Archive for September 2011

Shadows

The professor stood before the class,
his body bent, for time has had its way.
His voice, hushed, drew them to him.
Its strength reflective of his day.

The student tells the patient’s story,
as she sits alone within the hall.
The professor asks a point or two.
Overhead a voice seeks those on call.

The student pleased as to her mark,
directs attention to the screen
where hang the sheets of celluloid;
scans there waiting to be seen.

The professor frowns, perplexed he
asks, is this the path we take to find
the nature of this patient’s illness;
no physical exam of any kind.

The student now herself confused.
What else is there to seek, to find?
I’ve told her story, you see the films
which clearly show the lumbar spine.

How is it now, he quietly asks,
we can plan the details of her care
having failed to inspect the patient
for signs of illness lurking there?

Of concern to me, our descent to this:
we relate that which the patient said;
then, ignoring wherein the illness lies
we sift these shadows for clues instead.

In shadows it seems we have lost our way,
the lure of technology perverts our quest.
Since it is the body that projects the pain,
probe it as taught; then, if need be, the test.

Clark Watts, MD

(written after listening to surgeons give the
medical history then proceed to the films
to justify surgery, September 2009)

Neurocirugía Hoy, Vol. 3, Numero 10

Decision support for epidural hematoma

(this is a guest post from DigitalNeurosurgeon.com, slightly modified for Surgical Neurology International)

The Brain Trauma Foundation has created and published guidelines on the treatment of brain trauma a few years ago. The Guidelines for the Surgical Management of Traumatic Brain Injury are available as PDF and in a searchable online format. What lacks, is the availability on a mobile platform, preferably as an interactive decision support system (like their Head Injury Prognosis calculator). Seems an excellent topic for NeuroMind 2 (appears in Q1-2012).

Approach

The guidelines are text-based, no flowcharts have been provided. This makes direct implementation of the guidelines in an app difficult, as I think I need to make clear what algorithm is used in the app. In the end, if you intend to use it to make decisions, you need to be able to check the algorithm in case you want to. So here is the 1-2-3 of converting a text-based guideline into an application:

  1. Read the text of the guidelines (or in this case: the Recommendations)
  2. Create a flowchart from the text
  3. Build the app based on the flowchart

I will explain more about the symbols that are used in the flowchart in a separate topic. Until then, this Open Course Ware tutorial gives you a nice introduction.

Epidural hematoma

Now here is the flowchart I created:

And here is a screenshot of the app:

For some more details and screenshots, click here.

Pieter Kubben
Information Technology editor
Surgical Neurology International