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Flat Dysplasia: Ninjas of the Colon

12 August 2008 in medicine | No comments

Ninja Face

Flat dysplastic lesions are the ninjas of the colon: they’re deadly, they’re hard to find, and nobody really knows how common they are. My last hurrah in medical school (for two years, at least) was a presentation on flat colonic dysplasia at the colorectal surgery/gastroenterology conference. Whether you’re planning on a career in general surgery or primary care, these lesions are important - they have a higher rate of malignant transformation than normal polyps and are difficult to locate using standard endoscopic techniques, so you should know enough about them to counsel your patients about appropriate surveillance and therapy. Without special training or chromoendoscopy, most American endoscopists miss these lesions! That newfangled CT colonography is also terrible at picking them up. If you’ve just got to know more, the best recent reference I found is Soetikno’s 2008 paper in JAMA.

Management of Hypothermia

12 July 2008 in cardiology, medicine, wilderness | No comments

Another day, another presentation: this one’s from a brief talk I gave at the VA morning report in February. It covers some basic definitions and clinical strategies for management of hypothermia and includes references to a few relevant papers. One of the chief residents gave a separate talk on Osborn waves and other hypothermia-induced arrhythmias, so my talk doesn’t cover those aspects of care in much detail. Good references were surprisingly hard to find; though I didn’t end up including it in my talk, there’s a slide at the end of the presentation discussing the challenges to good hypothermia research. If you’re interested in wilderness medicine or healthcare for the homeless, this is a good talk to give.

Epocrates & iPhone: Everything You Expected Plus Pill Pics

11 July 2008 in geekery, medicine, productivity | No comments

Today is the beginning of the rest of your life - a life without antiquated paperback pharmacopeias. A life of ease and convenience. Yes, you guessed it - Epocrates Rx is finally available for the iPhone and iPod Touch. All the usual information is included (dosing, cost, interactions, pharmacology, etc.), and because Apple worked directly with Epocrates during development the interface is excellent and the layout is stunning. Yes, I just said that a drug reference has a stunning layout.

But all that is old hat - I mean, Palm-based devices are still mired in technology from the 1990s and they’ve had these capabilities for years. The really cool part of Epocrates for the iPhone is the integration of pill pictures (which have been available from Epocrates online for quite some time). This finally solves one of my most vexing problems on the wards: despite all the pharmacology I’ve learned, I have absolutely no idea what most medications actually look like. Is glipizide a small blue tablet or a big pink gelcap? No clue. Now, when the pleasantly demented, morbidly obese woman admitted with altered mental status mumbles, “I’m on them sugar pills - you know, the little blue ones,” I’ll have some clue what she’s talking about. The Epocrates interface is intuitive - input any pill characteristics your patient can remember and Epocrates will display up to 25 matching pills. So if my diabetic lady can tell me that her pill is round, blue, and coated, I can look at the list of matches and guess that she’s on low-dose glipizide. And I can even show her a big picture of the pills to make sure that we’re on the same page. Pretty great, if you ask me.

Unfortunately, Epocrates is definitely hampered by the iPhone’s touch keyboard. The phone’s auto-correct feature does a good job with standard English, but it’s hopeless with medical jargon and drug names. When you’re in a hurry (and your hands are all greased up with emollient-laden hand sanitizer), the last thing you need is to keep typing “glioizide” instead of “glipizide.” Epocrates would be noticeably more user-friendly if it added all the drug names in its formulary to the phone’s dictionary, at least while Epocrates is the active application. Nevertheless, this is a minor criticism; Epocrates for the iPhone not only brings a classic application to Apple fans, it adds a slick user interface and a few genuinely useful new features. Pretty sweet for a free download.

Surgical Management of Ulcerative Colitis

08 July 2008 in geekery, medicine, surgery | No comments

I’m supposed to be giving a 10-minute talk on the surgical management of ulcerative colitis this Thursday at teaching conference, so (as always) I’m posting my presentation online in case anyone else can use it. For all statistics, I’ve included references in the primary literature when possible and references to Sabiston otherwise (the footnotes are clickable hyperlinks). You can navigate through the presentation using the arrow keys, or you can mouse over the lower right-hand corner of the slides and some controls should pop up. If you’re so inclined, pressing “t” will toggle between presentation mode and my scanty speaking notes.

This is also my first attempt at using Eric Meyer’s S5 presentation format with John Manoogian’s Glossdeck theme, and they’ve been really great so far! S5 uses a nice mix of JavaScript, XHTML, and CSS to make simple, standards-compliant presentations that can play in any modern browser. Though I haven’t experienced this yet, I’m told that the images won’t scale well at resolutions other than 1024×768. I have to say that it’s really nice to be able to write a presentation in a text editor rather than something intensely visual like PowerPoint or Keynote. Like writing LaTeX markup instead of word processing, it lets me focus on content rather than style. It’s also nice to use when I’m trying to work in little snippets throughout the day, using whatever workstation I happen to be near. As a side note, I’d originally planned to test out Google Presentations, but the site was down for a while this afternoon and the thought of a server failure during the conference almost made me pee my pants.

Update, 10 Jul 2008: This talk was well-received by a group of surgeons renowned for their merciless pimping, so you may get some mileage out of it. The meta-analysis referenced on the DALM slide was particularly good fodder for discussion.

Mapping Human Cognition, Validating Free Journals

05 July 2008 in geekery, medicine, neurology | No comments

For the first time in quite a while, a scientific paper is getting lots of ink just for being cool - and it’s not attempting to debunk medical dogma, attacking cherished religious beliefs, or drumming up any scandal at all. As far as I can tell, everyone just thinks it’s really interesting. The authors of the paper, published in PLoS Biology, used functional and structural MRI to construct a map of connections between areas of human cortex. If you’re like me, this sounds pretty humdrum; after all, didn’t we already know most of this? The gory details of the authors’ methods and findings are so stupendously dry that it’s actually pretty difficult to tell what the big fuss is about (and before anyone says anything, I did eventually read the whole paper…with some difficulty). But the important thing to realize is that the authors aren’t just saying, “Look, these two areas are both involved in recognizing faces. They must be part of the face-recognition-sensation-memory-integration circuit! Nifty, eh?” Instead, they’ve actually mapped structural connections between functional areas of cortex. Now they can say, “Look, we know that areas A and B are both involved in recognizing faces; that’s not news. We’ve taken this a big step further and shown that A and B are physically connected via C, D, E, and F in the following circuits: blahdey-blahdey-blah. In fact, we’ve shown that the ABCDEF network is probably the brain’s central integrating network and we’ve mapped all its most important connections.” This type of map should permit the kind of mathematical modelling that’s common in computer science and AI applications.

I’m geeky enough to think that this is really sweet. But it’s great that the New York Times agrees - it’s rare that a paper with so few immediate practical applications and so little attached scandal gets much ink. Granted, the NYT Science section is not exactly the cover of USA Today, but this paper even made Metafilter’s top posts of the day. Oddly enough, though, the NYT article didn’t touch on the authors’ decision to publish in PLoS Biology rather than a more traditional, big-name journal (like one of the Nature group’s journals). PLoS is open-access and publishes everything under the Creative Commons Attribution License, which basically means that readers can do whatever they want with the work as long as they credit the original authors. This is quite unusual in scientific publishing, where the usual model is to charge ludicrously high fees for read-only access. This article’s publication also comes on the heels of Nature’s criticism of PLoS’s publication model and the flurry of discussion it prompted online. As a strong supporter of open science and free (as in speech, not as in beer) journals, I think it’s great that the authors chose to publish in a manner that supports perpetual, free access to research funded with public monies.

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