Tuesday, June 26, 2007

Review of the HydraCoach, an Intelligent Water Bottle

This is a brief review of the HydraCoach, an intelligent water bottle that measures how much you drink.

In my last post, I described the HydraCoach, which is marketed primarily to athletes and those concerned about maintain optimal hydration....

Full review on Tech Medicine.

Monday, June 25, 2007

Mac and PC Ads

I recently switched.

Thanks, Ves.

Better World Books in New York Times

(picture from NYT)

Founded by my cousin.

Crooked Little Vein by Warren Ellis

Warren Ellis' first novel, Crooked Little Vein, is currently #252 in book sales on Amazon even though it won't be released for a month. Ellis' website is a big influence on Kidney Notes. I like his work. Buy the book.

Request for Favorite Webcams

I use the ManyCams viewer for the Mac dashboard, and I've been less than completely satisfied with the webcams I've found. I have webcams for New York City, Niagra Falls, and the pyramids. (See here for examples.) If you have any favorite webcams of locations, please comment. Thanks. 

Medicine 2.0

This week's edition is on ScienceRoll.

Mac Blogger Widgets (for the Dashboard)

Give them a try if you have a Mac and post to Blogger. Especially useful if you have multiple blogs.

New Title Font

Always experimenting. Comments welcome.

Saturday, June 23, 2007

Updated GTD Mindmap, now with Printable PDF File

See here.

Flickr: the princess and the red frog

the princess and the red frog, originally uploaded by Karl's.

Links for 2007-06-23

Thursday, June 21, 2007

Links for 2007-06-21: The Onion on the iPhone

Ground Zero at Night via Dashboard Webcam

Nature Precedings: Prepublication Creative Commons Licensed Scientific Content

From the website:
Nature Precedings is a place for researchers to share pre-publication research, unpublished manuscripts, presentations, posters, white papers, technical papers, supplementary findings, and other scientific documents. Submissions are screened by our professional curation team for relevance and quality, but are not subjected to peer review. We welcome high-quality contributions from biology, medicine (except clinical trials), chemistry and the earth sciences.

Wednesday, June 20, 2007

Yahoo! Green Taxi

You have new Picture Mail!, originally uploaded by KidneyNotes.

Updated Mindmap / Flowchart of Getting Things Done (GTD) by David Allen

Posted to The Efficient MD.

Tuesday, June 19, 2007

Stop Going to Conferences for the Lectures. Listen to Podcasts Instead.

Posted to The Efficient MD.

World Trade Center -- "Sarcoid Like" Granulomatous Pulmonary Disease in New York City Fire Department Rescue Workers

From the journal Chest.

Will Google Buy Apple?

Yes, argues this month's New Yorker Magazine.

Dr. Roni Zeiger Posts about Google Health

From the Official Google Blog:
Before joining Google, I was a full-time primary care doctor. My time working with patients every day, hearing their stories and trying to help make them better, is an experience I will cherish forever. And about once a week, I still practice as an urgent care doctor at a county hospital. Based on these experiences, I have witnessed the problems patients face. One of the biggest ones I see is the difficulty patients have getting answers to the most basic questions, such as 'What tests and treatments should I know about if I have type 2 diabetes? Is the care I am getting on par with what most experts recommend?'

Monday, June 18, 2007

FBI to Battle Botnet Zombie Horde

Every PC is a botnet zombie until proven otherwise.

We should just start calling them BZ's.

(Can you tell I just switched to the Mac?)

Walk-In Medical Care at Your Local Drugstore! (Duane Reade)

My spouse was walking down the street and saw someone outside Duane Reade (a large drugstore chain) dressed in full surgical gear -- scrub top, scrub cap, and sneakers -- passing out pamphlets and announcing "Walk-In Medical Care! Walk-In Medical Care!" There was no difference between the way they announced this and the way you would announce, say, a show at a comedy club or a sale on cellphones.

More info here.

Sunday, June 17, 2007

Links for 2007-06-17

Saturday, June 16, 2007

Epocrates Viagra Screwup

Epocrates, a drug database for the Palm, is totally screwed up today.

For example, the dosage listed for Viagra is "0.5-1.0 mg IV q 3-5 min prn" -- in other words, the program is telling me to give Viagra 0.5 to 1 mg intravenously every 3 - 5 minutes as needed...

Addendum: This corruption of the Epocrates drug database, besides being humorous, has serious patient safety implications. To their credit, Epocrates noticed this post and quickly replied:
Dear Dr. Schwimmer,

It has come to our attention that an entry was recently posted to www.kidneynotes.com regarding our product. Specifically, the post [available at: http://www.kidneynotes.com/2007/06/epocrates-viagra-screwup.html ] reads as follows.

Epocrates Viagra Screwup
Epocrates, a drug database for the Palm, is totally screwed up today.
For example, the dosage listed for Viagra is "0.5-1.0 mg IV q 3-5 min prn" -- in other words, the program is telling me to give Viagra 0.5 to 1 mg intravenously every 3 - 5 minutes as needed...

We are concerned that you may have corrupted data, as our Viagra monograph has never contained such information. The dosing content contained in the Epocrates Rx Viagra monograph reads as follows, and has not substantially changed since its original publication.

erectile dysfunction
[50 mg PO x1]
Start: 25 mg PO x1 if >65 yo, potent CYP 3A4 inhibitor use; Max: 100 mg/dose, 1 dose/day; see Drug Interactions for drug-specific limits; Info: take 0.5-4h prior to intercourse
renal dosing
[adjust dose amount]
CrCl <30: start 25 mg PO x1; HD: not defined

hepatic dosing
[adjust dose amount]
hepatic impairment/cirrhosis: start 25 mg x1

The data that is displaying on your device sounds to be from an Epocrates Table for ACLS: Bradycardia, which is why we believe that your version if corrupted. Please contact me at your earliest convenience so that we may assist you in reinstalling your software to clear out this corrupted data.

Joshua Conrad, PharmD
Epocrates, Inc.

Tech Medicine: HydraCoach, an Intelligent Water Bottle

New Tech Medicine Post on HydraCoach, an intelligent water bottle. 

Dialysis as "Spinning"

My doctor-friends down South refer to dialysis as "Spinning." It's very natural to them. To me and to others up North, it still sounds bizarre.

Cluster of Hepatitis C Infections among Three Patients Seen by Same Anesthesiologist in New York

I've had at least two patients so far who've received a warning letter. Potentially thousands may need to be tested.
Please Distribute to All Clinical Staff in Anesthesia, Emergency Medicine, Primary Care, Infectious Diseases, Family Medicine, Laboratory Medicine, Gastroenterology, Surgery and Infection Control Staff

* DOHMH is investigating a cluster of hepatitis C infections in patients who had outpatient intravenous anesthesia from a particular anesthesiologist.
* DOHMH is notifying patients who received intravenous anesthesia from this provider that they should be tested for hepatitis B and C and HIV.
* Providers should use single dose vials for anesthesia when available. When multi-dose vials are necessary, extreme caution should be used to ensure that a new, sterile syringe and needle are used each time medications are drawn up.

June 15, 2007

Dear Colleagues,

The New York City Department of Health and Mental Hygiene (DOHMH) is investigating a cluster of three hepatitis C infections in patients who received intravenous anesthesia from a particular anesthesiologist during outpatient procedures performed in August 2006 in New York City. Initial laboratory testing of the hepatitis C viruses from these patients revealed that they closely match each other, suggesting that all three came from the same source.

Although the investigation is ongoing, the available evidence suggests that the infections occurred during the administration of anesthesia medications during outpatient medical procedures. There is no indication that the medical procedures themselves caused the infections. The anesthesiologist worked at approximately 10 different outpatient (non-hospital) practices, all of which are fully cooperating with the DOHMH. This anesthesiologist has stopped working during the investigation.

The DOHMH has not yet determined whether there were any other times when hepatitis transmission occurred during administration of anesthesia by this physician. Therefore, we are notifying all patients who received intravenous anesthesia from this anesthesiologist between December 1, 2003 and May 1, 2007 (the timeframe when the anesthesiologist practiced in New York City), and recommending that they be tested for hepatitis B and C, and HIV. We are recommending HIV testing as a precaution, since it is also transmitted by bloodborne exposure. However, spread of HIV through anesthesia is not common, and no HIV infections have been linked to this incident.

All patients who received anesthesia from this provider are being notified by mail by the DOHMH; the mailing includes a letter to bring to their provider. Patients who do not receive this letter do not need testing for this indication. Patients known to have been previously infected with either hepatitis B, hepatitis C, or HIV prior to receiving anesthesia from this physician, do not need testing for that specific virus; testing for the other viruses should still be done.

We are recommending the following tests for these patients:
For hepatitis B: Hepatitis B surface antigen (HbsAg), Hepatitis B surface antibody (HbsAb), and Hepatitis B core antibody Total (HbcAb).

For hepatitis C: Hepatitis C enzyme-linked immunosorbent assay (EIA) and if positive, a confirmatory test, such as HCV recombinant immunoblot assay (RIBA) or a polymerase chain reaction (PCR) should be done.

HIV: HIV EIA and if positive, a confirmatory Western Blot should be done.

Hepatitis B and C are reportable pursuant to the New York City Health Code §11.03 and New York State Sanitary Code §2.1. Because this is an ongoing investigation, we are requesting immediate reporting of results to the DOHMH so that we can determine if there were other instances where bloodborne disease transmission occurred during the administration of anesthesia by this anesthesiologist. Please report as follows:

Hepatitis B or C: Results should be reported to the Bureau of Communicable Diseases at 212-788-9830 (telephone) during normal business hours. When reporting, please mention that your patient was tested as part of this anesthesiology outbreak investigation. You can also fax the results to the attention of Dr. Bruce Gutelius at 212-788-4268.

HIV Infection: Positive tests for HIV infection or AIDS should be reported by completing a New York State Provider Report Form. For assistance in reporting a case of HIV, to receive Provider Report Forms, or to obtain more information, call the HIV Surveillance and Epidemiology Program at 212-442-3388 or refer to guidelines on the DOHMH website at: www.nyc.gov/html/doh/html/pub/pub.html.

This cluster appears to be related to a lapse in infection control technique during administration of intravenous anesthesia. This is similar to other outbreaks seen in NYC and elsewhere (Transmission of hepatitis B and C virus in outpatient settings. MMWR 2003;52(38):901-6). As a reminder, single-dose medication vials should always be used when possible to prevent such clusters. If no single dose preparation is available, all necessary medication should be drawn up in advance and labeled. Needles AND syringes should NEVER be reintroduced into a medication vial, even if they have only been in contact with the IV tubing (e.g., angiocatheter or heparin lock) in the patient. If you have any questions about this investigation or how to report, please call the Bureau of Communicable Disease during office hours at 212-788-9830. Thank you.


Marcelle Layton, MD,
Assistant Commissioner,
Bureau of Communicable Disease

Friday, June 15, 2007

New Blog: EfficientMD.com

EfficientMD.com is a new blog focusing on personal productivity for physicians. (And of course, it took me a few hours to get up and running...)

Monday, June 11, 2007

Unusual Medical News: A Fatal Overdose of Bengay; A Patient Bleeds Green Blood

Two medical cases in the news recently caught my eye.

In the first, tragic case, a 17 year old track star from Staten Island was found dead. The detectives who found her noticed a faint minty smell. Laboratory tests eventually revealed a fatal overdose of methyl salicylate, also known as oil of wintergreen, the active ingredient in Bengay. (The teenagers blood reportedly had six times the safe level of methyl salicylate.) Apparently, she had been applying more than the recommended amount of Ultra Strength Bengay to relieve her muscular pain from training....

Full post at Tech Medicine.

Friday, June 8, 2007

Cheney to Have Heart Defibrilator Replaced

Via Reuters:
Vice President Dick Cheney, a survivor of four heart attacks, will have his internal heart-regulating device replaced later this year, his office said on Friday after he had his annual checkup.
7 years is not bad for a defibrillator. (Thanks, Huck.)

"Breaking the Seal" at Over My Med Body!

over my med body! » Physiology of Breaking The Seal
Okay medical blogosphere, let’s figure this one out (comments are open!). Is there a physiologic mechanism to “breaking the seal,” or is it just a drinking myth? (Breaking the seal, if you’re not familiar with the term, refers to the idea that if you’re out drinking, once you start peeing, then you’re going to have to go urinate every 10-20 minutes after that. “Don’t break the seal!” means don’t start peeing, ’cause then you’ll never stop!)

"Heads Up: Brain Injury in Your Practice"

Link for 2007-06-08

Thursday, June 7, 2007

Reading List: The 4-Hour Workweek, Blindsight, Toast, Un Lun Dun

  • The 4-Hour Workweek by Timothy Ferriss
  • Blindsight by Peter Watts
  • Toast by Charles Stross
  • Un Lun Dun by China Mieville

Wednesday, June 6, 2007

Apple iPhone Ad

If the on screen keyboard is usable, this might replace my Treo 650 as soon as I can escape from Sprint.

Hilarious Journal Articles #83: Acute Wiiitis

From the New England Journal of Medicine:
To the Editor: A healthy 29-year-old medical resident awoke one Sunday morning with intense pain in the right shoulder. He did not recall any recent injuries or trauma and had not participated in any sports or physical exercise recently. He consulted a rheumatology colleague. The Patte's test was positive, consistent with acute tendonitis isolated to the right infraspinatus. After further review of his activities during the previous 24 hours, the patient recalled that he had bought a new Nintendo Wii (pronounced "wee") video-game system and had spent several hours playing the tennis video game...
More hilarious journal articles here.

Trends in Professional and Academic Online Information Services by Peter Jacso

From INFORUM 2007. Full text available. Lots of useful criticisms of Google Scholar.

Since the 1970s there has been significant competition among the major players within the traditional, subscription-based professional and academic online information services arena. Since the late 1990s some of the mushrooming (partially) open access information services which originally targeted the huge market of casual Internet users also entered the arena and posed a new challenge for the rival incumbents. The increasingly fierce competition enhances the academic and professional information services with increasingly better features. Traditional information retrieval techniques, such as citation-based searching, multiple database searching, ranking of result sets by multiple data elements, are being adopted and chiseled by the developers of the open access services. They create databases using autonomous citation indexing technology, metasearch tools for federated searching, sophisticated clustering algorithms for grouping results into topical and other subsets, link resolvers for guiding the users to complete documents, and various tools for visualizing information. Many also license content from the traditional services. In turn, these refined retrieval tools and resource enhancements keep showing up in the fee-based, professional and academic online information services, deployed in metadata-rich, highly structured mega-databases which have served academic, public, school and special libraries for decades. There are novel academic and professional information retrieval services, mashing up the best of both worlds, interlinked through one click or few clicks to deliver the most pertinent primary documents with informative metadata for the patrons. We, the end-users, will all be the beneficiaries of this rivalry -or rather, "co-opetition" - , enjoying the much improving solutions for resource discovery and result refinement, increasing recall and precision at our whim, reaping the benefits from the synergy of on-the-fly mash-ups of data from different sources in the process of searching - to turn it into finding and instant gratification.

Tuesday, June 5, 2007

Hilarious Journal Articles #82: Didgeridoo playing as alternative treatment for obstructive sleep apnea syndrome: randomized controlled trial

From the British Medical Journal (Where Else?):

Results Participants in the didgeridoo group practised an average of 5.9 days a week (SD 0.86) for 25.3 minutes (SD 3.4). Compared with the control group in the didgeridoo group daytime sleepiness (difference -3.0, 95% confidence interval -5.7 to -0.3, P = 0.03) and apnoea-hypopnoea index (difference -6.2, -12.3 to -0.1, P = 0.05) improved significantly and partners reported less sleep disturbance (difference -2.8, -4.7 to -0.9, P &lt; 0.01). There was no effect on the quality of sleep (difference -0.7, -2.1 to 0.6, P = 0.27). The combined analysis of sleep related outcomes showed a moderate to large effect of didgeridoo playing (difference between summary z scores -0.78 SD units, -1.27 to -0.28, P &lt; 0.01). Changes in health related quality of life did not differ between groups.

Conclusion Regular didgeridoo playing is an effective treatment alternative well accepted by patients with moderate obstructive sleep apnoea syndrome.
More hilarious journal articles here.

Monday, June 4, 2007

Classic Literature AudioBooks Read by Professional Actors (Naxos AudioBooks)

The Naxos AudioBooks Download Shop:

Our catalogue of more than 350 recordings of the finest works of classic literature – from the finest works of classic fiction through poetry and Junior Classics, to exciting modern and contemporary fiction – is now available to download. A growing number of visitors to the website as well as CD buyers throughout the world have asked when we would start our own download service – and here it is...

The FDA Advises You to Avoid These Toothpastes

I wrote about poisoning with diethylene glycol on Tech Medicine.

From the FDA News Release:

Consumers should examine toothpaste products for labeling that says the product is made in China. Out of an abundance of caution, FDA suggests that consumers throw away toothpaste with that labeling. FDA is concerned that these products may contain "diethylene glycol," also known as "diglycol" or "diglycol stearate."

FDA has identified the following brands of toothpaste from China that contain DEG and are included in the import alert: Cooldent Fluoride; Cooldent Spearmint; Cooldent ICE; Dr. Cool, Everfresh Toothpaste; Superdent Toothpaste; Clean Rite Toothpaste; Oralmax Extreme; Oral Bright Fresh Spearmint Flavor; Bright Max Peppermint Flavor; ShiR Fresh Mint Fluoride Paste; DentaPro; DentaKleen; and DentaKleen Junior. Manufacturers of these products are: Goldcredit International Enterprises Limited; Goldcredit International Trading Company Limited; and Suzhou City Jinmao Daily Chemicals Company Limited. The products typically are sold at low-cost, “bargain” retail outlets.

TV Kidney Competition was a Hoax


A Dutch TV contest that purported to show a dying woman choose a patient to receive her kidneys was a hoax.

The "donor" in the show was in fact an actress - though the three people vying for an organ were real patients in need of a kidney transplant.

Saturday, June 2, 2007

Office 2007 Being Rejected by Journals?

Genome of James Watson -- Who Discovered DNA -- Deciphered

New York Times:

The full genome of James D. Watson, who jointly discovered the structure of DNA in 1953, has been deciphered, marking what some scientists believe is the gateway to an impending era of personalized genomic medicine.

Warren Ellis Second Life Sketches from Reuters

Second Life Sketches, The Lay Of The Land:

A week before I left, I played a dirty trick. I put a spawning pool under the landing point, the place where people teleported into Winterstate. And I switched off the land’s Safe mode.

Friday, June 1, 2007

Cache of Flea's Blog

Flea, a pediatrician and medical blogger, blogged his malpractice trial, had it revealed in court, subsequently settled the case, and took down his blog. For those interested, the cached site is here: http://tinyurl.com/ysetyp (thanks to hub blog; tinyurl'd by me).

Recommendation: BBP Bags

If you're carrying a laptop around all day, check out BBP bags. They're a combination of messenger bag and backpack. Incredibly comfortable.