This is not organised. Items tend to move on as they become organised. It isn't a Blog either.

[Mouse Gestures] in JavaScript?

[BNF-background] occasionally gives background to decisions or statements made in the BNF. Good idea.

Dupuytren's or Palmar Fascia Contractures

[MerckManual] I'm a bit dubious about the advice on injecting the nodules. [e-Medicine] is as usual good on this and regards steroid injection as debatable, with an effect which is short-lived.

The condition is more common in Diabetes, and this is suggested to be because the mechanism by which it occurs involves micro-vascular damage.

I did some looking up and decided not to inject a Diabetic patient with new nodules.
A PUN, DEN and PLP entry for 20 October 2003.

Brain Tumours?

[Prodigy Guidance]

[Prodigy Index] Quite a useful aide memoire for referral criteria.

Anti-virus protection. This needs to be managed well so there are no gaps.
[SOPHOS Partners]
SOPHOS goes well with VPOP3

Identity Cards

[Grauniad 1][Grauniad 2 (Education)]

A book to read:
... [chapter 2]

[Open Source CMS] A list and summary of content management systems.

[Linux World ] exhibition Sept 3rd Birmingham.
Pity it was cancelled.

Complicated Organisation of Thoughts

Computers should be good at this. Idealist is a useful bit of English software but limited to Windows.
Personal Brain at may be worth looking at.

NHS eMail (NHS.Net)

[Sun ONE system. POP3 IMAP and LDAP setup](login required)

There is an SMTP server alternate (by name at least) to the older relay here.

GP Reference

A handy resource from McMaster? university, part of the project and department that produce the highly promising OSCAR Open Source medical record program suite.

[OSCAR Resources]

BMJ May Charge

[My response] is in terms of defoaming the medical web. Someone accuse me of being consistent then...

[Addenbrooke's web presence] is interesting, but why is so much of it hidden under nww from the people it treats?


Not fertility, the pre-Diabetic and spotty parts of it.
[Endocrinology forum]
[GP Thread]

PCOS is a complex including resistance to Insulin and excess androgen production. Metformin reduces this. Shoud we expect everyone with PCOS to gain advantage from starting Metformin?

[ RCOG Green top guideline Long term consequences of polycystic ovary syndrome] (PDF)
It is a well-written useful document although the logic in the discussion of lipids is frail.

ED and Viagra

Several years on, the guidelines are worth returning to. Simple, easy, effective, and not expensive.

[UK Management Guidelines for ED]

This is neat as well: [Spaceship One and windmills WIND-SPACE-4.jpg]

Medical Record Software

from the Veterinary Medicine Teaching Hospital at the University of California, Davis:


Looks like a possibility. Only for some work


Usually not present, of course.
[Lab test probabilities] 6% of those suspected were present; the LR for tests have a big range.
[ GP Notebook]VMA: Twice normal levels are generally considered diagnostic of phaeochromocytoma, but bananas can raise them.

MS Windows. Sale price $6

[Utility Fog]. Nice idea.


[ Out of hours rota]

[Linuxworld 2003] I think I'll go to the Wednesday. Some of it is very relevant to the Health Service.

[OSCAR Resources] a useful piece of the Knowledge Service. Part of David Chan's Open Source medical applications at McMaster? University.

Warfarin and risks
Perhaps not quite so many people as recently thought are likely to benefit from Warfarin.
It would be surprising if there was not a range of risk and benefit, and unlikely that everyone should be on Warfarin just because they have a particular condition.
"Patients with AF who do not have any of the 4 clinical features (previous stroke / TIA, treated hypertension or systolic BP > 140, Coronary Heart Disease, and Diabetes) which were identified by a recent analysis reported in Archives of Internal Medicine would not benefit from anticoagulation."
[Excellent thread on DNUK] PLP

[Audit Commission on hospitals] appointments and admissions etc.

[Clinical Terms revisited] The MIG briefing paper on it. SNOMED-CT now.

Politics and Spam

There is a bill in parliament against spam. [Hansard]

Patient Group Directives and flowchart

Linux Printing

[Sharing with Windows] [Printing to a Windows host]



This is less obvious than would be nice.

Treatment, Management

[Merck Manual on HT]
[Wikipedia article] (needs more work)

[1999][2000] Guidelines of the British Hypertension Society (summaries)

Hypertensive retinopathy usually settles when the blood pressure is controlled, but if it has become proliferative then attention to it with a laser may be suggested - elsewhere by Ophthalmologists. Maybe we should all get together on that one.

Nowadays a retinal photo seems worth having in hypertensives.

[NeLH] -> [HT]

Voodoo Economics and NHS Prescribing Costs

[DNUK Thread]

Badly presented information fails to save lives

[Challenger O Rings]
Tufte might have a lot to teach some parts of the NHS - now they are pumping out more and more graphs, few of which seem to be very useful.

SARS Main page
[GP page - useful]


[DNUK thread on this]

Linux in Business

Peoplesoft port major business apps to Linux

[Royal College of GPs] ditches Microsoft for Linux. Says it is keeping its options open (source)...
Sensible, I'd say. Well done Tony Betts.


April 2003: A couple of papers - one on what programming language we will be using in 100 years time and one on what sort of topics get researched. [Design and Research] by Paul Graham.

And on cycling.
As an example of unintended consequences in a complex system, the effect of helmets on cycling is worth noting.

[SW Devon Health Libraries] Good resource, with good decisions on deployment of it.


Floaters in the eyes.
You could reasonably expect that these could be avaporated with a laser, and a claimed 2/21000 US eye surgeons do this. At least one says he did do it 10y ago and stopped.
The BMJ article on Recent Advances, Ophthalmology in 1999 doesn't mention floaters, but is worth reading for what is new and interesting in eye surgery. Or was then.
How about locally?

Blogs are an interesting phenomenom. DailyMidge

Informaticists in medicine are getting more organised. UK Chip:
Health Informatics is defined as:

"The knowledge, skills and tools which enable information to be collected, managed, used and shared to support the delivery of healthcare and promote health"

UKCHIP is a professional registration body for all those involved in health informatics.

April 2003: [Dan Johnson's draft] on FLOSS management. Dan did the original specification for the notional software "QuickQuack" which anyone working on medical software should have read.

[e-Health newsletter] notes some of the risks that affect the very ambitious attempt to radically change NHS IT. Clinicians raising an eyebrow and doing little more is one of the big ones, and progress to date on involving them in hospitals has been disappointing. Meanwhile in primary care the disinvolvment of doctors in IT and the absence of involvement of other clinicians is a problem to thoe that depend upon it.

[DoH advice] on PCO responsibilities for GP software. THere is aof couorse no money.

Tim Churches' paper on anonymising regisers of diseases is worth reading. Certainly nobody who has not read it should construct a central data warehouse.

Pretty much as one would expect

Notes on an MS presentation on GPL.
It needs toning down, the unarguable facts are damning enough.
Useful point by point discussion and a good starting point for discussing Libre software vs FUD.

Linux-USB working devices list

I looked at the UK Government policy on OSS again$file/oss-policy.htm#policy

NHS IT Procurement.

One project had the goal of making more interesting mistakes each time. The NHS as a whole is aiming for standardisation.

Serendipity. The next article in a journal is often interesting or relevant, and the modern equivalent would be the other hits in Google or other search engines.
The Super Course is a good collection of material, and the screening for Retinpathy and Nephropathy one is worth looking at for a quick refresher.
Example slide: img003.GIF

Diabetic Retinopathy is the 7th cause of blindness, worldwide.
This lecture refers to several photographs, rather than one.

2002 February 17
Meanwhile, as NHS IT replacement or rejuvenation looms, a useful course at brunel University and series of articles is at
Brunel University's Business Class: How to avoid IT project failure
Small is beautiful.
We all know it, we can feel it, so why and how do NHS ptojects get wound up into something huge and over-committed and then fall apart?

2002 February 18
Problem is the answer to it occurring is the same as the answer to it not being there, strive for the best control possible.
The sticks are around 95% sensitive and specific, and positives should be confirmed by assay.

Each NHS manager is in direct competition with patients for clinician time. Increasing the number of managers must reduce the amount of time available for patient/clinician contacts. Secretaries and administrators and personal assistants for clinical staff, on the other hand, can increase the time of actual clinical activity involved in each patient contact. Which group shows the largest increase over the last 10 years say?


Sacket et al's handbook of doing and teaching EBM is a hard one to work through, but the presentation is one of the best using PDF that I have seen, and therefore can be left on a desktop to be dipped into in pauses. The book's associated website(Every book should have one) has moved to


The Python Wiki has a handy note of the slice notation which I still find hard.

MoinMoin is a Python based Wiki I may use later.

Open book on developing with the PyQT? toolkit:

20 February 2003
Bird Flu?


New guidelines. The BMJ leader is one reasonable starting place for them.

DoH/GP? negotiations are a mess, hardly by accident.

"Sudden death syndrome is a composite term for 10 main conditions. Hypertrophic cardiomyopathy, or HCM, accounts for about 30 per cent of the cases; arrythmogenic right ventricular caradiomyopathy, or ARVC, accounts for about 20 per cent of cases; and long QT syndrome accounts for another 10 per cent. Of those three categories, which account for 60 per cent of the cases generically known as SDS, four fifths would be detected by ordinary electrocardiogram screening. If they were caught, the very least action that would be taken would be an echocardiogram known as an ECHO which is an ultrasound of the heart."

If this is reasonably correct, then my first reaction, that an ECG was reasonable, and that it would be likely to catch conditions indicating further screening by echo-cardiography was indicated seems good..

That is from Hansard, extracted at
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22nd Feb
Business Week on Linux.
Some of the material is inaccurate, but the general drift is informative.

GP Contract

Keeping an eye on the State in the EU.

2003 Feb 28th and on
PLP etc
"Tenosynovitis of Posterior Tibial tendon.
Often the the tendon sheath is swollen. A tangential approach is used, directing the needle proximally. A correctly placed injection distends the tendon sheath further".

Rheumatology Examination & Injection Techniques. Michael Doherty et al, 1992.

It is more common than I thought. Exclude a ruptured tendon (stand on tip toe, not suddenly flat-footed.)

conservative treatment includes accomodative insoles / short articulated AFO + NSAIDs + Rehab.

Thyroid Disease and Treatment

[Thyroid Manager] is very good.

Testamentary Capacity etc

Enduring Poweers of Attorney and the like
[A useful summary] [Official Solicitor] - court of protection
[Public Guardianship Office (PGO)] - this gets you to enduring power of attorney info

Patients and The Web

Years ago I wrote about a new professional obligation related to the Internet. Yet another report makes it into learned journals saying how much more the authors know than anyone else has put there for patients to look at. I responded.

PCT Intranets

March 2003
[Simon Child's Wiki]
A useful page on the elements we need in a PCT intranet.

[ Fife Local Medical Committee (LMC)] is the representative body for GPs in the Fife area. Their website needs a bit of work since Microsoft Front Page was allowed to get at it - presumably there are commands that make FP turn out DTDs and metadata and the like. Somewhere.

[Linux on (Dell) Laptops]
I have one with SuSE 9.0 on it. It works wonderfully well. It started with SuSe 7.2 on, 8.1 and then 8.2 was even neater, and 9.0 is a nice incremental improvement on that.

The ThinkPad R40e is a neat bit of kit, also.