http://www.springerlink.com/content/l82373354314746j/

Accuracy of Cardiac Auscultation in Asymptomatic Neonates with Heart Murmurs: Comparison Between Pediatric Trainees and Neonatologists

The overall ability of pediatric trainees in identifying congenital heart disease (CHD) was moderate [area under the curve (AUC) = 0.855] and significantly lower compared to neonatologists (AUC = 0.919, p = 0.007). However, at “lower” levels of clinical confidence (i.e., clinical diagnosis of possibly pathologic murmurs), pediatric trainees had good ability in excluding CHD (sensitivity 94.6%; negative likelihood ratio = 0.09). The ability of cardiac auscultation for diagnosing CHD in asymptomatic neonates is limited and dependent on the physician’s experience and level of clinical confidence. Echocardiography should remain an option for all neonates with a possibly pathologic murmur.
Bottom Line: If you are in a place where echocardiogram is not readily read by the pediatric cardiologist, then you may record it with Littman's stethoscope (Digital) and email it. Studies have shown that one can reduce the echiocardiograms being done to rule out a pathjological murmur.

How should an ideal spouse be in this digital world?

This analysis is based on real life observations. On the Valentine’s Day, I followed the tradition of buying flowers for my spouse. The flower’s tradition was followed by traditional I love you expression. She was ecstatic and very much appreciated what I did. Her feelings were genuine. It wasn’t long ago, that I had an argument with her about not replacing my pen, after she was done with it. Though the issue was trivial, it ticked me off. I rebuked her, but, she explained that as she was busy making dosas (Indian Pan cakes) and hence she could not get to it. I realized that she was trying to write a new recipe, when the dosa needed immediate attention. I was still piqued that I could not find my pen in time, discounting any credit that she rightfully deserved for trying to make the family happy with new dishes and giving us a break from the monotony. But, I wanted her to be perfect!

It was then my friend rang the bell and I gave a break to my sour feelings. He was craving to see my new HP Slate 500, my pride new possession. My mood changed swiftly from sour feelings to soaring spirits. I began to demonstrate with exhilarated eagerness all the hardware options it came with (USB port, two cameras, SD card slot etc.) unlike the Ipad. He was fired up by now and I could see the verve and sprightliness in his face. He earnestly asked if it has any apps! I smiled and showed with renewed vigor the Intel’s appup center and some free apps especially for tablet pcs. I double clicked on the Unit Converter app. It was a bit slow to open up. Alas! It took no time to shake his head and deliver his spirit smothering verdict-It is Windows! He completely discredited all the alluring attributes; it possessed but was irked by one app, which was sluggish! Before, I could react to his irrational judgment; I was paged to attend a cesarean delivery. I was baffled by his attitude. He out and out disparaged its worthy attributes and swayed in to negativity by one small inconsequential application.

After, I was done with the C-section, the resident was earnestly waiting to show me his new Iphone4. He was revved up and showed many of the features, which I was already familiar with. He further wanted to impress me with CNN app. Alas! It did not open despite multiple taps. He immediately switched to show me the text to speech option. The moment it initialized, it began speaking after every tap he made on the Iphone. “safari”, “address bar” www.google.com “oil companies”. It opened up the page, he wanted to scroll down and tapped on the bottom of the page-“screw your” it spoke as they were the last words on the screen and he was touching that part of the screen to scroll. There was no scrolling, but it again announced unabashed “screw your”. He was unperturbed and tried again, “screw your” spoke repeatedly to turn other people’s faces in dismay. Another Iphone owner came to his rescue and suggested that he should use 3 fingers to scroll, when text to speech was app was active. Finally, we all heaved a sigh of relief.

But, I was shocked, as he continued-“look at this operating system, why will I ever go for any other smartphone, when this is so outstanding!” I was bewildered by the opposing attitudes of Microsoft and Apple fans. One was focused on the negative trait, however petty it was, and the other on the positive attributes solely. It then dawned upon me that my own behavior was not much different from my friend who was disappointed by one dopey app, since all he wanted was a perfect operating system, which probably does not exist. I was also so focused on petty inconsequential aspect of my wife that for a moment, I completely ignored the larger positive side of my spouse. My reaction to my friend’s judgment is in many ways akin to how our spouses feel about us when we express our intolerance to their short comings, ignoring everything they do for us.

What, if we adopt the attitude of this Apple fan in real life, which was so focused upon what the Iphone did for him on the whole, ignoring the aberrations? We will probably remain happy and take care of our spouses giving them their due appreciation and regard. Though this won’t sway me to become an Apple fan will make me a fan of an Apple fan!