Apple SDK

I had the opportunity to look at the SDK developmental platform for the iPhone last week, after signing up to become a member of the Developmental Team. Don't worry, anyone can sign up for this, it's not special. What I ended up downloading was a collection of videos showing how to use Cocoa (the developmental environment) to create Visual - C programs. It was a little heady, given the fact that I am not a C-Programmer.

But the results are definitely interesting. The buttons (virtual) are all accessible in the sdk, just like in Visual Basic. But they appear to be much more powerful, with pre-scripted macros already in place. There is nice fluid movement on the screen.

The actual writing of code is not simple, but again, there are many examples and macros that you simply plug into a button, that it looks a lot easier than writing in Visual Basic. There are address macros which automatically populate the correct fields. Again, somewhat similar to some of the visual basic sdk stuff. However with such automation, some programs may get that "look the same" feeling.

The products that I have seen thus far have been impressive. Credit Apple for showing these a month in advance and then allowing us to absorb all the hype before July 11th. It is becoming a frenzy at the moment. The medical applications, showing MRI and Pet scans at the WDC were impressive. I am still looking for other medical applications however to take over database tasks such as Smartlist, HandBase and OB programs found on the Palm platform. I have no doubt that they are just around the corner.

For the iPhone to be really successful, Apple must come out with a Database Program that will blow everything away. They already have Filemaker on the Mac end and I could see something coming from this, with the ability to put in conditional flags etc. Additionally, any database file must be simple to program.

Perhaps the most impressive thing that I saw last week and in the videos offered by the Developer team, was the over-the-air connectivity. I believe that I first saw this created well with Mobisystems Office on the Palm. I stand by that today. It is almost unwritten anywhere, but I truly believe that this suite was (before they went awry with the open source PDF) the best ever created for a Palm Top Device. The fact that they offered remote storage, accessible by the Lifedrive over the air, was jaw-dropping. It acted like a FTP service and it still works really well (did I mention that it's free)?

The Apple versions of this, in both Exchange and MobileMe are the next step forward. 20 Gigabytes of storage for MobileMe and if it works as advertised, seamless access to personal files both on the home computer and on the iPhone. Exchange's ability to auto sync to the office calendar and email is fantastic. One wonders if there will be an ability to have Exchange and MobileMe work at the same time, so that a personal calendar can be superimposed upon the Exchange calendar on the iPhone? Can Exchange be turned on and then off, without erasing the calendar. On the Lifedrive, if you try to sync the calendar to the desktop, it wipes out the Exchange dates. The same holds true when syncing to Exchange. Hopefully these fine points will be worked out.

Overall, I am impressed by the products. As for the SDK, I have not had the opportunity to work with it yet. I cannot tell if it will be simple to use or not. I am a little disappointed that Apple did not adopt the Widget route, so that we could transport the widgets to the iPhone, but it would appear that the company is doing everything right at the present time. A slow roll out and updated hardware to match.


LDD.

Lifedrive Essentials: BILITOOL (For Medical Professionals)

Have you ever been enamored by a piece of software that you just had to take a pause, inhale slowly and say "wow!?" Well I did just that this last weekend. One of our beloved nurses on the floor, decided that she had had enough of the waffling that most physicians do when they get a bilirubin level on a newborn. She had been made aware, by the Residents-in-Training of a new online tool called BILITOOL.ORG. This online program allows you to put in the date and time of birth of a baby and the hour at which the blood was drawn (if you know the age of the baby already, it has the ability to accept that as well). It will then take all of the data from the now relished and quoted BHUTANI GRAPH and display not only the risk category that your baby is in, but offer suggestions about when to place the baby on phototherapy.

I keep a copy of the BHUTANI GRAPH in my pocket at all times. I made a copy of it when the paper first came out and decreased its size, laminating it and saving it in my wallet. I do the same thing for the immunization schedules. My decision making is always done on a patient by patient basis mainly taken from BHUTANI's paper (Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics . 1999;103:6-14).

So, if I have a baby who is term and has a lot of bruising or a cephalohematoma, I know very well that within the first 24 hours, that baby is going to have a high bilirubin level. Whether it is high enough to start phototherapy has always been the issue. Many of us will not do this unless the numbers approach 18; then there are some who will wait for 20; or 14 (all numbers at 48 hours). However, for myself, if the index of suspicion is high ie. ABO incompatibility, uncertain dates, prolific jaundice after 12 hours, a mother with beta strep, I am inclined to start phototherpy a lot earlier than the allotted 24 hours. In fact, I am inclined to order a bili at 12 hours based on my index of suspicion and the aforementioned issues (obvious jaundice and decreased responsiveness) and on the AAP guidelines. But not everyone will do this. As clinicians, we still have that index of suspicion and clinical awareness and independence.

So where is the line drawn? For our seasoned nurse, it became a never ending battle among physicians. One would start phototherapy, one would not. Same scenario, different treatment plans. And none of the plans were wrong, usually leading to the same outcome --> Healthy baby.

Naturally, I was skeptical about BILITOOL at first, until I found that it conformed to the BHUTANI graph completely. I was particularly fascinated by the fact that the program took into account the various factors that accompanied the baby. All of the ones listed above are incorporated into the decision making model. A link to the Pediatrics listing for risk factors is a plus. The decision to start phototherapy is outlined in a nice table. See the diagram below:




Palm Software

What is an added plus for this program is the fact that the program, in addition to being online, is also available as a standalone download for all Palm devices. And does it work brilliantly? It is probably even better on the Palm than online. You are again greeted with two different ways to enter data, either by length of time or by date and time of birth:




Once the data is entered, you press (Calculate Risk Zone) and voila, you are greeted with the essential information taken from the BHUTANI GRAPH:




The beauty of this is that not only is there risk stratification, there is also a guideline as to whether to start Phototherapy or not:







Risk stratification is further defined by pressing one of the icons, where you are led to definitions of high, medium and low risk:




In the event that you have a baby "who is on the fence," you are also given the neurotoxicity risk factors to consider. As the adage goes, "Cure the problem and you'll cure the disease." So correcting the acidosis or the sepsis will enhance the correction of the bilirubinemia. This is priceless, particularly if you are not thinking about G6PD deficiency or hypoalbuminemia:





And finally, threshold guidelines are given for the baby, with age and other considerations given. This is really priceless:



Again, these numbers correspond not only to the BHUTANI GRAPH and paper, but also to the American Academy of Pediatrics (AAP) guidelines on the treatment of hyperbilirubinemia, with risk factors. This is really an impressive piece of work.

The authors are also impressive. Drs. Tony Burgos and Chris Longhurst are both Assistant Professors at Stanford University School of Medicine. Dr. Burgos is the Medical Director at Stanford's Lucille Packard Children's Hospital, while Dr. Longhurst is Physician lead and director of Informatics. Dr. Stuart Turner is at the Health Informatics Graduate Program at U.C. Davis.

This is an impressive lead of physicians heading this program. The software is free and appears to be a part of the Creative Commons license. Unbelievable, for the amount of work that must have gone into this piece of software, both on the online side and on the Palm side. I commend Drs. Burgos, Longhurst and Turner for creating this incredible tool. It is one of the best that I have seen in a long time.

If you deal with newborn babies, this piece of software is a must-have in your collection. I am still looking for flaws after a week of dealing with 3 hyperbili babies and I have yet to find one. The papers used for reference are of the finest caliber that can be found on the subject. They are peer reviewed and in the authoratitive journal on Pediatrics in America. Again, I highly recommend that you go to www.bilitool.org, you will not be disappointed.


LDD.

More on Epocrates......

Today, I have learned that Epocrates will be filing an IPO, with the expected symbol: EPOC, presumably on the NASDAQ. I only hope that my concerns about privacy will be heeded and that EPOC will not hold all of the names/members in its database as pawns to be sold to the nearest advertiser. That is my new fear. I have concerns about companies trying to make earnings reports each quarter and what they will do to make it happen.

Hopefully, growth will come from organic growth of membership and subscriptions and not from nefarious selling of names and prescribing practices.


LDD.

Whoa! FREE PEDIATRICS TEXTBOOK

Whoa! Stop the presses! Could this be correct? Well, as I perused the Universe looking for a Pediatric document, I ran into this web site. The University of Hawaii's professors have put together an online Textbook with questions and answers at the end of each chapter.

If you are a Family Physician, Midlevel provider or Medical student looking for some basic information in regards to in-hospital or outpatient Pediatrics, this is is a wonderful online source.

So confident is this group that they have made the hefty document available online in a Word document and pdf file format. Or can you say "Lifedrive compatible" and "iPhone compatible" file respectively :) ?

The data is spot-on, at least for many of the basic cases. The interactive introduction to a case, followed by a detailed response, with a basic medicine lesson taught in the interim, is especially nice. To top it off, there is a question and answer session at the end. Very Socratic!

I think this is a great addition to any Palm Device. It would fit perfectly in a Treo with either Documents or Mobi Office attached.

Kudos and many thanks to the professors at the University of Hawaii for sharing this wonderful gift. It is obvious that a lot of work has gone into this and making it available for everyone is truly wonderful.


LDD.