Jun 04

Kudos to Michelle Canipe and colleagues at Washburn University

This is unbelievably awful:


Former Washburn University librarian Michelle Canipe contends in a recently filed lawsuit that Washburn Dean of Libraries Alan Bearman was abusive to her and other employees, even punching one in the face and head.


I take it back. It’s not unbelievable. I think most of us know someone who works somewhere made horrible by an abusive boss. I know a few someones who work in libraries with bosses nearly this bad.

Just wanted to take a minute to express my admiration for Michelle Canipe and her colleagues for DOING something.


May 22

RAND: The Evolving Role of Emergency Departments in the United States

Added to my reading list:


The research described in this report was performed to develop a more complete picture of how hospital emergency departments (EDs) contribute to the U.S. health care system, which is currently evolving in response to economic, clinical, and political pressures. Using a mix of quantitative and qualitative methods, it explores the evolving role that EDs and the personnel who staff them play in evaluating and managing complex and high-acuity patients, serving as the key decisionmaker for roughly half of all inpatient hospital admissions, and serving as “the safety net of the safety net” for patients who cannot get care elsewhere. The report also examines the role that EDs may soon play in either contributing to or helping to control the rising costs of health care.

May 20

1994 Video Predicts iPad

Via PaleoFuture, this Knight Ridder video describes the iPad (okay “the tablet”…but Apple got there first) pretty damned well. Fascinating to me that an entity created by a newspaper company had this sort of prescience…and totally failed to act on it.

“Tablets will be a whole new class of computer, they’ll weigh under two pounds. They’ll be totally portable. They’ll have a clarity of screen display comparable to to ink on paper. They’ll be able to blend text, video, audio and graphics together and they’ll be part of our daily lives around the turn of the century. We may still use computers to create information, but we’ll use the tablet to interact with information.”



Thanks to On the Media for the heads-up on PaleoFuture.


Apr 25

Zebra Hunting

Photo credit: Lesage Stefaan http://tinyurl.com/bpprqn6

Non-clinicians may not be familiar with “zebra” as a medical slang term.

Zebra is a medical slang term for a surprising diagnosis.[1] Although rare diseases are, in general, surprising when they are encountered, other diseases can be surprising in a particular person and time, and so “zebra” is the broader concept.

The term derives from the aphorism “When you hear hoofbeats behind you, don’t expect to see a zebra”, which was coined in a slightly modified form in the late 1940s by Dr. Theodore Woodward, a former professor at the University of Maryland School of Medicine in Baltimore.[2] Since horses are the most commonly encountered hoofed animal for most people and zebras are comparatively rarely encountered, logically one could confidently guess that the animal making the hoofbeats is probably a horse. By 1960, the aphorism was widely known in medical circles.[3]


There are times, though, when it makes sense to go looking for zebras.

Search engines like Google and database search (PubMed, EBSCO, whatever) rely on frequency and/or co-occurrence to rank search results, so common conditions are going to be easy to find and rank high in search results, while a rare disease/diagnosis  will not.

Enter FindZebra.

FindZebra is a specialised search engine supporting medical professionals in diagnosing difficult patient cases. Rare diseases are especially difficult to diagnose and this online medical search engines comes in support of medical personnel looking for diagnostic hypotheses. With a simple and consistent interface across all devices, it can be easily used as an aid tool at the time and place where medical decisions are made. The retrieved information is collected from reputable sources across the internet storing public medical articles on rare and genetic diseases.

FindZebra indexes 31,000 articles on rare and genetic diseases from these sources:

  • Orphanet: an online rare disease and orphan drug data base. Copyright, INSERM 1997. Available on www.orpha.net
  • Wikipedia: The free encyclopedia. Wikimedia Foundation, Inc., Category Rare Diseases. Available on en.wikipedia.org/wiki/Category:Rare_diseases
  • NORD Rare Disease Database and Organizational Database. The National Organization for Rare Disorders (NORD). Available on rarediseases.org/
  • The Genetic and Rare Diseases Information Center (GARD). Available on rarediseases.info.nih.gov/GARD
  • Swedish Information Centre for Rare Diseases. Swedish National Board of Health and Welfare. Available on www.socialstyrelsen.se/rarediseases
  • m-Power Rare Disease Database. Madisons Foundation. Available on www.madisonsfoundation.org/
  • Health On the Net Foundation. Available on www.hon.ch/HONselect/RareDiseases/
  • Rare Diseases. About.com Health. Available on rarediseases.about.com/
  • Genetics Home Reference: A service of the U.S. National Library of Medicine. Available on: ghr.nlm.nih.gov/BrowseConditions
  • Wikipedia: The free encyclopedia. Wikimedia Foundation, Inc., Category Syndromes. Available on en.wikipedia.org/wiki/Category:Syndromes
  • Online Mendelian Inheritance in Man, OMIM. McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University (Baltimore, MD) and National Center for Biotechnology Information, National Library of Medicine (Bethesda, MD). Available on www.ncbi.nlm.nih.gov/omim/
  • Wikipedia: The free encyclopedia. Wikimedia Foundation, Inc., Selected pages on rare diseases. Available on en.wikipedia.org/


To test FindZebra, I decided to search using the symptoms of a not-terribly-well-known condition called “Familial Mediterranean Fever.” My search string was: peritonitis fever inflamation 

Pretty cool results:



Because the site makes a point of repeating it, I’ll do the same:

WARNING! This is a research project to be used only by medical professionals.


Apr 11

“Social media has changed Emergency Medicine Education” (free resources)

EM Resident Jeremy Webb MD (Wake Forrest, PGYIII) lists some of his favorite resources, adding: “I promise, you will read something today that may save a life tomorrow.”


Website: EMCrit.org
Twitter: @emcrit

Description: Scott Weingart is a critical care fellowship trained EM doc who specializes in bringing “upstairs care (ICU) downstairs” to the ED. If it involves critically ill patients, you’ll find it discussed here.


Website: Resus.me
Twitter: @cliffreid

Description: Cliff Reid is a prehospital physician with expertise in resuscitation. His site seeks to provide up-to-date information and cutting edge techniques in the field of resus.


Website: Regionstraumapro.com
Twitter: @regionstrauma

Description: Michael McGonigal MD is the Director of Trauma Services for Regions Hospital in St. Paul, MN. If you’re interested in the who, whys, and whats of trauma care, he’s your man.


Website: hqmeded-ecg.blogspot.com
Twitter: @smithecgblog

Description: Dr. Stephen W. Smith is a faculty physician at Hennepin County Medical Center in Minneapolis, MN. He is known for his mastery of ECGs and his posts literally walk you through an ECG of an emergency department patient from start to finish.


Website: ccpem.com
Twitter: @critcareguys

Description: Mike Winters (U of Md), Peter DeBlieux (LSU), and Rob Rodriguez (UCSF). The website is a $60 investment in audio commentary by critical care experts, but the Twitter account is useful in providing and linking to critical care pearls around the net.


Website: ekgumen.tumblr.com
Twitter: @amalmattu

Description: The master of EM cardiology in the digital flesh. His tumblr site is awesome and he provoides weekly 15 min case presentations surrounding ECGs.


Website: emeducation.org
Twitter: @keepingupwithEM

iPhone app: Up-Shot Emergency Medicine

Description: Clay Smith is a clinical monster who completed IM-Peds as well as EM residencies and is now professor of all these disciplines at Vanderbilt in TN. His main push is evidence based medicine and you’ll enjoy the discussion of recent articles of interest.


Website: UltrasoundPodcast.com
Twitter: @ultrasoundpod

Description: Matt Dawson and Mike Mallin, both ultrasound directors at University of KY and University of UT respectively. Great podcast that any one from interns to attendings can listen to in order to up their game.


Website: Emlitofnote.com

Twitter: @emlitofnote

Description: Want to know the hot articles that everyone in EM is reading? Look no further than Ryan Radecki’s site. You’ll find critical appraisals of current literature that typically start a discussion among other EM bloggers.

Life in the Fastlane

Website: lifeinthefastlane.com
Twitter: @sandnsurf, @kane_guthrie, @precordialthump, @eleytherius

Description: Authors at Life in the Fast Lane (Mike Cadogan, Kane Guthrie, Chris Nickson, and Michelle Johnston), one of the pre-eminent blogs on everything emergency medicine and some of the biggest proponents of FOAM (free open access medical education).

Academic Life in EM

Website: academiclifeinem.blogspot.com
Twitter: @m_lin

Description: Michelle Lin leads a team of Physician writers in providing tips for EM. She is legendary for her Paucis Verbis cards — great quick reference cards that you can link to your dropbox and evernote account for free.  Her blog is great for in depth lit reviews as well.

In addition to the twitter handles, podcasts, and blogs of these social media patrons, you can also find feeds by eminent journals and emergency medicine colleges as well (i.e. @JAMA_current, @NEJM, @AnnalsofEM, @EmergencyDocs (ACEP)). You may also want to visit http://www.foamem.com/ which is an RSS feed that collates many of these resources together.

Other free resources for medical education: iMedicalApps top 10 free iPad medical Apps list . The following is a link to all the Emergency Medicine specific medial apps reviewed on iMedicalApps: iMA EM apps