Friday, February 27, 2009

Government Push for Electronic Medical Records

"The economic stimulus plan currently being considered by Congress allocates $20 billion to health information technology such as electronic medical records (EMRs)...mixed opinions"..."'EMR is the worst thing that has happened to me professionally in over 25 years of practice' says ..."..."'I absolutely love our EMR,' says a nephrologist"

I work at a big hospital as an IT professional. Having gone through a few projects responsible for data model design, I know exactly what a good model and hard work mean. A few years ago a gynecological cancer project was handed to me. The data analyst, representing the users, already did excellent work in gathering requirement and use cases. But to implement that correctly in my Oracle database still took a lot of thinking. For instance, there're more than a hundred input fields that are like:

* Option1
* Option2
* Other
If other, specify details _____________.

Programmers and DBAs always love fixed fields and hate free text because free text is hard to program and difficult to search. But users are our God's and we have no choice. The above example must be implemented as multiple fixed choices using a reference table *plus a free text field* in the data table! When there're 100 of them, you get tired quickly.

The quoted Medscape article says primary care physicians tend to hate EMR and specialists generally embrace it. The former has to face a more undetermined situation when patients first come in. No doubt there's tension between their needs and programmers' pitiful preference.

We all know the IT in healthcare is the servant for doctors and nurses. If we don't constantly remind ourselves of this role, we're not living up to tax payers' high expectations and their precious contributions to keep us employed.

Monday, February 23, 2009

Outdoor time may protect kids from nearsightedness

Original research journal summary at Optometry and Vision Science:Volume 86(1)January 2009pp 2-3
Reuters' summary (Note this summary probably stretched by adding "exposure to sunlight may play a role")

* Having myopic parents
is a very minor risk factor
* So are near [distance] work, schooling, watching TV, working on computer screens
* Ethnicity plays no role
* Reasons for protection of outdoor time may be "lesser accommodative demands in outdoor environments (despite the considerable evidence that accommodation is not important), pupil constriction in the brighter light typical of outdoor environments resulting in greater depth of focus, or a direct effect of light exposure, perhaps mediated by release of a retinal transmitter such as dopamine, which is known to inhibit eye growth in certain circumstances."
* Outdoor time matters, regardless activity or inactivity; even reading outdoors is good
* "around 2 to 3 hours a day outside of school hours seems to be sufficient to markedly lower the risk of myopia"

My comments:

The sunlight comment is probably added by the Reuters summary. If sunlight exposure is not the key, then the researchers' speculation all come down to one factor: brighter white light. If that's the case, we may just need to make sure the brightness of indoor environment matches that of outdoor and indoor light covers the entire visible light spectrum. On the other hand, if sunlight is essential, then the UV component of the sunlight may be a critical factor and therefore Vitamin D may play an important role in proctecting eyesight. It's so annoying that we don't know if the summary author or the original researchers suggested the role of natural sunlight.

Having read that, I recollect my teenage years when my eye sight degraded at a typical alarming rate from about 10 years to 15 years of age, while I was strict in following all eye usage hygiene rules (no reading in dim areas or in supine position, etc.), perhaps except one, not stopping reading when the eyes are tired. At the same time, other kids, including one habitually reading inside the quilt with a flashlight, were fine with their eyesight. We all spent a great deal of time outdoors, probably 3 hours a day. And in the southern city Chongqing (with about the same latitude as Houston, Texas) there's no shortage of sunlight, although it's almost always cloudy in winter.

(If a summary in Chinese is needed, search for "孩子在室外度过的时间长就不容易近视" on, or click here. But note this summary probably stretched by adding "晒太阳促使体内分泌更多多巴胺")

Tuesday, February 3, 2009

Americans are not eating enough fruits and vegetables

"Fewer than 1 in 10 Americans meet their calorie-specific MyPyramid fruit or vegetable recommendations. ... The primary contributors to total fruit intake were whole fruits among adults and fruit juices among adolescents. The largest single contributor to overall fruit intake was orange juice. Potatoes dominated vegetable consumption, particularly among adolescents, in whom fried potatoes increased the median vegetable intake from 0.72 cup to 1.21 cups per day. Dark green and orange vegetables and legumes accounted for a small portion of vegetable intake,"

Italics are mine.

Calcium supplementation is as important for men as for women

Calcium Supplementation in Healthy Nonosteoporotic Men

"One quarter of all hip fractures occur in men, and 30% of older men experience fragility fractures."..."The results suggest that calcium supplementation is as important for men as it is for women. Additional studies will be required to determine precise dosing regimens (calcium 600 mg daily vs. 600 mg twice daily), the role of vitamin D supplementation in men, and supplementation's effect on fracture risk."

Risky to be part of clinical trial?

Black Parents May Be More Likely to Distrust Medical Research


February 3, 2009 ... February issue of the Archives of Pediatric and Adolescent Medicine.

"Among minority groups, African Americans are frequently underrepresented in clinical research," ... African Americans' distrust of medical research has been suggested to be an important reason for their lack of participation. ... "African American parents were significantly more likely than white parents to believe that medical research involved too much risk to the participant;


A friend of mine was a doctor when he was in China and is not working at a hospital but not as a doctor any more. Once I asked him if he would be interested in being recruited to any clinical trial. He said Definitely not! The reason? Pretty much the same as those "black parents", in believing medical research involves too much risk to the participant: What if you get seriously sick by trying those not fully tested drugs? You don't want to be a guinea pig, said my friend.