Monday, June 14, 2010

Technology bottle necks, it's not brain surgery...except when it is.

I was observing the removal of an intraventricular brain tumour the other day when the importance of actually involving designers and users in the design process of, well, anything was confirmed.

The surgeons were removing a cyst from a patient's brain. They removed a portion of this patient's skull, cut through the dura, which is tissue between the brain and the skull, while avoiding all of the vital blood vessels along the way.

The next step was to place a tube into the patient's brain and insert a camera, laser, and foreceps through this tube and remove the tumour. Unfortunately, this next step almost didn't happen.

The problem? It could have been a complication with the earlier steps in the surgery, maybe they cut the wrong part of the skull, they could have accidently cut a vessel, maybe the child woke up during the surgery?! No, the problem was that the surgeons could not figure out how to set up the surgical equipment and combine the different parts.

Now, keep in mind, that this specific surgery wasn't a common one. The surgeons were not using this equipment regulary, but still, not being able to set up the equipment should not be the reason a surgery is delayed or stopped altogether. The problem here was that the equipment was probably designed by a group of engineers in an ivory tower somewhere without surgeons and designers providing input in the design process.

Technology should always be as easy to use as possible, especially when someone's life depends on it! Providing a complicated instruction manual is not a solution because surgeons are already excessively busy and most will not want to spend time reading a manual for a tool that they rarely use.

Just keep the design simple. Putting together the equipment should not be the toughest part of brain surgery!

Thursday, June 3, 2010

Speed of technology - it's difficult to take a programming hiatus

There was a point in time when I was very comfortable programming. I had finished my engineering degree and I had co-op and project experience in embedded and network programming. Next, I went to Microsoft and worked on the VB compiler there for a year. It was amazing how much more I learned about programming working at that company and more importantly, working with the people there. Being around a group of co-workers that were fanatically passionate about their work meant that I was exposed to new techniques, tools, and ideas that made me a much more efficient and talented programmer.

When I left Microsoft for medical school, I told myself that I would program on a semi-regular basis to make sure I retained what I had learned and stayed on top of the latest developments in the software industry. I was not under the delusion that I would have the time or energy to program regularly and become better, I just thought I could prevent regression.

After the first term of my first year, I threw together a very simple physics engine and created an incredibly basic simulation of the human immune system. This was a hacky project at best, but it was really the most I could do considering I actually wanted to take a break during my vacation.

Then in the summer after first year, I was using Excel to analyze data for a research project. I was able to dramatically reduce analysis time by writing VBA scripts to automate a lot of the grunt work. Again, this wasn't really programming, this was just scripting.

Now, as I'm looking at some of the most recent posts on programming blogs and forums, I realize that in two years there has been a lot of development in programming and the tools programmers use. Some of these changes are just fads or modified ideology (read: the flavour of the month), but many of them are true developments in the evolution of programming. Even though I currently feel like my programming knowledge is not up to date, I'm sure I can catch up if I dedicate some solid time to actually coding, but programming isn't really the most important skill for me to develop at this point in my career. With CaRMS (residency matching) coming around the corner, I should probably dedicate the time I would spend coding on, y'know, learning how to be a better doctor. It seems like the reality is that by the time programming will be a useful skill for me to have (in residency when I'm doing research is my best guess), I will probably have to re-learn a great deal of it. Fortunately, the most important skill a programmer can have is an analytical thought process...and that is something that doesn't degenerate (unless you have dementia).

The reality is...if you want to be a should code. Taking a break can be rejuvenating, but don't take it for too long because the industry will have moved along rapidly without you...

Tuesday, June 1, 2010

Multiple sclerosis breakthrough as researcher saves wife

Dr. Paolo Zamboni has been in the news several times in the past twelve months for his breakthrough discovery. He claims that patients with multiple sclerosis (MS) have been found to have clogged veins that are responsible for the symptoms of their disease. He bases this claim on his finding that most patients with MS have clogged veins, but their symptoms stop progressing and often become better after the veins have been unclogged. This is a breakthrough because currently we have been treating MS with immunosuppresive drugs that have had mixed results.

The article makes an error when it claims that Dr. Zamboni's findings contradict the current understanding that MS is an autoimmune disease. Hypothetically, the clogged veins prevent drainage of toxins which causes an inflammatory response in the brain. This inflammatory response causes the blood brain barrier to become permeable to immune cells, which is normally a good thing because it allows immune cells to enter the brain and attack the toxins or infection causing the inflammation. However, when these immune cells enter the brain constantly they may may instead wreak havoc on the myelin of the nerves (the current supported pathogenetic mechanism of MS is that the immune cells attack the myelin of the nerves). This theory, which is also mentioned in the article (so it really doesn't make sense that the article claims the findings oppose the belief that MS is an autoimmune disease), allows both the current understanding of MS and Dr. Zamboni's findings to co-exist peacefully.

An interesting subplot in this story is that Dr. Zamboni was motivated to perform this research because his wife was suffering from MS. He studied the current research on MS thoroughly and realized that patients consistently had increased iron deposits around the veins that drain blood from the brain. Most physicians and researchers attributed this to the constant autoimmune reactions associated with MS, but Dr. Zamboni thought that it might be more significant. After measuring the blood flow of the venous drainage of MS patients and realizing that they were significantly lower than healthy people...he developed his new therapy...

I bet that he won't be yelled at if he forgets to put his clothes in the hamper, at least not for a couple of months...