davycro

Agreed, it’s better for acute complaints instead of routine physical exams. If a patient with COPD or CHF comes into your primary care office with a little cough, then you could enhance your bedside workup with a quick cardiac and pulmonary ultrasound. You could see if they have pleural effusions, pulmonary edema, consolidations, and make an informal assessment of their ejection fraction. This info takes about two minutes to acquire, and helps you rule-out dangerous diagnosis.

Or even worse you put the microphone on the epigastric vessels and hear moms heartbeat instead of the babies.

Perspective from an emergency doctor. Many comments ask if non-medical persons would use ultrasound should it become affordable. I think not.

There aren’t enough common medical conditions that you would monitor with a personal ultrasound[1]. Also it’s a tough skill to learn without a solid background in anatomy. This would deter many.

Primary care doctors (eg family, internal, and emergency medicine) will benefit most from affordable ultrasound. We are learning that it’s a powerful diagnostic tool when used along side the physical exam. Some zealots have equated bedside ultrasound to be the biggest advancement to medicine since antibiotics. This notion I feel is exaggerated, but— it taps into the underlying excitement in the medical community for bedside ultrasound.

Here are some sample cases.

Patient came in with all the symptoms and findings of a stroke— altered mental status, inability to move their left arm. Before giving the treatment for a stroke, a potent blood thinner called tPA, the doctor decided to do an informal ultrasound of the patients heart. He found the patient had a massive dissection of their aorta. The patient wasn’t getting adequate blood flow to their arm or brain. Had the patient been given tPA they most likely would have died. A quick bedside ultrasound revealed a difficult diagnosis and saved the patients life.

Another case- a young female came in unresponsive and without a pulse. Her husband said she had complained of belly pain for the past several days but nothing else. While doing cpr we placed an ultrasound on her abdomen and saw a massive amount of blood in her belly. A pelvic binder was applied and we immediately started massive transfusion for presumed ruptured ectopic pregnancy. In this case the easy access to ultrasound gave us a diagnosis in under a minute.

Both of these cases occurred in the emergency department. Of all specialties I think emergency medicine has been quickest to adopt bedside ultrasound. Other fields however could benefit too. Ultrasound is underutilized in family medicine and internal medicine clinics. Making it affordable, say close in price to a stethoscope, should encourage its use in these specialties and lead to more discoveries of its use as a diagnostic aide.

1. patients with an abdominal aneurysm may wish to monitor its size with a personal ultrasound. This seems extreme.

Emergency doctor and hacker here. The closed systems and lack of support for interoperability between EHRs upsets me the most because it leads to patient harm.

I just had a patient transferred from an outside hospital for abdominal pain and somehow their CT scan was lost in transit. Because it was an emergency we had to CT scan them again which doubled their radiation exposure and their risk for a kidney injury from the iv contrast. It was midnight so it would have taken until business hours to obtain the scans from the hospital.

Things like this happen almost daily.

Agreed. I use Soylent as a replacement for cliff bars when I ski or climb. It's easier to get down and has more calories.

For medical training, Soylent has been wonderful. On emergency shifts I often won't have 10 or 20 minutes to go to the cafeteria for a meal as there are too many acute patients. I used to rely on energy bars to get me through but I much prefer Soylent. They are quicker to eat and I know that I am drinking a someone balanced meal. I usually drink about three in an eight hour shift.

You raise a great point about self reflection and Soylent. To stop cooking entirely is madness, and Soylent can enable antisocial tendencies or depression. They shouldn't brand themselves as a complete dietary replacement for food.

Not intrusive, thank you for the question. I'm a self-taught hacker/coder. Before medical school I made a Facebook application, when those were a thing, called Quiz Monster, which had about 3 million DAU for a few years. Thankfully earned enough through ad revenue to pay for my medical education. I see myself as a clinician first, but will always be a hacker and plan to return to software after residency.

I have. Figure1 feels too noisey and not specific to my interests. Twitter is more personal with better quality.

@EMcardiac (Badass south african doc) @EMNerd_ (Great research commentaries) @M_Lin (Program director at UCSF, posts lots of clinical pearls)

My favorites though are docs I know from away rotations and the wards. They aren't famous, but their opinions especially matter to me.

Also follow @medicalaxioms

"Twitter's modern-day utility seems very low outside of news/sports/politics"

Twitter has tremendous utility for the medical community. I am final year medical student and through twitter can follow worldwide leaders in emergency medicine (my field of interest). These doctors post clinical factoids, cases reports, unique ekgs, and other learning points live from the wards (all de-identified to protect patients of course). They also post opinions on the latest research publications. Twitter has become my best way to stay current in medicine.

Other apps targeted for doctors have attempted this. Doximity and Figure1 are examples. But twitter has done the best job.

Cortisol levels fluctuate with diet and time of day. I don't think I could draw conclusions from the change in cortisol levels and testosterone levels.

Strange. It's an outlier on the map, and contradicts the author's main point. Yet there's no mention of Colorado in the article.

Make a great product. Know your audience. If they try it and don't use it then the product is bad. You don't have a marketing problem. You have a product problem.

It's still possible, and relatively easy, to discover new ruins in the southwest. Especially around Cedar Mesa.

The biggest challenge to these box stores is that they lack any sort of natural light inside them. Even the fancy library in the article lacked windows, which in my opinion adds more to the comfort of a workspace than designer furniture. I wonder what strategies architects could come up with to open these giant dark boxes.

Studies show that surgeons who play first person shooter video games are faster and better with laproscopic and robotic procedures. Does that not count as brain training?

I'm not being snarky. I saw several patients with LVADs on my cardiology rotation in medical school. As far as I know they are the only patients exempt from CPR if they have a cardiac arrest, although device failure should be the only reason for this.

How do you perform CPR on a person with an LVAD? Plug the device in.

This is such a bad idea.

Lithium has horrible side effects. It's mechanism is to dampen transmission throughout your entire nervous system. We don't know how it works exactly but we think it occupies some of the bandwidth through sodium ion transport channels (Li and Na are similar ions).

Anyway. We don't want an entire population on this.

I love this, well said

I knew a bipolar patient who believed he was a shaman. In his last manic episode he was found wandering outside naked in minus twenty temperatures. He said he had transcended to a higher consciousness where the cold no longer affected him.

I interviewed him a few months later to see if he was taking his medicine. He was, but said he didn't like the medicines because they took away his special powers.

He had frost bite on his hands and feet from the incident by the way.

A courageous story. I felt the author captured the pace and psychotic features of a manic episode. Call me a terrible person, but I chuckled when I read about the "Dynamo algorithm to replicate life". I can imagine the author wandering around the hospital with the whitepaper in hand demanding that doctors read it.

A 51 year old man came into the hospital yesterday with chest pain. He was having a major heart attack. I watched the cardiologist catheterize and stent his coronaries. i saw the moment that the stent opened the coronary artery. I saw the blood flow restored to the left heart. The patient was 51, and that doctor, with the flick of his wrist, added decades to the mans life. That doctor does this everyday.

Zynga has strong lawyers. They would force small devs to take them to court, if they could afford the legal fees, then settle if they had a strong case. By then Zynga's game went viral and the smaller devs lost their first mover advantage. The SF chronicle wrote a great piece about these tactics a few years ago. The article showed how they cloned FarmVille, then settled with the victim for 11 million (FarmVille would make a billion in rev that year). im on mobile and can't search for the article rn

> The early moves of Pincus were very impressive

His early moves were deplorable. He cloned-- pixel by pixel-- emerging games built by small developers, then seeded them with traffic from other Zynga games.

I'd like to see these graphs for every hn story

Same. I learned from library books w/o Internet.

Could be worse. The pandemic will start if Ebola spreads to a low-resource country with a large urban population. Worst case, in my opinion, would be an Ebola case diagnosed in Johannesburg.

I work in a family practice every other week as a requirement for medical school. I've noticed that EMRs are very disruptive to a doctors bedside manner. For every visit the doctor types notes into a laptop while the patient speaks to her. Communication is inhibited and the doctor struggles to maintain rapport with her patient.

I would love to see the patients EMR displayed on a screen so the patient could see what the doctor typed as he spoke. This would make the process collaborative instead of one sided. It would also be a great feedback mechanism where the patient could double check that his doctor understood what he just said.

Mr Draper states that Bitcoin is badly needed in resource-poor countries with unstable currencies. How does he expect Bitcoin to compete with mobile currencies such as M-Pesa?

Thinking about it, I imagine that the advantage of Bitcoin is that it can be sent globally, whereas M-Pesa type currencies are restricted to specific countries.

I followed the Starting Strength regime for about 7 months and had great results where I added about 15 lbs of muscle to my frame. Its a fantastic method for building a foundation of strength and muscle. My biggest complaint during the process was that it was difficult to track my progress. To my surprise none of the iPhone applications out there were very good for tracking lifts and I ended up tracking with the Notes application. Recently, I stumbled upon the StrongLifts app, which is tailored for a different lifting regime, but one that is somewhat similar to Starting Strength. StrongLifts is executed perfectly, in my opinion. If I wasn't in school, I'd try and build a StrongLifts clone retooled for Starting Strength. I think there would be a huge market for that app.

I would like to see an iPhone application that tracks your progress in the Starting Strength routine. The app StrongLifts would be a great starting place. StrongLifts has a fitness regime that is similar to Starting Strength, and is executed beautifully. I love the idea of combining a fitness program with a smartphone application.