Tuesday, August 28, 2007

Your Favorite Chief Complaint / Initial Presentation

"A 23 year old pregnant jockey presents with a fever, a sore throat, and a red eye."

Saturday, August 25, 2007

Hilarious Journal Articles #85: Pac Man and Functional MRI

When Fear Is Near: Threat Imminence Elicits Prefrontal-Periaqueductal Gray Shifts in Humans, in Science:
Humans, like other animals, alter their behavior depending on whether a threat is close or distant. We investigated spatial imminence of threat by developing an active avoidance paradigm in which volunteers were pursued through a maze by a virtual predator endowed with an ability to chase, capture, and inflict pain. Using functional magnetic resonance imaging, we found that as the virtual predator grew closer, brain activity shifted from the ventromedial prefrontal cortex to the periaqueductal gray. This shift showed maximal expression when a high degree of pain was anticipated. Moreover, imminence-driven periaqueductal gray activity correlated with increased subjective degree of dread and decreased confidence of escape. Our findings cast light on the neural dynamics of threat anticipation and have implications for the neurobiology of human anxiety-related disorders.

Friday, August 24, 2007

The "Spook Country" Audiobook by William Gibson

On the way to work, listened to William Gibson's Spook Country, the audiobook. I persistently can't believe it's been twenty years since Neuromancer. (Anyone share this feeling?) To its credit, Spook Country brings back the thrill of reading Neuromancer for the first time.

Thursday, August 23, 2007

Central Park

Central Park, originally uploaded by KidneyNotes.

Wednesday, August 22, 2007

Abandoned Space

Abandoned Space, originally uploaded by KidneyNotes.

Tuesday, August 21, 2007

Hilarious Journal Articles #84: The untapped potential of virtual game worlds to shed light on real world epidemics

The artice from BBC News is here. This paper, from the Lancet Infectious Diseases, discusses the "Corrupted Blood Plague" in World of Warcraft:
Simulation models are of increasing importance within the field of applied epidemiology. However, very little can be done to validate such models or to tailor their use to incorporate important human behaviours. In a recent incident in the virtual world of online gaming, the accidental inclusion of a disease-like phenomenon provided an excellent example of the potential of such systems to alleviate these modelling constraints. We discuss this incident and how appropriate exploitation of these gaming systems could greatly advance the capabilities of applied simulation modelling in infectious disease research.
The Hilarious Journal Article collection is here.

Does Clostridium Difficile Colonize Alcohol-Based Hand Sanitizers?

C. difficile is not killed by the alcohol-based hand sanitizers commonly used in most hospitals (alcohol, apparently, is not "sporicidal"). Here's my question: has anyone shown that C. difficile doesn't colonize these hand sanitizers? Wouldn't that be the perfect way to spread?

Hurricane Dean Side View

Hurricane Dean Side View, originally uploaded by cayobo.

Sunday, August 19, 2007

Film Shoot, NYC, by iPhone

Film Shoot, NYC, by iPhone, originally uploaded by KidneyNotes.

Saturday, August 18, 2007

Medicare Says it Won't Cover Hospital Errors

Look for the definition of an "error" to be expanded dramatically... Central line infection? C. difficile colitis? Ventilator associated pneumonia? From the New York Times:
In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.

Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients.

Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.”

Wednesday, August 15, 2007

Adam Bosworth Lecturing on Google Health

Saturday, August 11, 2007

Columbia's Forms for Implementing Patient-Physician Email

On Tech Medicine, I recently discussed patient-physician email. As part of the review, I looked at Columbia University's guidelines for allowing providers to use nonencrypted email and still be compliant with the HIPAA privacy law. (Their web page is excellent and I strongly recommend that you read it if you're interested in this topic.) I've extracted the text from the two forms below, "Important Information About Provider/Patient Email" and "Patient Request for Email Communications."

These forms are provided for informational purposes only.

Important Information About Provider/Patient Email

As a patient of this office, you have the right to request we communicate with you by electronic mail (email). It is also your right to be informed in sufficient detail about the risks of communicating via email with your health care provider or office, and how your provider will use and disclose provider/patient email.


Email communications are two-way communications. However, responses and replies to emails sent to or received by either you or your health care provider may be hours or days apart. This means that there could be a delay in receiving treatment for an acute condition.

If you have an urgent or an emergency situation, you should not rely solely on provider/patient email to request assistance or to describe the urgent or emergency situation. Instead, you should act as though provider/patient email is not available to you – and seek assistance by means consistent with your needs.

Email messages on your computer, your laptop, and/or your PDA have inherent privacy risks – especially when your email access is provided through your employer or when access to your email messages is not password protected.

Unencrypted email provides as much privacy as a postcard. You should not communicate any information with your health care provider that you would not want to be included on a postcard that is sent through the post office.

Email messages may be inadvertently missed. To minimize this risk, your doctor requires you respond appropriately to a test email message before we will allow health information about you to be communicated with you via email. You can also help minimize this risk by using only the email address that you are provided at the successful conclusion of the testing period to communicate with your doctor.

Email is sent at the touch of a button. Once sent, an email message cannot be recalled or cancelled. Errors in transmission, regardless of the sender’s caution, can occur.

In order to forward or to process and respond to your email, individuals other than your health care provider may read your email message. Your email message is not a private communication between you and your treating provider.

Neither you nor the person reading your email can see the facial expressions or gestures or hear the voice of the sender. Email can be misinterpreted.

At your health care provider’s discretion, your email messages and any and all responses to them may become part of your medical record.

Patient Request for Email Communications

Communications over the Internet and/or using the email system are not encrypted and are inherently insecure. There is no assurance of confidentiality of information when communicated this way. Nevertheless,you may request that we communicate with you via email. To do so, you must complete this form and return it to your health care provider’s office.

Please be advised that:
(1) This Request applies only to the health care provider or office that you indicate below. If you would like to request to communicate via email with another health care provider or office, you must complete a separate Request for that office.
(2) Your health care provider will not communicate health information that is specially protected under state and federal law (e.g., HIV/AIDS information, substance abuse treatment records information, mental health information) via email even if we agree to communicate with you via email.
(3) Your Request will not be effective until you receive and respond appropriately to a test email message from your doctor. Please select the test question you want to use below, and provide us with your answer.

Please provide the following information:
Patient Name: ________________________ Date of Birth: _________
Phone number: _______________________
Address: _______________________________________________
Please specify the email address to which communications should be addressed:
Please specify the health care provider or office from which you are requesting email communications:
Please select the question you want to use (by checking the one of the boxes below) for your test email and provide your answer.
o The last four digits of my Social Security Number: _______________
o My mother’s maiden name: _______________
o My middle name: _______________
o The street number of my residence: _______________
Please initial each blank and sign below:
____ I certify the email address provided on this Request is accurate, and that I, or my designee on my behalf, accept full responsibility for messages sent to or from this address.
____ I have received a copy of the IMPORTANT INFORMATION ABOUT PROVIDER/PATIENT EMAIL form, and I have read and understand it.
____ I understand and acknowledge that communications over the Internet and/or using the email system are not encrypted and are inherently insecure; that there is no assurance of confidentiality of information when communicated this way.
____ I understand that all email communications in which I engage may be forwarded to other providers, including providers not associated with my doctor, for purposes of providing treatment to
____ I agree to hold my doctor and individuals associated with him/her harmless from any and
all claims and liabilities arising from or related to this Request to communicate via email.
Signature of patient or personal representative
If personal representative, authority to act on behalf of patient

Thursday, August 9, 2007

Patient-Physician Email

New post on Tech Medicine about patient-physician email.

Medical Boards Interactive: "Your Patient Has Died."

I spoke with someone who recently took the medical boards (USMLE Step III, to be exact). There's a section which is interactive -- that is, it give you an actual case, sort of like an old style Infocom adventure game, and you must type in your responses. For example, when I took it a few years back, one of the questions went like this:
Your patient arrives in the emergency department after being beaten with a baseball bat.

> Examine abdomen

He has left upper quadrant tenderness and is complaining of abdominal pain.

> CT scan of abdomen

The CT scan reveals a splenic hematoma

> Call surgery consult
You get the idea. It was actually fun.

Well, the person I spoke to, who recently took this exam, was shaken and lost his confidence. During the interactive part of the exam, he may (or may not) have done something incorrect, because the case abruptly ended with "Your patient develops ventricular fibrillation and dies."

Personally, I think sometimes the people who write exams indulge their twisted sense of humor.

Can anyone verify this?