Busy week: We have the

Busy week:

  • We have the webservice interface to Oncalls.com up and running.  Just in test now .. so I can't post a URL.  But I can say that using Coldfusion MX made it a rather straightofrward process.  It's easier than using Radio or Frontier … and much easier than it would be with Microsoft's .net platform.  Having this interface running will enable us to rather easily develop interfaces to practice management systems and even hospital information systems.   It's exciting, since OnCalls could now "tell" the practice management system who is working in the office on September 23rd .. making the manual entry of templates unnecessary.  So far, we have only lukewarm interest in this scenario from practice management system vendors … and it's (unfortunately?) not my nature to be pushy .. so I'm not sure we will ever do this .. but it wouldn't be very hard to do …
  • Discovered the Generic SOAP Client .. a wonderful tool to test webservices.
  • Medicine (sorry for the lapse into technology):
    • A few interesting articles this month in Journal of Family Practice .. but I can't link to them .. they're behind the login screen. One interesting paper reports that:
      • Computer-using patients desire Web-based services to augment their care.
      • Practice Web sites should be designed to go beyond information alone and incorporate services such as online appointments.
      • Physicians should consider providing “virtual visits” to assist with disease management.
    • Indoor Tanning.  While the FTC has a warning about the risks of indoor tanning .. but I don't think this warning goes far enough.  It's rather clear that indoor tanning increases the risk of cancer by as much as 2.5 times.  duh.
    • Otitis Media.   OK . so I've blabbed about this before.
      • Despite the suggestions of previous authors, who suggested that 50% of AOM is misdiagnosed .. this study suggests that physicians only overdiagnose AOM only 30% of the time.   The author suggests that use of the "NYROP" Guideline .. which I haven't seen .. but I expect that it is similar to the CROP guideline, of which I was the primary architect. 
      • Oddly, there remains little research on Acoustic Reflectometry.  There is only one vendor of a tool that my colleagues and I have found wonderfully useful .. and rather few papers on the topic (here's one).  I'm certain that this tool helps keep us from overdiagnosis .. and kids really don't mind.  I find that using the tool has enabled be to struggle less with getting a perfect view of the TM.  If I get reassuring readings on the "ear toy" as the nurses call it .. I'm unlikely to see trouble.   So I often use it first .. then use the otoscope.  Using pneumatic otoscopy only rarely these days … but had a case of AOM last week that was hard to pick up:  the TM was grey .. (no sign of inflammation) … the child was s/p tx for AOM about 14 days earlier … and it wasn't until I tried to move the TM that I saw how retracted it was … with a better view of the frank pus behind … oh … AR was 39 .. so predictive of a very dull ear.  The rationale for AR is rather simple:  sound waves are emitted from the device and bounced off the TM.  The device can do an analysis of the waves bounced back.  An empty coffee can .. when tapped with a pencil .. will convey high pitch sounds.  A dull one .. low.  An empty middle ear will convey high pitch, and a full one … low.  It works.