References for the Green Team’s Project Management Presentation

If you’re interested in a list of references about Project Management and Addressing EHR burden on clinicians and staff, you’ve come to the right place.

As a member of the “Green Team” for the Project Management course offered by OHSU’s Department of Medical Informatics and Clinical Epidemiology (DMICE), we wanted to be able to share the complete references with folks, so here they are.

Revisiting landscape irrigation

Technology has changed since we did the landscaping in 2007, particularly with the ability to control things remotely. I had to replace the controller (timer) at my mom’s when the hard-working device my dad placed well over 20 years ago finally failed. I got a Rainbird, with a WiFi option, so I can see what’s going on at her house. I wanted to do the same thing at our house, both for the WiFi option and because I’d never particularly liked the Rainmaster controller that was put in originally.

I did some research to figure out which model Rainbird I should get, but couldn’t find anyone who would take out the old and install the new. Fortunately, our original irrigation expert came back to San Jose for a big job this spring, and was willing to do the work between his other obligations.

Rainbird ESP-ME3 controller. Base unit is 4 channels, expands to 22 channels. Uses the LNK WiFi

We selected the Rainbird ESP-ME3 series, with the LNK WiFi module, and added a rain sensor. We also added a flow sensor, which can help us determine if a circuit doesn’t shut off, has a leak, etc. After some initial issues with the flow sensor, we got it all settled so that we can track water usage, really important with the current drought. We also put in a “normally off” Master Valve, which will shut off the water when the sprinklers aren’t running, and prevent leaks.

The app, showing water use. Of course, since we just put it in this year, we don’t have prior years to compare with.

Of course, now I will probably redo mom’s setup so that we can track water usage the same way, not just adjust the programming, etc.

*See also the post Drip Irrigation conversion from 2015.

Upgrading a ceiling fan – DIY is never that simple

When we first bought the house, we installed a ceiling fan in the kitchen. That fan ended up in my office, and has been really great… but it finally stopped working. Newer devices have options for remote controls, integrate with smart home technology, etc, so it was worth the upgrade.

Step 1: Figure out how to disassemble the existing fan and take it down. Of course, we first put it together and hung it up nearly 20 years ago, so we don’t have the manual any more. Total time: 90 minutes.

Original fan from 2002

Step 2-A: Swear at the manufacturer who provides you with 3″ long screws, but doesn’t also provide you with the appropriate size and length drill bit*. Regular drill bits in the 9/64″ size are about 2″ long… which potentially leaves you driving in a full inch of that screw by hand (because a drill driver will just strip the head). All done while on a ladder, and working over your head. We tried, but couldn’t get that last half inch screwed into the joist. Take out the first screw before you totally mess up the Philips head. Use the second screw. Do the same. Decide it’s time to quit for the day, while leaving off the circuit breaker.

Step 2-B: go to Home Depot to get the special 12″ long drill bit, and more screws.

Step 2-C: Bend one screw. Remove it. Break one screw. Shift the bracket location and drill a new pilot hole.

Step 2-D: Return to Home Depot, get more screws. Also get a nifty ratchet screwdriver. Hope that I don’t get blisters on my palm from all of this.

Step 2-E: Finally get the mounting bracket installed. Total time for this first part (not counting dinner and sleep): 6 hours.

Step 3: Connect the wiring, mount the central unit. It’s heavy, and plan on two people just to get it onto the posts. Everything else is a one-person job. Mounting the blades is a bit fussy, because the alignment is tricky to see when you’re working above your head. Mount the light brackets, light (LED) and glass cover. Total time: 1 hour. Turn on the circuit breaker, turn on the switch, and viola! New fan works like a dream.

New fan installed.

Step 4: Setup the app. SIMPLEconnect is not simple. Apparently, many items in the Internet of Things (IOT) only work with 2.4GHz wifi networks. Your phone (or tablet) needs to be using that network for the setup to be completed. Of course, most of our phones nowadays use the 5GHz networks, so the two won’t talk so you can do the setup. You will get an error saying it’s Unable to Pair, and you have “Inadequate Permission” — which of course doesn’t actually tell you what’s wrong.

We had to rename most of our household network to isolate one device that we could force to stay on 2.4GHz, then “forget” the normal network and then rejoin the network, and then we could set up the app. Once it’s setup, however, you can shift everything back to normal.

See also this article: https://pocketables.com/2018/05/how-to-set-up-that-2-4ghz-device-on-your-dual-ghz-network.html

*See also this post: https://www.monty-doyle.com/?p=1240

Jean Monty Doyle

Jean Monty Doyle, age 96, passed away at her home on March 14, 2021. The youngest of six children, she was born in Omaha, Nebraska. The family moved to San Jose when she was three years old, and Jean considered herself a native Californian.  Jean was an organizer, a planner, a manager, and a problem solver.  She would graciously help you with as much or as little as you needed to solve your problem.

Jean wore many hats over the years.  She was a registered medical record administrator and graduate of San Jose State University.  Early in her career, she worked at San Jose Hospital Medical Center, in medical records, as well as the surgery and pathology departments.  She also helped her brother, Dr. A.J. Monty, start the Santa Clara County Heart Association.  At the request of the Santa Clara County Medical Society, she started the first medical personnel agency and medical secretarial service in San Jose. This led to her meeting her future husband David when she visited to enquire if he needed office help.  

She later started a hospital transcription service and medical office consulting business, including establishing and managing a billing office for a group of physicians.  New physicians contacted her and asked for help in starting their practices, including some of the first Vietnamese physicians in San Jose.

As part of her transcription service, she also wrote several handbooks which were published and used nationally. Her handbooks include “The Complete Handbook for Medical Secretaries and Assistants”, co-authored with Dr. Robert Lee Dennis, which got this rave review from Annals of Internal Medicine: “Retrieving this compendium from my secretarial-nurse staff evoked the response one might expect from Mama Bear when caught stealing one of her cubs.”

She was always extremely organized, and managed to have a successful career, run a busy household, and have an active social life.  Her favorite pastimes were golf, ballroom dancing, and reading.  She and her husband David traveled to many countries, and spent many happy hours dancing in each country that they visited, as well as at home.

Jean and David were very active volunteers with their daughter Christine’s Catholic schools.  Jean organized student medical records for the schools to ensure everyone had gotten their childhood immunizations, in addition to providing help wherever needed.  She and her husband became good and long-lasting friends with many of the high school band parents, who were ultimately dubbed “The Green Spaghetti Gang” after the fundraising spaghetti dinners.  They chaperoned many of the high school band trips and had many a reunion dinner after all of their children had graduated.

In her retirement, she was a HICAP counselor for 16 years, helping seniors with their Medicare insurance questions and problems.  She enjoyed sharing her medical insurance knowledge with seniors seeking advice.

She is predeceased by her loving husband David B. Doyle, MD, and her brothers, sisters, and parents.  She is survived by her daughter Christine A. Doyle, MD, son-in-law Stephen Nelson, and several nieces and nephews.

Vaccines! Vaccines!

Just about everyone at the hospital was thrilled when we heard we would start giving vaccines to the staff before Christmas.

We started on December 17th, and had just over 350 people go through in 4 hours. We are now averaging well over 1000 doses per day within our hospital system and the county is now starting to branch out to other healthcare workers (physicians and their office staff), as well as our elderly and their caregivers. In just under 4 weeks, we have given well over 21,000 doses within our system and are giving second doses to those who were in the first week. This doesn’t include other facilities within Santa Clara County, like Stanford or Kaiser.

Do we know all of the fine details about the vaccines? Of course not. Just like this pandemic, what we know at the beginning is not what we will know 3 months or 6 months in the future, let alone years from now. We can’t say how long the vaccine will last yet (but at least 8 months). We don’t know whether folks will require booster vaccinations after the initial series.

Despite claims, this vaccine has gone through the exact same scrutiny that other vaccines have. We are doing the longer-term follow up, just like normal. What is different is the speed with which these vaccines were reviewed — on average, a new drug or vaccine sits in limbo for 2-3 years before the review is done. In addition, we had far more people in the studies than is typical. And we are continuing to do post-vaccination followups, not only with the study participants, but with everyone who is getting the vaccine. I expect in the end, both the Pfizer-BioNTech and Moderna vaccines will be the most studied vaccines we’ve ever had.

Yes, mRNA vaccines are new. But we have been studying them for a couple of decades, and they are being looked at as possible anti-cancer vaccines. Sounds like a SciFi novel, but reality gets closer to fiction every day. They don’t change your DNA, because they can’t. They do use your body’s “assembly line” to make the protein that stimulates the antibody creation. That’s the same thing that a virus does.

Most of the reactions that people are talking about are the same reactions your body has when fighting off any infection, whether bacterial or viral. Fever, chills, body aches. It means things are working. Not everyone has the same reaction, and not everyone will have the same reaction with both doses.

Please get your vaccine as soon as your are able to do so.

Boosting Bluetooth Range

I got a Bose SoundSport headset earlier this year, and it’s quite nice when I’m trying to do work around the office… except for when I walk out of range. Unfortunately, the range issue was happening even within my 13’x13′ office.

So I asked for a bluetooth booster for the holidays, and I received an AIRcable Host XR5. Small device, with an adjustable antenna and a mini-USB cable. The experience has been a bit mixed.

The device arrived with no instructions. The website has no instructions. We could only find a few comments on the web: turn off the Bluetooth on the computer before plugging the device in, wait 5 minutes or so, download Xcode, etc. Not that helpful.

Although there is no specific Documentation or Technical Help page on their website, I was able to find this: https://aircable.co/blog/aircable-news-1/post/the-aircable-host-xr-on-a-mac-37 Even this blog post is a bit short on details, as key steps are buried in text instead of in the bullet list.

To make this work you need to:

  1. Make sure that you are using a wired keyboard and mouse.
  2. Ensure that Bluetooth shows on your menu bar at the top of your screen.
  3. Hold “shift” and “option” together and then click on the Bluetooth icon. This will bring up a variation of what you normally see, which includes the MAC address. Note down that MAC address, since you will need to see a change to verify that the device is working. The AIRcable MAC address will start with 00-25-BF-
  4. Turn off your Bluetooth.
  5. Choose DEBUG and remove all of your devices.
  6. Plug in the device to a *powered* USB port. The light will appear red.
  7. Turn Bluetooth back on. Wait about 5-10 seconds, and the icon will return and the light will change to a reddish-purple (not blue) and flickering/flashing.
  8. Pair your devices if they don’t come up automatically. Airpods and other Apple devices will not automatically appear, and will require manual re-pair.
What you see when you click on the Bluetooth icon in the toolbar as you go through the steps.

Once you get this setup, it may be unstable initially, and keep dropping. Be patient. Make sure that the antenna is upright (not flat on the table/surface). And it may drop periodically, even when sitting still at your desk. It’s unclear what makes that happen, but it will reconnect automatically.

The other issue with Bluetooth headphones is which codec is used as the default. You can check that by using “option” when clicking the Bluetooth icon. If you are sending audio to your headset, you should be able to click on it and see which codec is being used. If you’re using AAC or aptX, you will get better audio than using the SBC codec. For more details on how to optimize this, look here: https://www.macrumors.com/how-to/enable-aptx-aac-bluetooth-audio-codecs-macos/

Option-click to see the details of the devices

Mind the Gap

Bridging the Gap between Wanting to be a Leader and Getting There.
A Practical Guide for Women in Anesthesia.

If you attended the ASA Virtual Meeting presentation on October 3rd, or are watching the recording, here are the recommended readings about Sponsorship, with links to the articles. Each will open in a new window.

Of note, the most useful references on this topic, as well as the others in our SnapTalk presentations, do not come from typical medical references, but from the various business and tech sites that talk about professional development.

I may have periodic updates, but will note which items are new.

Masks, Masks, and More Masks

With the pandemic continuing worldwide, most communities require masks if you’re outside of your home. What are the different types of masks, and which one should you be wearing?

What is the purpose of a mask (or gloves, or cover gowns)? It depends a bit on context. Masks can be used to protect you, or can be used to protect others, or both.

Personal Protective Equipment (PPE) can be rated depending on the context. Are you looking for protection from fire/burns/electrical? Or protection from biohazards? It totally changes what recommendations are made.

PPE for biohazards typically includes respiratory protection (a variety of masks and respirators), eye protection (goggles and face shields), and skin/hand protection (gloves and gowns).

I’m wearing: N95 mask, with a 3M 1818 mask over it, a face shield,
plus a lead apron for x-ray protection.

Masks also have different levels of protection, based on how fine they are and what can get in (or out). Any mask made of fabric or a paper-type product will freely allow oxygen and carbon dioxide to pass; hard plastic masks like scuba or others require a source of fresh air.

The shape of the mask and the way it’s secured also has a role to play in how effective the mask is. Masks can be pleated, cone-shaped, duck-bill, or contoured. They can have an ear loop, an elastic strap, or ties. Each has issues related to fit and efficacy.

I strongly suggest you view this video from Sewstine (also an anesthesiologist), as she makes 4 different types of masks and formally fit tests them. And provides the research behind it all.

Mask Ratings:

Masks are rated by either NIOSH (in the US) or the European Safety Federation (ESF). They will be rated for Particle Filtration Efficiency (PFE) and may also be rated for Bacterial Filtration Efficiency (BFE). They are considered Air-Purifying Respirators because they protect by filtering particles out of the air you breathe.

Both ratings organizations classify masks based on the percentage of airborne particles that are filtered. For NIOSH, the number of the mask is approximately the percentage of the PFE. NIOSH approved masks also have a letter, which has to do with how the mask deals with oil.

  • N – solid and liquid aerosols that do not contain oil (Non-oil)
  • R – solid and liquid aerosols that may contain oil (Resistant to oil)
  • P – solid and liquid aerosols that may contain oil (Protective to oil)

The European P2 mask or FFP2 filter is equivalent to the NIOSH N95. The P3 or FFP3 is equivalent to the NIOSH P99.

ASTM Mask Certifications

Dust Masks aka “nuisance” masks, that you might get at the hardware store, are good for things like gardening, and some tasks like painting or light sanding, but are not adequate for pandemic protection, particularly not in close or indoor situations.

Gaiters will depend on the fabric that was used to make them. Fleece as a whole provides warmth but no filtration efficacy. Many performance fabrics are designed to “breathe” and may protect you, but not protect others.

What about Powered devices?

Powered Air-Purifying Respirators (PAPRs) are types of hoods which have a battery-operated blower that sends purified (filtered) air from a device on a belt or backpack up to the hood so you are breathing clean air. Controlled Air-Purifying Respirators (CAPRs) are a proprietary variant, where the filtration all happens in the helmet portion of the hood. Ortho-hoods, used to protect surgeons during orthopedic surgery, are not filtering the air, so are inadequate alone (but may be used in conjunction with an N-95 mask).

Wearing a CAPR for aerosol-generating procedures.

Closing Thoughts

If your goal is a secure fit to prevent aerosol transmission, the mask or other device will need to be very tight to the face. And it will probably be uncomfortable in some way because of that fit. But it will *not* adversely affect your ability to breathe in oxygen or exhale carbon dioxide.

Other resources & reading:

Making Drapes

It’s been years since I last made drapes, but the back-light in my office has become a problem as we do more video conferences. So, I need drapes that will help balance the lighting in the afternoon.

I ordered some inexpensive backdrop drapes from Amazon. When they arrived, they were still too light-weight, and I would need more of them to get enough fullness to get any sort of light-blocking effect. Most of the drapes you can get at any retail store are really designed to just be hanging on the edge of the window — they are in no way designed to be drawn across the window, even when they are advertised as black-out drapes. The panels aren’t full enough, and if you need 2 (or more) sets, then you have the gap between panels.

Time to design drapes. In this case, I wanted something full enough that it would give good coverage when drawn, but be able to be tied back most of the time, so I could easily adjust the blinds.

The last time I made drapes, I did balloon shades for my room at parents house, over 25 years ago. Balloon shades can be raised to various degrees or left down. They should be long enough to puff at the bottom when fully down. In this case, I also put a swag and jabots at the top. Because it was a bow window, I ended up doing 5 separate drapes, one for each window, and put the pulls into two batches. These replaced the classic pinch pleat drapes and sheers, which had finally fallen apart from the heavy sun exposure. My mother was concerned that they would “look like a sheet” from the outside, but you can put in enough gather that it looks just fine.

picture of drapes with swag and jabot
gathered balloon shades – except that the bottom dowels have been removed, so they just fall in gathers

Given the size of the window and the length I wanted, and a deadline for an event, I took a look at what I had in my stash. Natural linen was an easy choice, but would need a lining to get me adequate light blocking. I could use the cheap drapes as the lining. But I would need a bit more length. Color block patterns seemed like a good way to go, and I picked a green that would work well with the walls.

A brief digression into terminology.
– Stack: how wide the fabric is when the drapes are fully open
– Fullness: the width of the fabric in relation to the curtain rod. Usually should be 2-3x.
– Railroading: using the fabric “sideways” or cross-grain. This minimizes the number of seams
See also this nice post: https://www.dwfcontract.com/Drapery–Window-Covering-Blog/bid/34627/Glossary-of-Drapery-Terminology

Fabric ordered, should have been easy. FedEx sent the package from LA to Texas, instead of to Northern California. And then lost it. Deadline blown. They found it a week later, and got it to me nearly 2 weeks after the date I was aiming for having these done. Oh well.

Wash fabric. Iron fabric. Re-iron fabric using steamer. Cut panels of the natural linen. I thought about using it cross-grain, but the natural creases would then have been horizontal, and I didn’t think that would look all that great. On the other hand, the green didn’t drape quite the same way, and was perfect for railroading the contrast bands. Find enough floor space to lay everything out (the hardest part).

I opted to use a series of inverted pleats. This is what you will see in theater scrims (the drapes on the sides and back of the stage). It provides a lot of volume but isn’t that fussy to do — certainly not like pinch pleats. But I didn’t want a lot of volume at the top on the rod, so added the header block after the pleats were finished. And then finally added the tie-backs to hold them back when I don’t want them down.

Coronavirus, COVID-19 and resources

We’re all overwhelmed with the information out there. This is an attempt to bring some of the best pieces together into one location. I have divided things into Peer-Reviewed articles (i.e., the medical journals), News articles, Websites/Blog posts, and some of the California county health department sites and recommendations. Not all of these are new, but bringing it all together is.

Peer-Reviewed articles
News articles
Websites/Blog posts
California Counties

The Biggies:

CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html
WHO: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
ASA: https://www.asahq.org/in-the-spotlight/coronavirus-covid-19-information
ASPF: https://www.apsf.org/news-updates/perioperative-considerations-for-the-2019-novel-coronavirus-covid-19/
CDPH: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx
SCCM: https://www.sccm.org/disaster?utm_source=3%2F12%20-%20NEWS&utm_medium=Link&utm_campaign=eNewsletter&_zs=0hMjd1&_zl=b6db6

Peer-Reviewed articles:

News Articles:

Websites & Blogs

California County Info

I’m focusing on the Bay Area, since that’s where I live and work.