Cabbage Palm

Epocrates has put up an interesting Case Study which demonstrates how their suite may be useful in a real-life patient scenario.
Its a nice little Demo - Flash required. View it - if you want to know what Cabbage Palm really is. (Hint: it has nothing to do with PDAs!)

Speaking of Epocrates, I'm even more convinced they have to get their act together and come out with a long overdue version which supports SD cards. I have had to temporarily ditch Epocrates as I can't fit it into the paltry Treo 650's Ram. I am sure other Treo users will much welcome Epocrates with full SD card support!

Family Practitioners are Embracing Mobile Medical Reference Solutions

Are they? I always though hospital based docs would be the first to happily embrace mobile referencing - something very useful when you are rounding or seeing consults.
Skyscape reports though that Fmaily Practitioners are also quickly turining to mobile references. Press release:

SAN FRANCISCO – Sept. 28, 2005 – Family Practitioners are enthusiastically embracing the use of mobile medical reference solutions and cite the timeliness of information and help in reducing medical errors among the greatest benefits, according to Skyscape, Inc., the leading provider of interactive mobile references for over 475,000 medical professionals. “Already well aware of the personal productivity advantages of PDAs, a rapidly increasing number of family practitioners are employing their mobile devices as digital medical reference tools,” said Sandeep Shah, president and CEO of Skyscape. The value of digital medical reference solutions among family practitioners is clear, Shah said. Physicians cite the timeliness of information and ability to instantly cross-index information between titles as the top two reasons for adopting the technology. Additional benefits include the accuracy and safety of referencing information from trusted sources, improving the quality of patient treatment at the point of care, and enhancements in personal productivity and efficiency. Skyscape continuously updates its 300+ mobile medical reference titles on Palm, Pocket PC PDAS and smartphones, providing a timely resource that print publications cannot match, he noted. In addition, Skyscape's patented smARTlink™ technology enables readers to easily cross-index with its other clinical and drug prescription products. Combined, the technologies deliver a powerful and integrated source of mobile information for family practitioners, Shah said. At Skyscape, the most popular downloaded titles by family practitioners include The Washington Manual of Medical Therapeutics, 31st Ed; Harrison's Manual of Medicine, 16th Ed.; Outlines in Clinical Medicine, and the PIER Evidence-Based database from the American College of Physicians. “Each physician typically has his or her own favorite texts – representing the ‘go to’ resources for the bulk of their daily reference needs. Today the print versions of those favorites largely remain in the office, as family practitioners load those same titles – in digital format – onto their PDAs to serve as up-to-date, anytime, anywhere mobile reference sources,” Shah said. "I find that many family practitioners are using mobile devices, today. I personally use my PDA on a daily basis and the Skyscape references have become central to my mobile medical library,” says Dr. Alvin B. Lin, MD, FAAFP. “The ability to look up every important detail in trusted references like Harrison’s and the PIER Evidence-Based database from the American College of Physicians is such a tremendous asset when it comes to providing quality care to my patients.” For more information, visit Skyscape in booth #3943 at the American Academy of Family Physician’s 2005 Scientific Assembly in San Francisco, Sept. 28 – Oct. 2, 2005. Skyscape is on the Net at http://www.skyscape.com.

Clinical Pulmonology

Pacific Primary Care have released the 2006 version of Clinical Pulmonology in Palmgear.

Application Description: Topics include: asthma, COPD, pneumonia, pneumonitis, lung cancer, sleep apnea, chronic cough, effusions, pleurisy, sarcoidosis, interstitial lung disease, pulmonary hypertension, hemoptysis, lung nodules, dyspnea, vocal cord dysfunction, atelectasis, PFT's, chest X-ray.....

As one of their customers, I can testify that their iSilo compatible references are great. Simple and concise - handy references when you need them.

Free Emergency Responder Resource for PDAs

Got this Press Release:

MARLBOROUGH, Mass. – Sept. 26, 2005 – Skyscape Inc. has updated its free “.911” emergency responder resource for Palm OS and Pocket PC devices with new recommendations from the Centers for Disease Control (CDC) based on Hurricane Katrina experiences. Designed as a concise and user-friendly resource for PDA and smartphone use by first responders, medical professionals, and the general public, “.911” is free and available for download from Skyscape at: http://www.skyscape.com/hurricanes. The new CDC recommendations include both preparations to undertake when facing an approaching hurricane as well as recovery efforts and healthcare issues to address following a storm. Hurricane recovery topics include: * Preventing illness * Preventing injury * Keeping food & water safe * Clean up safety * Animal and insect hazards * Environmental concerns * Disaster mental health * CDC Katrina update Diagnosis, treatment, and vaccine information for infectious diseases that might threaten communities following a hurricane strike, is also included. In addition to the CDC, sources include The Medical Letter, and Outlines in Clinical Medicine/Medical Emergencies. “.911” content is automatically updated via Skyscape's patented smARTlink™ technology. smARTlink also enables users to cross-index information with other Skyscape clinical and drug prescription solutions.

Related post: PDA helps in hurricane relief work

I got a Treo650!

Well I have taken the Convergence route. Then again high time too since looking at what I usually carry (thank goodness for Dockers Mobile pants) you could say I was well and truly into Divergence, since I usually have 2 cell phones and 2 PDAs on me!
Anyway, my 2 cell phones (both Sony Ericssons, a t610 and a t68i) were giving a little trouble so instead of getting new phones, I managed to grab a used Treo 650 off Ebay. It's about 6 months old and in pristine condition. A new unlocked GSM Treo650 here would cost about US$636. I paid US$410 for mine.
Another reason I got the Treo 650 was the news that the next Treo is going to be a Windows Mobile powered device. That's not for me. So I will hold out till the rumoured Cobalt powered Palm Treo is released, and wait till the bugs are ironed out.
I'll post my Treo650 experiences in this thread in the MMR forums. I am struggling a bit with trying to optimise putting stuff into the paltry 23MB Ram. If you are an experienced Treo 650 Medical Palm user, I would love to hear from you.

First Aid Clinical Clerkship Series

Help is on the way for Medical Students and House officers. USBMIS has announced that PDA Applications are now available for The First Aid Clinical Clerkship Series in Medicine, Emergency Medicine, Pediatrics, Psychiatry, Surgery, and OB/GYN

Our applications contain all of the same trusted information as the text versions, plus many more exciting features: * Special Flash Card feature allows user to create high-yield study tools * Separate tabbed sections for High-Yield Exam Tips and Ward Tips * Create/Share Notes to customize patient information on any PDA * Dynamic hierarchy for rapid navigation of the contents * “Jump-To” combo box allows quick look-ups for epidemiology, etiology, signs & symptoms, diagnosis, and treatment * Calculators allow quick computation of medical formulas * Bookmarks enable frequently-accessed material to be found quickly

Geriatrics At Your Fingertips

The 2005th edition of the Geriatrics At Your Fingertips has been released.
The good news is that the PDA version (Palm and PPC) remains free (supported by a grant from The John A. Hartford Foundation).
This new PDA version offers several new, interactive features that enhance the guide's utility.
These include:
* a bookmark feature that allows you to quickly locate the references you use most frequently
* a "Jump To" navigation button that lets you quickly view all the subheadings under a particular topic and go directly to the specific information you're seeking
* more than 20 new working calculators and equations
* a new "Help" button that provides a guide to using the PDA version, and contact information for technical support
* a table that allows you to use inductive reasoning to find the answers to queries

What are you waiting for? Go grab it now!

Dataviz does native PDF too

Good news. Palminfocenter reports that Dataviz, the makers of Documents-To-Go, the Office Suite which comes bundled with your Palm Tungstens and Treos, will be demo-ing native PDF support (albeit in the Premium version of their Office suite)
Currently, we can get a Native PDF reader but have to use hacked software not designed originally for the Palm Tungsten or Treo. Actually, I don't see why Adobe can't get off their butts and improve their free Adobe reader for PalmOS and make it capable of reading native PDF files too. Just like their Pocket PC version.

Another reason to get a Palm

Brian of MedPDA.net has an amusing excuse for medical students to get Palm PDAs - so that they can impress on a first date!

Ok, so here's a med-student secret, if you want to impress a date, use your ANATOMY skills. Now, it may or may not impress them if you can rattle off the branches brachial plexus, or tell them the branches of the pudendals, but if you have a picture to back up what you're saying, now you're REALLY going to impress them. So if you're looking to impress on-the-fly, or just brush on your anatomy, this product is the one for you. Icon, the publisher of the famed Dr. Netter's works have released an interactive human anatomy reference tool for anyone and everyone from students to dateless lovebirds.

Who would have thought. Netters on your Palm to impress your date. Branches of the pudendal nerve... hmm.. that will really stir up interest.
LOL

Agendus 10

Iambic has released Agendus 10 which is a major upgrade over the previous version.
If like me, you rely heavily on your Palm to manage patient appointments, schedules and tasks, Agendus is a must. In fact I keep my patient details in a separate Contact category and rely on this to log activity into the Contact notes field, schedule new appointments etc. One feature I really missed from Supernames is the ability to link Contacts and now Agendus 10 has added this super feature. This is only one of the tons of other New features in Agendus. This is one worthy upgrade!

Palm Addict 2005 Reader Award Nominations

< shameless plug >
PalmAddicts are currently holding a 2005 Reader Award Nominations. What you need to do now is to head over to the polling booth and don't forget to cast a vote for the Palmdoc Chronicles
< / shameless plug >

MiniRX 3.0

MiniRX 3.0 looks like an interesting application if you are concerned about tracking your medication and prescription refills.

Application Description: # Records user names, medication names, Rx#s, refills, costs, refill and alarm dates, quantities, dose, doctors, pharmacies, generics, and notes. Includes two free utilities. # Multi-user so you can store your information as well as anyone elses. # Links with your address book to find pharmacy or doctor phone numbers. # The first allows you to transfer data to/from your PC. # The second lets you print/view reports from your PC or export a report to HTML.

At $9.99 I think it's worth checking out.

LabNotes

Skyscape has released LabNotes: Guide to Lab & Diagnostic Tests in Palmgear

A Davis's Notes book, LabNotes provides students, nurses, and other health professionals with a quick and portable reference tool for competently explaining, preparing, and caring for patients before, during, and after common lab and diagnostic testing. Concise information explains lab reference ranges and considerations, diagnostic test purposes and procedures, pre-test preparation, and post-test care.

No, that's not the perfect PDA

A Windows powered Treo as the perfect PDA? Good grief.
No, I hope Bruce McKenzie comes to his senses and realises that "Mac friendly" and Windows Mobile don't go together. My experience with PPC 2003 on a 600MHz Dell Axim x50v is that it is a SLOW, INEFFICIENT OS. I still rely on my trusty Tungsten T3 for my day to day PIM apps. Sure, Versamail does not support Gmail but there are others which do e.g. Snappermail.
My perfect PDA? Perhaps the rumoured Cobalt powered Treo

Free cardiopulmonary apps

Spotted in Freewarepalm :-

Puff v2.5

Description: Puff - This application allows users to quickly calculate predicted values for spirometry, flow-volume and body plethysmography using the patient's age, height and gender.

O2 Tank v2.5

Description: O2 Tank - An application that allows users to calculate the amount of time a specific cylinder of oxygen will last, given the tank pressure, cylinder size and the rate of flow.

ABG Decoder v3.5

Description: ABG Decoder - An analysis engine that allows users to interpret blood gas values.

Top Flow v1.5

Description: Top Flow - This application enables a perfusionist to quickly calculate cardiac outputs for a range of cardiac indexes using the patient's height and weight

The author, Metaworks, has updated all the above to be PalmOS 5 compatible

New Palm Models!

Palminfocenter has kicked off the official rumour season as October approaches. The rumour mill is grinding and there's a hint of a couple of new models next month - see the PIC article: Upcoming Palm Tungsten T X and Zire 22
The Palm Tungsten X would be what the T5 should have been in the first place, especially if it indeed has a 320x480 pixel display, 128MB of non-volatile memory, 802.11b WiFi, Bluetooth 1.2, digital camera and a voice recorder! If it has the usual useful software bundle like Docs2Go, then it'll be a solid bundle that I will look forward to as a T3 replacement.

PDA helps in hurricane relief work

There have been numerous physician accounts of their experiences with Hurricane Katrina including the widely circulated email by Greg Henderson and the account by Max Brito. Joseph Pulvirenti, M.D.writes of his in Marooned at the Ritz

Back in the clinic, we developed a medical record form documenting our patients. We only had a blood pressure cuff and flashlights, but we were later able to fashion a rudimentary stethoscope (Marcy from Galveston did this) using a semi-stethoscope from a blood pressure cuff attached to a small plastic dosing cup with a hole cut in the bottom for the tubing to be threaded through. The most common issues in the beginning were medication refills; many of the guests had chronic medical conditions and had brought only limited supplies of medications. We refilled as many meds as we could and substituted when we had to. Luckily my PDA had Epocrates, which was very helpful. We also saw panic attacks and sinus and asthma complaints. These conditions were worsened by the heat and humidity and stench of a hotel without airconditioning sitting in three feet of sewer water with backed-up toilets with 90-100 degree temperatures outside. In parts of the hotel the temperatures and humidity were far higher.

We can only marvel at the heroics of the healthcare providers and their ingenuity when faced with adversity with scarce resources. At least Dr. Pulvirenti had his Palm and Epocrates to help him. Last year when the Tsunami struck Asia, a colleague of mine, "Orenjus", volunteered to help and went to Sri Lanka, I did remind him to take his Palm along with him.
You never know when disaster will strike. Moral of the story? Don't leave home without your PDA!

ActiveECG™ bundle for the Treo 650

It's an interesting week for medical PDA users who make use of ECGs.
Apart from the new Skyscape release ECG Notes, you might be interested to know that you could use your Treo650 as a portable ECG monitoring device! Imagine if you are a truly mobile Physician and you want to be able to ascertain your patient's heart rhythm, there is a product called ActiveECG, a unique hardware/software add-on, which allows you to do this. The makers of ActiveECG now announce Treo650 support as well.

Active Corporation Announces an ActiveECG™ bundle for the palmOne® Treo 650 CASTINE, Maine – September 13, 2005 – Active Corporation, Inc., producer of portable medical devices used “when life is on the line™,” today announced a product bundle specifically for the palmOne Treo 650. ActiveECG is an inexpensive, handheld, professional cardiac monitor which can be used with palmOne handheld computers. The ActiveECG for Treo 650 bundle will include the ActiveECG cardiac monitor and accessories, and a Treo 650 compatible serial cable produced by PN Technologies (www.pcables.com), a $65 value at no additional charge. ActiveECG was first introduced in 2001 for Palm OS® handheld computers and has seen success in many applications including home health care, emergency medicine, and veterinary medicine. It was the first Palm OS based device to receive FDA 510(k) clearance for diagnostic use. ActiveECG provides real-time display of ECG data and recording of ECG “strips” on a Palm OS handheld. ECG strips can be stored, reviewed and printed on any compatible PC, or transmitted to other computers or handhelds. This capability allows quick and easy remote diagnosis. “The popularity of Palm’s Treo 650 has soared,” stated Jeffrey Siegel, President of Active Corporation. “We wanted to make it simple for Treo 650 users to obtain all the components they need to turn their handheld device into a diagnostic quality, portable cardiac monitor. With this product bundle, they can purchase everything they need in one place.” Active Corporation is also announcing today the immediate availability of ActiveECG for Treo 650 via its eCommerce site http://www.activecenter.com. Orders may also be placed via phone at (207) 326-9100. ActiveECG for Treo 650 has a price of $699 and includes the ActiveECG hardware, a Treo 650 compatible serial cable, software for the Treo 650 and companion software for the PC, ECG leadwires, battery, test cable, extra cover, one set of ECG electrodes and is covered by a one-year warranty. More information on Active Corporation and ActiveECG is available at http://www.activecenter.com. Press Contacts: Active Corporation (207) 326-9100

Skyscape does VGA

Got this email from Spinosum which should interest Pocket PC users:
"Thought this might interest you! I just came across (after downloading and installing the trial version) the ECG Notes: Interpretation and Management from Skyscape (just released on 1/9/05) is in fact full VGA display!! Really superb for the first time viewing this skyscape software on my Dell x50v! The words and diagrams are so crisp and sharp!! In fact now i look back at the other softwares i purchased (eg 5MCC 2005) i just awful!! ;(

Anyway, hope skyscape will continue this good effort! "

Thanks for the tip, Spinosum. No I wasn't aware. And no, I haven't gone over completely to the "dark side" as I use the Dell Axim only for select applications (Skype VOIP and UpToDate Pocket PC in particular). Most of the time I still use my trusty Palm Tungsten T3!

A couple of Pharma updates

JavaPK for PalmOS PDA has been updated in Palmgear

JavaPK (JPK) is a clinical pharmacokinetic program (or therapeutic drug monitoring, TDM) designed to run on a PalmOS-based PDA and a Java-supported cellular phone. The program contains individualized pharmacokinetic parameters estimation for digoxin, aminoglysocides (gentamicin, tobramycin & amikacin), vancomycin, phenytoin and cyclosporin-A using both Sawchuk-Zaske method and Bayesian method. With Bayesian estimation, one can use any single-blood sample (at steady-state) to estimate individual pharmacokinetic parameters. For more information: http://ce.kmu.edu.tw/JavaPK.htm.

OnTimeRx® 2.5 has also been updated in Palmgear

Award-winning OnTimeRx® is a valuable healthcare tool developed by a pharmacist. *For people or for pets*, it works equally well on Treo 600s or basic Palm PDAs. Features pill reminder alarms for each drug dose and displays remaining Days Supply on each alarm screen. Schedule all To Do events, doctor appointments, and other healthcare activities in On Time Rx. With editable dropdowns and help TIPS throughout, OnTimeRx® is easy to customize for specific patient needs. It can also be localized for many other languages with International symbols.

Diagnostic aids

Dov of PalmAddicts talks about Putting a Doctor in Your Pocket, and specifically Diagnosaurus, a free differential diagnosis tool by McGraw-Hill. It's not bad and priced very nicely too.
I was reminded to see how Diagnosis Pro is faring in the PDA scene. Their web page still states "A Palm version is currently in development". It's been in development for like 2 years now since I last contacted them. Hopefully the wait will be over soon!!

Native PDF reader update

Earlier I blogged about Pics_el Browser hacked by enthusiasts and working as a native PDF reader for the Palm.
There were problems with the earlier attempts as launching the program gives rise to a "Document Error" message as it is trying to open a missing help file, if you try to change the program settings the Palm crashed and the menus were in Japanese/Chinese.
Browsing thru the usual Palm forums, I learnt that a newer version has been hacked together which has corrected these problems.

You can now change the settings and the menu is in English (item circled in red)


The "Document Error" on startup is due to a missing help file but no problems, as now with the Settings, you can just start up with a blank page or previously opened file and the error is gone.


Pics_el Browser has not been officially released (it was only previously bundled with some PDAs/Smartphones) but I think they should not just look for PalmOS licensees since the earlier notable licensees are no more in the PalmOS business. They should instead look to market this to the PalmOS user community and I think there will be tons of people most happy to purchase it. Many medical Palm users would certainly be amongst their customers since journal articles are commonly read in PDF format. Right now, it is only restricted to the Palm enthusiasts who have to resort to this hacking and quite intricate installation method (not the usual easy Hotsync installation) - definitely not for the ordinary Palm PDA user who is normally not into such experimenting with their PDAs.

Rumours of the next Treo

This thread in Treocentral has got me all excited again about a possible new Treo - perhaps to be released by the end of the year.
Rumoured specs according to one post in that long thread:
* Palm OS Cobalt 6.1
* 64 MB Ram (NVFS)
* 1xEvDo radio
* Bluetooth 1.2 Stack (with A2DP profile enabled?)
* reset button on outside left
* Headphone jack on top
* No PTT
* No wifi
* Sprint Nextel version?

The OS version doesn't bother me so much but if it were the new Cobalt, I might hold back a little to see what bugs appear. 64MB is what I'm looking for as medical spps like Epocrates and some others like Avantgo really eat Ram.
I have over 5000 contacts now and on my T5 and it's NVFS Ram similar to the Treo's, the database really bloats so 64MB would be welcome as well.
BT 1.2 would be really interesting too. One of the cool things I notice about the Dell Axim x50v is I can stay connected with my BT phone via GPRS and still send an SMS out to the same phone.
No wifi? Not that important but at least get those Wifi drivers written, Palm!
I said it before and I'll say it again - Palm must come out with a model without that silly external antenna - it just otherwise won't sell as well as it could in Asia and Europe. People will superficially compare with other smartphones like the smaller O2XDA Mini which looks more compact and sleek.

Some PPC apps

Occasionally I dip over to see some software from the "dark side" and I spotted a couple which might or might not interest you.
Hangovers Remedy - Acupressure Guide 3.0is completely free. It's also devoid of any RCTs to backup its effectiveness but that's another matter ;) The blurb says "Acupressure is an effective way to relieve painful sensation associated with hangover. The full version is free."
International Travel and Health 1.0 costs $19.99. Before you part with your money, you might be interested to know that you can also pop over to the WHO website and there you can download the PDFs for free! You could use the PPC's free Adobe reader to read the PDFs.

Statistics for doctors

Spotted in freewarepalm.com: Stati v6.2

Description: Statistic Calculator (scatterplot, histogram, individual chart...).

Coincidentally, Doc Tamil just emailed me a bunch of links to Basic Statistics For Doctors, from the Singapore Medical Journal (all PDF format). So this app might come in handy for students of statistics!
The list of articles:
101: Data Presentation (June 2003)
102: Quantitative Data - Parametric & Non-Parametric Tests (August 2003)
103: Qualitative Data - Tests of Independence (October 2003)
104: Correlational Analysis (Decemeber 2003)
201: Linear Regression Analysis (February 2004)
202: Logistic Regression Analysis (April 2004)
203: Survival Analysis (June 2004)
301: Repeated Measurement Analysis (GLM) (August 2004)
301A: Repeated Measurement Analysis - mixed models (GLM) (October 2004)
302: Principal Component & Factor Analysis (December 2004)
303: Discriminant Analysis (February 2005)
304: Cluster Analysis (April 2005)
305: Multinomial Logistic Regression (June 2005)
306: Log-linear models - Poisson Regression (August 2005)
Randomised Control Trials (RCTs) - Essentials (Feb 2003)
Randomised Control Trials (RCTs) - Sample Size: The Magic Number? (April 2003)
Evidence-based medicine and healthcare: advancing the practice(Sept 2004) - Editorial
What is this thing called EBM?(Sept 2004)
Finding the evidence: resources and skills for locating information on clinical effectiveness (Dec 2004)
How to read a paper: critical appraisal of studies for application in healthcare (March 2005)
Systematic reviews and meta-analysis (June 2005)
Critically appraised topics and evidence-based medicine journals (Sept 2005)

Email me if you are interested and I'll send you the download links to the articles.

Davis's Drug Guide for Physicians

Medical Wizards Corporation has released Davis's Drug Guide for Physicians in Palmgear

Davis's Drug Guide for Physicians with Integrated Calculators, based on Davis's Drug Guide (FA Davis Co) is a remarkable advance in drug reference. DDGPIC contains the entire content of the Davis s Drug Guide (9th Edition) - and has integrated calculation tools with all weight based medications. This product merges many of the advantages of weight based drug dosing calculation with a comprehensive drug reference. The user should review the integrated critical care infusion calculators for items such as dopamine, nitroglycerin, amiodarone, and over 30 other common critical care medications. The flashing red calculator icon alerts the user when looking up a drug that a calculator is available. DDGPIC includes over 5000 trade and generic drugs, nearly 140 drug classifications, over 1000 drug monographs and 700 commonly used combination drugs.

Anesthesia Clinical Tutor and Calculator

Are you a "gasshead"? I was surfing around and stumbled upon the Anesthesia Clinical Tutor and Calculator - free download and it seems chock-a-block with great features:

Description: It is designed to teach and simplify the everyday calculations that are involved in our Anesthesia Practice By inputting simple variables, such as Patient type, weight, NPO status, evaporative constants, and certain blood values it produces patient specific information to include: •Fluid Requirements, Hourly, Evaporative, NPO (HTN and Non HTN) with an hourly total guide •Pediatric Drug dosages (recommended and weight based). Default categories include – Induction, Sedatives, Analgesics, Paralytics, Antiemetics, and PALS. Adult database is to be added with the next Version- see below for future additions •Allowable Blood Loss (user defined starting and ending points) •Estimated Blood Volume •Current HCT with ongoing Blood Loss •Transfusion Guide with Required Whole Blood and PRBC ( provided in CCs and Units required) •Coagulapathic guidance ( Wt Based FFP calculations, Unit Number and Weight based Platelet transfusion guide, Cryoprecipitate Information) •Emergency Drip information providing weight based dosages along with a Drip Calculator •Malignant Hyperthermia Emergent and Non Emergent Information and Dose guides (both in mg, CCs, and Vials required). Reproduced with permission from the Malignant Hyperthermia Association.