexus EHR – which is promoted as an "XML- and Java-based EHR."  I don't get why XML and Java are meaningful in any way as a marketing pitch.  The end'user should not give a hoot what language the code is written in – not should we care how the data is stored.  It could be written in assembler and have the data stored in mvbase for all I care .. just so long as I can query the database (or XML-Base?) in a meaningful way.  The MedPlexus user interface is well-short of intuitive .. but I guess this doesn't make it unique.   OK .. I'll be quiet.
  • Dave and I went down to NYC and met with Steve and his team.  it was fun, and we talked about some ways to get Medscape involved in Medlogs (or perhaps I should say Medlogs involved in Medscape) ..
  • I discovered BMJUpdates+ last week.  It's a free e-mail based medical update service that sends you links to abstracts of articles that have been selected by an editorial team for high relevance and newsworthiness.  This is good.  It's similar to the POEM concept.  Here's what yesterday's e-mail had for me.  Not bad.  No RS feed though 😉

New articles: colleagues in your discipline have identified the following article(s) as being of interest:

Article TitleDisciplineRele-
Long-term dual blockade with candesartan and lisinopril in hypertensive patients with diabetes: the CALM II study.General Practice(GP)/Family Practice(FP)(all)66
Pro-active call center treatment support (PACCTS) to improve glucose control in type 2 diabetes: a randomized controlled trial.General Practice(GP)/Family Practice(FP)(all)66
A 5-year prospective assessment of the risk associated with individual benzodiazepines and doses in new elderly users.General Practice(GP)/Family Practice(FP)(all)76