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Tinderbox in medicine (Read 19194 times)
yogicaro
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Tinderbox in medicine
Jul 19th, 2008, 9:05am
 
Hello,
I'm a new Tinderbox user and also new to this forum, which is a very inspiring and interesting way to learn about TB.

I've just started to work as a psychiatrist in a clinic. Apart from clinical work, I also do research.

Most of patient documentation is done with clinic-internal software and on the (paper-based) chart. However, I'm looking for ways to incorporate TB into my workflow. For instance, there are things I need to keep in mind about a patient that neither fits into the computer system nor in the chart.

I would also like to use TB as a place to keep notes about things I'm learning.

Are there any doctors out there working in a clinical setting & using TB? I'd appreciate any comments or ideas.

Many thanks & greetings from Cologne, Germany,
Carolin


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Mark Anderson
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Re: Tinderbox in medicine
Reply #1 - Jul 19th, 2008, 10:46am
 
You might find this page of interest:
http://www.eastgate.com/Tinderbox/Using/ForensicPsychiatry.html

Dr Lenihan is a forum member. I was at that Tinderbox Weekend and saw his original presentation and it's been good to see how Tinderbox was able to help contribute to a seemingly non-digital workflow.
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Roger C. Eddy
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Re: Tinderbox in medicine
Reply #2 - Aug 12th, 2008, 11:45pm
 
Hi Carolin,
I am a senior psychiatrist and psychoanalyst. I have been using Tinderbox for some time to organize a project conceptualizing medical and human error. This area of knowledge suffers from a great deal of conceptual confusion and a quick jump to the fix of the day.
I have found the learning curve quite  difficult as I am no programmer or coder and am over 70. But nevertheless I feel if I keep at it the program will be very helpful.
I would be interested in how you use Tinderbox and anything else about it but could not be of much technical help.
Roger
also <niteloggerATmac.com>
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Mark Bernstein
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Re: Tinderbox in medicine
Reply #3 - Aug 13th, 2008, 11:35am
 
Dr. Jon Leavitt has given several talks at Tinderbox Weekends about Tinderbox and topics relating to psychotherapy practice; I particularly enjoyed one in which he explored contempory issues around record keeping.

    http://doublesquids.net/coffeeblog/

Alwin Hawkins, a cardiac nurse, wrote some interesting notes about Tinderbox and emergency care.  He's currently pursuing a degree in medical informatics; his screencast series on making a simple Tinderbox tool for diabetes management is available on the screencasts page.
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Xavier
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Re: Tinderbox in medicine
Reply #4 - Aug 13th, 2008, 12:28pm
 
Hi Carolin,

We use Tinderbox to manage both dermatology patients and a website that provides regularly updated dermatological information.

In our instance, patients tolerate being in the presence of some direct (keyboard) entry.

We use the custom-fields within notes to record name, contact details, skin type, condition, allergies etc and the text of the note for comments and general notes/concerns.

Agents can then gather, for example, lists of patients with phototype III, dry skin, wrinkles, no pigmentary problems and an allergy to a particular ingredient.

The notes of patients with dry skin are set (by agents) to turn light orange, dry wrinkled skin dark orange, and so on.

Product ingredient lists are also kept in Tinderbox, so an agent can find the most suitable products (if any) and print them.

A large screen helps if you set up a lot of fields because they can infringe on the room left for text within notes.

Perhaps you could use Tinderbox to automatically garner statistics, such as number and kind of bipolar patients whom were unable to tolerate a particular SSRI, and under precisely what conditions – I suspect that'd be more intricate information than some drug manufacturers have considered!  

Tinderbox can always do more than what we can keep in mind and remains almost infinitely flexible.

Moreover the data can be organized (and reorganized) however you please and is never prone to being compromised by or stuck within a proprietary file system.

If your document becomes heavily laden with agents and aliases, document performance can become an issue.

Nevertheless I find having one large file is preferable over several smaller ones because more data can be computed.

It's worth getting the look of the document (particularly fonts) to your liking before heavily populating the file.
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Mark Anderson
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Re: Tinderbox in medicine
Reply #5 - Aug 13th, 2008, 2:16pm
 
Quote:
If your document becomes heavily laden with agents and aliases, document performance can become an issue.

That can be true, especially if you set up the code early in your use of Tinderbox. As you TBX's size and your TB experience grows, it pays to revisit some of your early automation ideas.  For instance, setting some agents at lower priorities - or even off - can help as can setting agent query scope so only pertinent notes (i.e. fewer) are tested by the query. forums like this and the wiki can help with figuring out the logic if it seems too complex.
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Alwin
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Re: Tinderbox in medicine
Reply #6 - Aug 13th, 2008, 11:45pm
 
No real clinical experience - I am a nurse with 25 years experience in ICU/Emergency Departments, but started my career in the state mental hospital system here in Oregon.  I had enough interest in informatics to pick up some coursework at the local medical school recently.

I would recommend Mark's "Notes About Notes" site. The subject matter can help you do a little planning in regards to what sort of details you want in your basic note. The page regarding Incremental Formalization should ease your mind about trying to "do it perfect the first time".


I had a hard time letting the automation functions in TB do the work for me, and resisted learning them for a long time. As you begin to accumulate large numbers of notes, though, you will want to start filtering some of your output in order to keep the important things in front of your eyes.

I think it's an excellent idea to keep a "memory jogger" of things that you want to remember about your patients from visit to visit. There are things that may not be appropriate for a medical document that you still want to be prompted about in subsequent visits. TB is a great place to jot fast notes that you want to be able to search through quickly.
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Fionnbar Lenihan
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Re: Tinderbox in medicine
Reply #7 - Aug 15th, 2008, 4:02pm
 
Late dropping by the forum and late to this particular thread ... Mark Anderson mentioned me earlier

I work as a forensic psychiatrist and use Tinderbox for helping with some of the cognitive heavy lifting when compiling risk assessment and other reports.

I find the ability to tag notes with arbitrary metadata and then use agents to herd these notes into different arrangements for different purposes very useful.

More recently I've been using it during supervision of my SHO and ST4 (residents for US readers).  Each supervision topic is a note, notes for each session are held together in a container.  Some notes are also tasks for either the trainee or me to do, these get marked as "action item" and an agent keeps track of tasks we need to do.

Will try to fancy it up a bit but it's pretty useful as is.

Would be interested in sharing tips with others in the trade

Fionnbar
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Mark Bernstein
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Re: Tinderbox in medicine
Reply #8 - Aug 16th, 2008, 4:24pm
 
While not a medical application, Jolyon Patten discusses a very interesting kind of problem that does crop up in medicine from time to time: reconstructing what actually has happened from the evidence of multiple sources, some of which are not reliable and some of which might actually be less than forthright.  He uses the Map View to form a layered time line to sort out who knew what, and when.

    http://www.rerisk.net/?p=204
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Xavier
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Re: Tinderbox in medicine
Reply #9 - Aug 19th, 2008, 3:27am
 
Quote:
Will try to fancy it up a bit but it's pretty useful as is.


On a larger screen or screens I set up both map and outline views, where long alphabetical lists may be linked to more easily.

I find the map view is best for more subjective matters, and the outline view makes sense where alphabetical listing ensures notes appear universally important.
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Mark Bernstein
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Re: Tinderbox in medicine at Tinderbox Weekend
Reply #10 - Aug 22nd, 2008, 2:36pm
 
We'll have at least one session -- maybe more -- on Tinderbox in Medicine at Tinderbox Weekend San Francisco, November 22-23.
http://www.eastgate.com/Tinderbox/TbxWeekend.html

We appreciate early registration a lot (and you save a lot of money too).
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Fionnbar Lenihan
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Re: Tinderbox in medicine
Reply #11 - Aug 25th, 2008, 5:23pm
 
Quote:
On a larger screen or screens I set up both map and outline views, where long alphabetical lists may be linked to more easily.


I keep looking at 24 inch iMacs and thinking how nice it would be to be able to work like that ...

Undecided
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Fionnbar Lenihan
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Re: Tinderbox in medicine
Reply #12 - Aug 25th, 2008, 5:23pm
 
I know, I know, size isn't everything ...

Smiley
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