Docnotes

Web - Based Signout Lists

Working today on introducing the pediatric residents at Albany Medical Center to the concept of web-based signouts .. and taking another look at our code from the software that was written in 1997.

Back then, Patrick Norton (a dorky medical student at the time) and I built this system to help facilitate signout.  We presented a paper at AMIA. 

The concept is that the pediatric residents will use this list for daily sign-out.  The family physicaians have been using it for about 5 years .. and the Internal Medicine Residents have been using it for about 6 months.  Everyone seems to like it very much, but I've learned that what works for one group of docs doesn't always work for another.  Hence the meeting today ... I'll document as we go ..

Changes that the peds folks want/need:

1. Weight (in kg) ... If over 50 remind to use adult dose.
2. Primary physician name
3. Hosptial Attending name
4. Off-Service Field with drop-down menu for selecting:
   1. Pediatric Surgery
   2. ENT
   3. Ortho
   4. Neurosurgery
   5. Adult Neurology
   6. Urology
   7. Other
5. Which Service list
   1. Red
   2. Green
   3. PICU
6. NICU is separate
   1. 1
   2. 2
   3. 3
   4. 4
   5. 5
   6. 6
   7. 7
7. Output:
   1. If age < 2 then express in months
   2. if age , 30 days then express in days
   3. Put weight next to patient name

We'll implement this stuff for now ... and then likely re-visit in the summer, after the new interns have settled in.

Healthcare Rationing

Five Points "The inevitable result of socialized medicine is the rationing of healthcare."

uh ... what?  This comment reveals a perspective that I fear is more destructive than constructive as we consider options to improve the delivery of healthcare in the United States.

Let's not forget what ration means.  The root word is ratio:

Latin:

ratio -onis f. [a reckoning , account, consideration, calculation]; 'rationem ducere', [to compute]; [any transaction, affair, business; a reason, motive, ground; a plan, scheme, system; reasonableness, method, order; a theory, doctrine, science; the reasoning faculty].

ratiocinatio -onis f. [reasoning; esp. a form of argument , syllogism].

ratiocinativus -a -um [argumentative; syllogistic].

ratiocinator -oris m. [a calculator , accountant].

ratiocinor -ari dep. [to compute , calculate; to argue, infer, conclude].

rationalis -e [reasonable , rational].

rationarium -i n. [a statistical account].

Rationing is all about distributing a limited resource in a reasonable manner.  All countries ration healthcare.  In most countries, the goal is to distribute this resource carefully based on need.  Yes, someone has to decide what tests get done and what tests don't .. and this usually involves some sort of central management.

But in this country, we ration healthcare based on a far less "rational" variable: ability to pay.  The poor and working poor in this country get worse care than the wealthy  .. and of course there are many variations in between.

There is a lot to debate .. but let's not throw stones fro our glass house and denounce healthcare rationing.

Serotonin Syndrome

From CMAJ this week: Serotonin syndrome: a brief review. I was asked about this topic just last week. It's a decent case report - though not as thorough as I would have liked.  There's a better summary on FPnotebook

Order Sets - CPOE

Here's another survey question. interesting ...

Micromedex Survey

I don't often fill out online surveys .. but I thought that this one mught tell me something about products that Micromedex is working on.  It's a marketing survey .. and since I didn't sign any NDA  (or anything prohibiting my re-publication of this) .. here's an example of a question.  The context is a question about a new information product that can be integrated into a CPOE system:

 

 

Physician Order Entry

On Medscape:  Computerized Physician Order Entry: Has the Time Come?  ... it's a so-so article on a complex topic, written by ... me. 

No kidding.  I think the article is OK .. but not great.  CPOE is a tough topic to cover in a thumbnail, and while I think I provide a reasonable overview to anyone who's never heard of CPOE .. the author doesn't focus enough on the potential bumps in the road of CPOE implementation.    It's VERY important to listen to the physicians as an implementation is planned.  Meeting their needs is the key to a successful implementation.

Asthma Patient info

Always on the lookout for good patient info .. here's some stuff on asthma .. with a good selection of links:

Asthma: Breathing Easier -- With a Little Online Help - familydoctor.org

(http://allergy.mcg.edu/glossary/index.html) that may help you in understanding other asthma resources. Allergies can also play a role in asthma. Allergies were the focus of a previous review (http://familydoctor.org/webreviews/webreview21.html). Medicines have an important role in controlling asthma. familydoctor.org offers handouts on asthma medicines (http://familydoctor.org/handouts/573.html and http://familydoctor.org/handouts/665.html) and on taking asthma medicine safely (http://familydoctor.org/handouts/171.html). At the AANMA's online pharmacy (http://www.aanma.org/pharmacy/) you can find pointers on medicines and devices for people with asthma and allergies, including questions to ask your pharmacist, guidelines on purchasing safely online, information on recalls, and assistance programs to help low-income people get the medicines they need. The American Lung Association features an Asthma Profiler designed to help patients and their physicians make decisions about treatment based on scientific evidence

Counterfeit Lipitor

FDA Alerts Consumers and Health Professionals to Recall of Counterfeit Lipitor

FDA Alerts Consumers and Health Professionals to Recall of Counterfeit Lipitor

 The Food and Drug Administration (FDA) today announced that Albers Medical Distributors, Inc., has voluntarily recalled three lots of 90-count bottles of the cholesterol-lowering drug Lipitor and is warning healthcare providers and others that these three lots of counterfeit Lipitor represent a potentially significant risk to consumers. The product was repackaged by Med-Pro, Inc., of Lexington, Neb., and the labels say "Repackaged by: MED-PRO, Inc. Lexington, Neb." in the lower left-hand corner. The following lots are involved in this recall: 20722V - 90-tablet bottles, Expiration 09-2004 04132V - 90-tablet bottles, Expiration 01-2004 16942V - 90-tablet bottles, Expiration 09-2004

Pharmaceutical Trademarks

From The Trademark Blog:

Plainitff Shire manufactures and sells ADDERALL which is prescribed for ADHD. It moved to enjoin defendant Barr Lab's generic alternative on the grounds that it infringed Shire's trade dress in the shape and color of the pill. The Third Circuit affirmed the refsual of the motion for preliminary injunction because Shire did not establish that its trade dress was non-functional. The case has a thorough discussion of the functionality of color in medication.

ABC of interventional cardiology

bmj.com:

ABC of interventional cardiology.

This is a great review of this procedure for those of us who haven't seen one since residency.