Docnotes

Primary Care = Good

Here's a little summary of Barbara Starfield's presentation at thei year's WONCA.

 'Grand lady' of public health proclaims: The best care is primary care -- FP Report

 ... For example, in the United States, a "20 percent increase in the number of primary care physicians is associated with a 5 percent decrease in mortality (40 fewer deaths per 100,000)," she said. But the benefit is even greater if the primary care physician is a family physician. Adding one more FP per 10,000 people "is associated with 70 fewer deaths per 100,000, which is a 9 percent reduction in mortality," she said.

This year, we have seven students out of ~125 4th year students who will going into family medicine - the fewest in 15 years. Somehow, they are not getting the message that this is important .. and they are not getting the message that this is good fulfilling work. The message that they hear - from misinformed specialists - is that "family medicine is dying." ugh.

Medical Podcast version 0.5

Ok ...  to celebrate the ~ 5 year anniversary of my weblog (1st post was 11/14/1999) .. I couldn't help but try the newest thing .. podcasting.  It's hard.  Much harder than writing a weblog .. and it's gonna take me a while to get better at this.  Listening to the 1st five minutes (I couldn't bear to listen to more!) .. I found my voice to be all-too soporific.  I'm not really so dull.  Really I'm not!   So .. here it is.  I'm using the Coral Cache to minimize the bandwidth hit on my server .. we'll see how that goes.

Goals for future versions:

1. Make it shorter  (U=V/W)
2. Be less sleepy (don't do it at midnight)
3. Share some information that is useful and (maybe?) insightful

Gmail goes POP, flu vaccine delivery

So Gmail now will allow POP and SMTP .. which is very cool .. so I could get gmail from my treo ...   but it's not working.  I've set it up right (I think) .. but so far, I can't connect to the gmail pop or smtp servers ... hmm .. I'll post a note when I get it workin.

.. and last week I delivered some flu vaccine to Albany Medical Center since they didn't have any .. and we did .. so now the patients with Cystic Fibrosis will be vaccinated this winter:

BloggerCon III - Medicine

I'm listening now to the Medical Blogs session at BloggerCon .. which was just posted .. and it's darn interesting.

I never knew Matthew was from Across the Pond .. but now I do .. and I continue to be impressed with his intellect.

Lisa is impressive as well -- with a well spoken "patient perspective"

Enoch, of course, did a great job facilitating.  Oops .. Enoch pronounced my name wrong  .. it's Reider ..  say it like the trucks ..

Overall .. it's interesting to hear ..

PubMed Text Lookup

Here's a link to the text only version of Pubmed.

.. and here's a link to the Palm OS version ...

More on usability

The "Fitts Law" quiz that Bruce (aka "tog") developed doesn't seem like it would have anything to do with user interface design for an EMR .. but it does.  An example:

Explain why a Macintosh pull-down menu can be accessed at least five times faster than a typical Windows pull-down menu. For extra credit, suggest at least two reasons why Microsoft made such an apparently stupid decision.

Answer:

Microsoft, Sun, and others have made the decision to mount the menu bar on the window, rather than at the top of the display, as Apple did. They made this decision for at least two reasons:

1. Apple claimed copyright and patent rights on the Apple menu bar
2. Everyone else assumed that moving the menu bar closer to the user, by putting it at the top of the window, would speed things up.

Phalanxes of lawyers have discussed point 1. Let's deal with point two. The Apple menu bar is a lot faster than menu bars in windows. Why? Because, since the menu bar lies on a screen edge, it has an infinite height. As a result, Mac users can just throw their mice toward the top of the screen with the assurance that it will never penetrate and disappear.

Unless, of course, I'm testing them at the time. I did a test at Apple where I mounted one monitor on top of another, with the menu bar at the top of the lower display. The only way the user could get to the top monitor way by passing through the menu bar enroute.

I then gave users the task of repeatedly accessing menu bar items. When they first started out, they penetrated into the upper screen by around nine inches on average, just because their mouse velocity was so high. Then they learned they had to slow down and really aim for the menu. By the time they adjusted, their menu-access times became so ponderously slow, they took around the same time as the average Windows user.

The other "advantage" usually ascribed to a menu bar at the top of each window is that they user always knows where to look for the items pertaining to the task they are carrying out. This is silly. Users may do various tasks within a given window, and the menu items may change. Not only that, but a great many perverse applications exist, particularly in the Sun world, where the menu bar you need to access is not even in the window in which you are working! That is truly bizarre and mind-bending.

Microsoft applications are beginning to offer the possibility, in full-screen mode, of a menu bar at the top of the display. Try this out in Word or Excel. It is much faster. Microsofts general cluelessness has never been so amply displayed, however, as it is in Microsoft Visual Studio, which has a menu bar at the top of the screen with a one-pixel barrier between the screentop and the menu. Talk about snatching defeat from the jaws of victory.

Tog has been writing about usability since the early 1980's.  He used to write a column in the Apple Developer's newsletter that I would turn to right away as soon as the newsletter arrived in the mail.   Ahhh ... the mail.  Not much of value arrives in the little white truck anymore ...

e-learning

Nice review of e-learning in BMJ ..

Otitis Media

This paper caught my eye .. I'll include the whole abstract

Acute Otitis Media Caused by Drug-resistant Bacteria: Correlation with Antibiotic Treatment.

Objective Although acute otitis media (AOM) is the commonest infectious disease of childhood, the emergence of drug-resistant bacteria has dramatically changed its clinical outcome. Here, we report the trend of AOM due to drug-resistant Staphylococcus pneumoniae (DRSP) and beta-lactamase-negative ampicillin-resistant Haemophilus influenzae (BLNAR), and the relation between antibiotics used for the management of AOM and the isolation of bacterial pathogens. Material and Methods Bacterial isolation and susceptibility tests were performed on specimens from children with AOM. Clinical information, including antibiotic treatment within the previous 30 days, was analyzed. Results DRSP was detected in 59.3% of Pneumococci isolates and BLNAR in 26.0% of H. influenzae isolates. As expected, the incidence of AOM caused by such drug-resistant bacteria has been increasing year on year, and 32% of cases have been treated with inappropriate antibiotics. In contrast, 32% of cases of AOM caused by DRSP and 50% caused by BLNAR were given antibiotics with high susceptibility to drug-resistant bacteria. Conclusion In order to ensure the most appropriate use of antibiotics, clinicians should consider performing tympanocentesis or myringotomy, with subsequent submission of the middle ear fluid for susceptibility testing. Furthermore, these results suggest that, as well as the selection of antibiotics, the dosage and period of dosing should also be considered in the management of AOM. In addition, other factors, in particular horizontal transmission from other infants in day care or nursery school, may affect the rapid spread of such drug-resistant bacteria.

Cousin "CityKitty" .. mother of Paul .. recently called about his second bout of otitis media.    It's so hard.  In the context of good research that demonstrates how most cases of AOM resolve spontaneously, physicians are not only prescribing plenty of antibiotics .. but second-line agents as well .. hmm.

Bandwidth

"Bandwidth" is the amount of data a website consumes/generates/requires over a given period of time.  Since building Medlogs.com, the bandwidth consumed by my account on our web host has increased quite a bit.  How ironic that a successful weblog or public service site like Medlogs will cost (rather than earn) the owner more money.

Last month (october, 2004) we used nearly 12 GB of bandwidth ... and one morning our sites were down because we had gone over the limit of 10 GB.  So today I'm experimenting with gzip compression to improve the speed of page downloads on both Medlogs and Docnotes.  There are several ways to enable gzip, but the simplest is to use php:

At the beginning of every document (or add it to the MoveableType template) insert this line:

<?php
ob_start("ob_gzhandler");
?>

Of course, if it's already a php document, you can omit the <?php ... ?>

This will imporve performance on Medlogs.com and will reduce the amount of bandwidth that we use.

Blogrank.org is coming soon too ;-)