Customer Service via Twitter

It seems that over the years I have ended up with a different Norton Anti-virus product key for three different computers rather than one for all three.  The renewal emails are staggered through the spring.

This week I decided to tackle the issue and see if I could get it changed.  I visited the website and when I saw the option of contacting them via twitter I did just that.

Twitter worked!

I sent my question to @nortonforumsusa which began an email correspondence.   Within less than 24 hours I had all three computers running Norton 360 Premier under the same product key.

The first contact, TL, even forwarded my question regarding refund or credit from the other two to customer relations rep RV who gave me two options (I chose the credit one).

One reason it worked for me was I did my homework before I contacted them.  I helped them help me by having all three product key numbers available, giving them a working email address, and responded to their questions quickly.

This post is simply meant to be a public expression of gratitude and thanks for how well Norton’s customer service worked.  Thanks to TL and RV.

……

But I will take it further ----

Perhaps hospitals and clinics could use twitter the same way for non-emergency/non-diagnostic/non-treatment issues like billing, scheduling, etc. 

First, a public request for help.  Second, take the help to a private venue (email or phone).

Keeping Patients Warm Perioperatively

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Last week I read this article in the Medical Industry News written by Kaye Spector: Warm wakeup from surgery has roots with Cleveland doctor. I am impressed with this new patient gown that works with the Bair Hugger System (photo credit)

It would work well to pre-warm patients in the holding area. It would work well for facial, abdominal, or extremity surgery as shown in the photo. For chest case, perhaps it is possible to roll the gown downward covering the abdomen and legs. If not then the traditional lower-body Bair Hugger blanket could still be used.

If kept clean in the operating room, then it could be used in recovery to continue warming the patient there.

The 2006 article by Dr. Leroy Young on preventing perioperative hypothermia in plastic surgery patients is a very good article – well written, easy to read, covers the topic thoroughly. Here are the big suggestions for prevention given:

• Actively prewarm patients in preoperative area for approximately 1 hour with forced-air heating or resistive-heating blanket.
• Keep the ambient temperature of the operating room at a minimum of 73°F.
  
• Monitor core temperature throughout administration of general and regional anesthesia.
  
• Cover as much body surface area as possible with blankets or drapes to reduce radiant and convective heat loss through the skin.
  
• Actively warm patients intraoperatively with forced-air heaters or resistive-heating blanket to prevent heat loss and add heat content. Rearrange covers every time patient is repositioned to warm as much surface area as possible.
• Minimize repositioning time as much as possible so that the active warming method can be quickly continued.
  
• Warm intravenous fluids and/or infiltration fluids if large volumes are used. Warm incision irrigation fluids.
  
• Aggressively treat postoperative shivering with forced-air heater or resistive-heating blanket and consider pharmacologic intervention.

Perioperative hypothermia is associated with increased surgical site infections, slower wound healing, coagulation disorders, and increased bleeding. So it is very important to keep patients warm. It also makes them more comfortable, so improved hospital and surgeon ratings.

As the surgeon (and one with the occasional hot flash), I can tell you it is difficult to work in an OR with temperatures higher than 70°F. My fellow female colleagues (scrub nurses, circulating nurses, etc) at the surgery center I work most frequently often want the temperature even lower. It is a struggle to keep everyone happy and comfortable.

The article referenced below states

The minimum OR temperature recommended in the literature is 22°C (71.6°F), and most researchers agree that an ambient temperature of at least 23°C (73.4°F) is better. Sessler recommends an OR temperature of 25°C (77°F). One study by El-Gamal and colleagues determined that nearly all cases of perioperative hypothermia could be eliminated if OR temperatures were 26°C (79°F).

REFERENCES

Prevention of perioperative hypothermia in plastic surgery; Aesthetic Surgery Journal September 2006, Vol. 26, Issue 5, Pages 551-571; V. Leroy Young, Marla E. Watson

Shout Outs

Updated 3/2017-- photos/video and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Codeblog  is this week's host of Grand Rounds.  You can read this week’s “Trick or Treating” edition here.

Welcome to Grand Rounds!  This is volume 6, number 6…. and the 6th time I am hosting… during the week of Halloween.  Does anyone else find that creepy coincidentally satanic fascinating?!

For this edition, I thought we could go out Trick or Treating on Medblogger Lane.  I’m sure we will find some colorful stories along the way…

………………………….

Better Health highlights’ Evan Falchuk JD  post:  If I Could Fix One Thing About US Healthcare.

………….In response, a friend of mine challenged me:  if the system is too complicated, how should we simplify it?

I wish more policy-makers were asking this question.

For me, the answer is clear: Primary care.  Time was, your primary care doctor was able to serve as the hub of your medical activity.  He or she could spend all the time needed to figure out what was wrong and to coordinate with your specialists.  It’s not true anymore.  Patients are left on their own trying to navigate the system.  In many ways they end up acting  almost as their own primary care doctors.  Patients try to pick their specialists, find out what to do about their condition, decide on good treatment choices……………….

………………………………………

H/T to @EvidenceMatters  for the link via twitter to the Jenner Museum.  What a wonderful website filled with history of Dr Edward Jenner and the story of the smallpox vaccination!

Interested in smallpox vaccination history as mentioned by @badastronomer? Jenner Museum in on Twitter @JennerMuseum

……………………………………….

When is it important for physician’s to tell patient’s about their own illnesses (the physician’s)?  Dr. Anne Brewster has multiple sclerosis.  She writes about revealing this to a patient with the same disease in her essay:  Boundary Issues: A Doctor with MS Confides in Her Patient

I called her at home to give her this news. While I informed her ……., she heard only “Multiple Sclerosis”. “What does this mean?” she asked, but she didn’t wait for my answer. She began to cry. “I am so young. There was so much I wanted to do. I wanted to have a family.”

“I have the same disease,” I told her. I had decided to reach across the space between us and to share a bit of myself. I went on to say that I have four kids, that I still ski, run, play lacrosse and work as a doctor, that I am healthy and energetic. “There is tremendous variability in how people do,” I offered, “and some people do very well. It is the unknown that is scary.”

……………………………..

Good for fellow bloggers for taking on Suzanne Somers!  (photo credit)

• Suzanne Somers carpet bombs the media with napalm-grade stupid about cancer – Orac at Respectful Insolence
• Suzanne Somers’ Knockout: Dangerous misinformation about cancer (part 1) -- David Gorski at Science-Based Medicine
• Suzie's At it Again – Margaret Polaneczky,MD (aka TBTAM)
• Suzanne Somers, Larry King and Cancer - Enough is Enough (TBTAM)

………………………………..

I just recently signed up for Skype (haven’t used it) but have wondered about using it as Shrink Rap suggests:  Skype Therapy.   I think HIPAA may prevent us from making the most of Skype, texting, etc.  Too many privacy/legal  issues for now and that’s a shameful waste of good technology.

So what do you think about the idea of videochatting with your shrink on the computer? Patrick Barta is a psychiatrist in Maryland who has started having some of his sessions (5 percent or so) on Skype. He's blogging about his experiences and talking about the good and the bad aspects. Do visit his blog: Adventures in Telepsychiatry and let him know what you think about Skype-Therapy!

……………………………..

If you live in or near Washington DC, you may want to Bring your kids! Halloween at the Medical Museum, Sat. 10/31, 10am-1pm.  It’s a free event, but photo ID’s are required.

The National Museum of Health and Medicine and Family Magazine will host family-friendly Halloween activities for ages 5 and up. Children will be able to participate in a costume contest (with prizes!) and make skeleton crafts (a dancing macaroni skeleton, a medieval plague mask, and a skeleton wall hanging) as well as join in a Halloween-themed family yoga demonstration by Shakti Yoga.

……………………………………..

H/T to Dr Isis for this video on Polaroid.  I am a Polaroid fan and was saddened when they quit making the film.

Also, check out this post at Cocktail Party Physics:  images from supernovae to supermodels by Diandra Leslie-Pelecky

A brief review: Light can be modeled as photons, which are characterized by a wavelength λ and a frequency f. …………..…

The camera obscura, a system of lenses used to project images, was known in the 1000's CE, but it was an aid for drawing – there was no way to save the images. Daguerre developed a process in 1839 that employed copper plates and mercury vapor;…………..

Before film, photographs were taken on glass plates, which produce much more durable images, but are very difficult to carry in your wallet or purse………..

Eastman Kodak is credited with the first flexible (although not transparent) film in 1885…………..

…………..…………………

There has not been an announced guest or topic for this Thursday night  Dr Anonymous’ show.   The show starts at 10 pm EST.   Dr. A has a couple of nice videos up of his appearance on local TV news giving his take on H1N1.

Scar-free surgery?

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

H/T to MedGadget for bring this research to my attention.  Wow!  I know it is not ready for primetime, but still – wow!  Currently, this isn’t the case (no scar-free tummy tucks or facelifts), but the possibility may exist in the future.

Michael Berger over at Nanowerk profiles the work of Japanese scientists who created adhesive ultrathin "nanosheets" which are able to bind tissue together.  Their goal was to create a material that can help avoid suturing or stapling of fragile tissue during surgery.   (photo credit)

Shinji Takeoka tells Nanowerk. "We found that our ultra-thin PLLA nanosheet has an excellent sealing efficacy for gastric incision as a novel wound dressing that does not require adhesive agents. Furthermore, the sealing operation repaired the incision completely without scars and tissue adhesion. This approach would constitute an ideal candidate for an alternative to conventional suture/ligation procedures, from the perspective not only of a minimally invasive surgical technique but also reduction of operation times."

Takeoka and colleagues have published their findings in a recent paper in Advanced Materials ("Free-Standing Biodegradable Poly(lactic acid) Nanosheet for Sealing Operations in Surgery").

Shout Outs

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

Kim at Emergiblog is this week's host of Grand Rounds. You can read it here (photo credit).  A Cracking Grand Rounds!

Welcome to the latest edition of Grand Rounds, the weekly compilation of the best of the medical blogosphere!

Our theme this week comes to us courtesy of that loveable, wacky duo, Wallace and Gromit!

Dr Nancy Brown writes about  The Newest Eating Disorder: Orthorexia Nervosa.

Orthorexia is a term coined by Dr. Steven Bratman. “Ortho” simply means straight or correct, while “orexia” refers to appetite. Orthorexia nervosa refers to a nervous obsession with eating proper foods. While anorexia nervosa is an obsession with the quantity, orthorexia is an obsession with the quality of the food consumed.

While on food, how about checking out this NY Times article “101 Simple Salads for the Season” By Mark Bittman.  (photo credit)

SUMMER may not be the best time to cook, but it’s certainly among the best times to eat. Toss watermelon and peaches with some ingredients you have lying around already, and you can produce a salad that’s delicious, unusual, fast and perfectly seasonal. 

More on eating -- Dr. Val Offers ABC News Secrets To Long-Term Weight Loss.  Good for you Dr Val!!!  It takes diet and exercise.

Check out Dr Wes’ “careful exam” – a Pepsi is not always a Pepsi.

Dr Graham Walker talks about “never events” in his post “Fixing Medical Err-ERs”

The NYT has an Op-Ed by a former head of the National Transportation Safety Board talking about reforming the health care system and reducing medical errors. He cites the To Err Is Human Institute of Medicine report suggesting 98,000 annual deaths and billions of dollars due to medical errors, and notes:

H/T to Clinical Cases and Images – Blog for TED Talks: Daniel Kraft invents a better way to harvest bone marrow

Remember the crazy quilt I made back in  May for entry into the “Crazy for Quilts” contest?  Well, the quilts are making their rounds for exhibit.  If you get a chance, I hope you will go to one of them.  From an email I received:

Our next exhibit venue will be the Virginia Quilt Museum from August 17-September 11, 2009. Since we had such an incredible response to this year’s contest (86 quilts total) the VQM will not be able to hang all of the quilts.

On September 24, all of the quilts will be exhibited in a one-day presentation in Asheville, NC, at the AAQ’s home base- 125 S. Lexington Avenue. The exhibit will be co-presented by the AAQ and HandMade in America, a regional nonprofit that leases us office space.

Dr Rob is now doing podcast as the “House Call Doctor”  giving “quick and dirty tips” to help you take charge of your health.   You can find the list of his podcasts here.  Enjoy!

                      

This week Dr Anonymous returns from taking July off.  Come joint us.  The show starts at 9 pm EST.

Upcoming Dr. A Shows 

8/13: The Hollums Adoption
8/20: Dr. Rob & House Call Doctor podcast
8/27: Dr. A Show 2nd Anniversary & BlogWorldExpo
9/3 : Dr. A Show (9:30pmET)

Bioactive Sutures

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

H/T to MedGadget who’s post introduced me to “bioactive sutures.”  What a great idea by the Johns Hopkins biomedical engineering students! 

……have demonstrated a practical way to embed a patient’s own adult stem cells in the surgical thread that doctors use to repair serious orthopedic injuries such as ruptured tendons. The goal, the students said, is to enhance healing and reduce the likelihood of re-injury without changing the surgical procedure itself.

The project team of 10 undergraduates focused on Achilles tendon injuries which require repair in approximately 46,000 people in the United States every year.   The surgery may fail in as many as 20%.  Recovery can take up to a year even with successful surgery.  If this new suture speeds healing and lowers failure rates – what potential! 

At the site of the injury, the stem cells are expected to reduce inflammation and release growth factor proteins that speed up the healing, enhancing the prospects for a full recovery and reducing the likelihood of re-injury. The team’s preliminary experiments in an animal model have yielded promising results, indicating that the stem cells attached to the sutures can survive the surgical process and retain the ability to turn into replacement tissue, such as tendon or cartilage……………

As envisioned by the company and the students, a doctor would withdraw bone marrow containing stem cells from a patient’s hip while the patient was under anesthesia. The stem cells would then be embedded in the novel suture through a quick and easily performed proprietary process. The surgeon would then stitch together the ruptured Achilles tendon or other injury in the conventional manner but using the sutures embedded with stem cells.

Indications for Breast MRI – an Article Review

 Updated 3/2017-- all links (except to my own posts) removed as many are no longer active and it's easier than checking each one.

The full title is “Indications for Breast MRI in the Patient with Newly Diagnosed Breast Cancer.” It is a Medscape CME article. The article discussed exactly what the title implies. It does so by looking at the published research.
Some of their findings:

• MRIs have a high sensitivity for detecting otherwise occult cancers in women recently diagnosed with breast cancer.
• MRIs can improve assessment of disease extent in the breast known to be affected with cancer and may detect mammographically occult cancer in the contralateral breast.

• Nothing published suggests that breast MRI should be used as a substitute for screening or diagnostic mammography.
• MRIs should be used as an adjunct to mammography and not in lieu of standard breast imaging with mammography and, when indicated, diagnostic breast ultrasound.
• MRI detects the primary cancer in up to 70% of these patients with adenocarcinoma meta states in the axillary lumph nodes without an identified primary source, changing the staging from T0 (unknown primary) to the defined T1 to T3.
• To address the current lack of standardization in MRI technique, the American College of Radiology (ACR) is developing a voluntary Breast MRI Accreditation Program, which will include minimum standards for breast MRI.

Other Blog Posts of Interest:
Breast Self Exam (BSE) (Oct 6, 2008)
Mammograms (Oct 13, 2008)
Breast Cancer Screening in Childhood Cancer Survivors (Feb 4, 2009)
REFERENCE
Indications for Breast MRI in the Patient With Newly Diagnosed Breast Cancer; Medscape Article, posted 02/16/2009; Constance D. Lehman, MD, PhD; Wendy DeMartini, MD; Benjamin O. Anderson, MD; Stephen B. Edge, MD

Sponge Count

 Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active and it was easier than checking each one.

It’s one of those things you do (or rather the OR staff does) at the end of a case.  I usually continue to sew the last layer of skin as the count occurs.  If there is ever a question, then I may help locate a “missing” sponge or lap.  Usually (in my cases) they are just bunched together or one got tucked into the drapes.  That will mean that the first “final” count was wrong, but the second “final” count correct. 

Apparently, according to a recent article in the Annuals of Surgery that was quoted in the AMA News: 

While cases of retained foreign objects are rare -- occurring once in every 5,000 surgeries -- discrepancies in counts happen in 13% of surgeries, according to an August Annals of Surgery study.

I can honestly say, all the counts on all the surgeries I have ever done  have been correct.  No sponges, laps, needles, or instruments have been lost.  My cases now are more organized than some of the major trauma cases I was involved in during my training.  I can see how the counts were sometimes off.  When you have what amounts to 2-3 different surgery teams (neuro, ortho, and gen surgery) all working on a single patient at the same time, it can get chaotic.  In times like that, you sometimes wonder if the initial count was correct.  In other words, sponges, laps, needles, etc don’t have to be lost for the final count (end of case) not to match the initial count (beginning of case).

My fear of loosing a sponge in a breast case means I don’t use them.   If they come in the pack, I ask the scrub tech to put them on the back field to be used as part of the dressing.  Years ago, I finally managed to make the “the powers that be” see that if the count was correct, then it was wasteful to not use the clean sponges as part of the dressing.  If an x-ray did need to be done for any reason in the recovery, I would happily just change the tagged sponges out for them.  Hasn’t happened (knock on wood).

I use lap sponges (see above photo) with the blue tags.  This tag helps keep them from being lost.


There is a push to get hospitals and surgery centers to buy gadgets (photo credit) like the SurgiCount's Safety-Sponge™ System featured recently over at Medgadget.  The surgical sponges are individually bar-coded and then counted with the portable scanner.  This would work nicely on scheduled cases, but I wonder how well it would work on those trauma cases when the sponges are needed three minutes ago.  Would be interesting to see it in action on those cases.

 SurgiCount Medical website


REFERENCES
Sponges, surgical instruments miscounted in 13% of surgeries:  Getting the count right in the operating room is a challenge. New technologies could make things easier.  By Kevin B. O'Reilly, AMNews, Sept. 22/29, 2008.
"The Frequency and Significance of Discrepancies in the Surgical Count," abstract, Annals of Surgery, 248(2):337-341 August 2008; Greenberg, Caprice C MD, Regenbogen, Scott E MD, Lipsitz, Stuart R ScD, Diaz-Flores, Rafael MD, Gawande, Atul A MD
NoThing Left Behind: A Surgical Safety Project to Prevent Retained Surgical Items

For Scanman

 Updated 3/2017--all links removed as many are no longer active and it was easier than checking each one.

Several of my blog friends/colleagues are Mac users and very tech savvy. Vijay (Scanman) has gently nudged me into doing this one. In his recent post, he explains it

This post is my contribution to the series of posts that a bunch of us agreed to post following a conversation on twitter (relevant tweets here, here & here).

The theme: core Mac/iPhone applications for doctors / healthcare professionals.
DrCris’s post is here.
symtym’s is here.
Walter’s is here.
Theresa’s is here.
I was a bit apprehensive about posting after Tim’s masterpiece of Mac-geekery.
But I decided to go ahead and post a list similar to the ones posted by Cris, Walter and Theresa.

I am not a mac user, other than my recent addition of my iPhone. I do not feel that I am tech savvy, but Vijay is encouraging me to do this post. Part of my reason for blogging is to learn, so here goes.

I feel (know) that many of my online friends are much more tech savvy than I am (Moof, Enrico, Rob, Walter, symtym, Cris, and Vijay). They are slowly increasing my knowledge and tech use.

PC hardware that I use.

Toshiba Satellite A105 - My personal laptop. 2002 model, Windows XP operating system
Screen Size: 15.4 inches diagonal
Weight: 6 lbs
Processor Options: Core Duo, Intel Pentium M, 1.6 GHz came with 1 GB RAM which I recently increased to 1.99 GB
Graphics Options: Integrated, nVidia Go 7300 (Dedicated), nVidia Go 7600 (Dedicated)
Home Computer, etc

HP Pavillion -- model a6400f--our home computer. This was recently acquired after spring storm fried our hard drive on the old computer. Lightening came in through the phone line so bypassed all the surge protection. I was out-of-town at the Physics Reunion. My husband was working out-of-town, so no one home. Felt lucky that the house didn't catch on fire.

Intel Pentium Dual-Core E2200 Dual Core Processor; 3GB PC2-5300 DDR2 Memory; 500GB 7200rpm SATA Hard Drive; v.92 56Kbps Modem, Gigabit Ethernet; Vista Home Premium

Monitor is the HP w17e, a 17 in flat screen.

Home printer is the HP Officejet J5780 all-in-one. I used to be able to print from my laptop, but somehow haven't managed to get the new computer to allow me to do so. I admit I haven't spent much time trying to correct it.

We have a Linksys 2.4 GH wireless broadband router (allows me to use my lap top anywhere while my husband uses the main computer). We have DSL through AT&T for our Internet connection.

Office Computer, etc.
HP Pavillion -- model a1510n
AMD Athlon 64 Processor, 3800, 2.41 GHz, Graphics Adapter: nVidia GeForce 6150 LE , Total HD Size (GB): 200; MS Windows XP Professional Version 2002
Monitor is the HP vx17e, a 17 in flat screen.
Printers: HP Deskjet 3915, Epson Stylus CX 7800 (also a scanner/copier)
Fax (not hooked to my computer): HP 1040
Copier: Brother DCP 8045D
Type Writer: Smith Corona DX 4600 (when there are forms that need to be filled out and would take too much "fussing" to get lined up properly in computer/printer)

Browsers - AOL primarily, but have added Firefox to my laptop and office computers. I use IE when listening to Blog Talk Radio, as the techs there told me (via e-mail) that BTR was designed to work with IE). I am not sure I like the tab system, but am giving it a try. I have used AOL so long that I am much more comfortable with it and have things book marked and my favorites in the toolbar. I am beginning to get the Firefox toolbar set up with my favorites (Medscape, JPRS, NPR, etc)

Backup: I am not as good with backup as I should be. I know this, so about a year ago I bought on-line backup storage through Norton and now my laptop and office computer routinely backup without me having to think about it. I have it set to backup my documents, my patient information files, my photos, my Quicken files, etc. I have book-marked this post by Joshua Swimmer, MD regarding "Bulletproof Backup Strategies" so I can improve there.

Mobile Phone - the new 3G iPhone, which my husband gave to me for my birthday. I sync it to my laptop and office computer, but not my home computer since I share that one with my husband. I use the password protection feature. So far I have added the following apps: NYTimes, Twitterriffic, Facebook, Evernote, Weatherbug, Epocrates Rx, and Mediquations.

Cameras --

Canon Sure Shot Z115 -- I have had this camera since I started my practice in 1990. It is the camera that I use most often for patient photos. It is a 35 mm and takes good pictures.

Polaroid Spectra System -- Use to take photos in the office, especially when I need one the same day to send with a pre-approval letter.

Polaroid Macro 5 SLR -- Very nice for taking extreme close ups of small lesions, ie nevi or scars on faces.

Kodak EasyShare C713 -- I bought this camera shortly after I began to blog so I could share quilt and other photos. So far have only used for personal, blog pictures. I like having the negatives for patient photos, but am finding it more and more difficult to get them developed.

Core Software

On my laptop and office computer, MS Office Student and Teacher Edition 2003 -- Don't use this much at home, but it allows me to read documents e-mailed to me when Word is used. I much prefer Word Perfect for my letter writing, etc. I use the Outlook calendar and contact. To learn the ExCel, I made myself use it for keeping up with my CME's, breast implant patients (name, date of surgery, deflation, replacement/removal, etc), and other such information. I have never writer a power point presentation.

Windows Live Writer -- This is via Dr Rob who recommended it to me shortly after I started writing my blog. I have it on all my computers, so I can work on posts from any of them. It is a free download from MicroSoft. There are add-ons that allow you to insert videos, etc.

WordPerfect 11 on my office computer. This is the word processor program I use for letters, office procedure notes, yearly Christmas newsletter for my med school class, etc. I know how to justify the right and left sides of the letters with this program. I think it looks neater. [Vijay has recently in an e-mail told me how to do this with MS Word, so will have to try it.]

Adobe Reader for reading pdf documents, on all my computers. I have not learned how to write a pdf, but would like to do so.
Quicken to keep track of my bank accounts, etc.
TaxCut-- yes, I do my own taxes.

Physician Office Manager for dealing with patient addresses, insurance info/filing, etc. No I haven't managed to add a EMR system. I am able to file insurance electronically, but don't do so. It is more expensive for me to do it that way as I only file less than ten each month. So I print them out. Also, when it is a surgical procedure (ie a reduction mammoplasty) I need to send the operative and path reports with the insurance bill. That is not possible with electronic billing.

iTunes -- for music, podcasts, etc, on all my computers
AOL's Mail and GMail for email.

Now for some of the Fun stuff that I couldn’t do without…

I use Bloglines to keep up with the blogs I read. As I find more and more, that is getting more difficult to do. Anyone know what the limit is to follow and actually read?

Evernote - for saving interesting stuff for future perusal. Thanks to Cris. I really like this application!

I'll end my post with the end of Vijay's:

That brings me to the end of a rather long and an unusually technical post. I hope it wasn’t a total waste of your time. I’ll end with this tweet from twitter-pal Jen McCabe-Gorman. How True!!

Posts by others on this theme (in chronological order with twitter names and urls in parenthesis):

PF Anderson(@pfanderson): My Top Ten Tools Today
Cris Cuthbertson (@DrCris): Medical Software I Couldn’t Do Without
Tim Sturgill (@symtym): Core Mac Software, Hardware and Practices
Walter Jessen (@wjjessen): Core Biomedical Research Software and Web 2.0 Tools
Theresa Chan (@ruraldoctoring ): Web 1.69: Rural Doc’s Core Mac Apps, Hardware, Peripherals

If you are a healthcare professional or biomedical scientist, we invite you to share the hardware, software or Web 2.0 tools that you couldn’t live without. What are your core apps? Share in the comments below or write your own post and link back here or to Walter’s post.