dogmatism

given the entrenched attitudes and the time it takes to actually get people to do the thing as evidenced by all the contrarians in the thread...

it would take a lot more than that. Ain't no doc got all that time to go through all this with every person who should take cholesterol lowering medicine but wants to argue their internet sourced bs

I mean, how can you not like it?

It's hyperlegible!

you can get that both from Lenovo and Dell

>The requirements for the physics major were only a handful of math credits shy of the math major.

lol, that's how I ended up with a math major. Got lost in the physics (realized I had no intuition for what was actually happening, just manipulating equations) took a couple extra courses, and boom! Math!

It doesn't really work like that for the most part

If you actually need a really high risk surgery, you probably have a terrible prognosis without it

For instance, in the pivotal trial of transcatheter aortic valve replacement for aortic stenosis (TAVR) the people were deemed too high risk for surgery, so got nothing (well, medicine only which doesn't really change anything for this condition) or TAVR. The medicine arm had 50% mortality (1 year I think?) whereas the TAVR arm was "only" 30%!

Now that didn't mean all those 30% of deaths were due to the procedure or even the aortic stenosis. I think that ran 10% or so (going off memory here). They just had so many other problems. For comparison, TAVR is now done in low-risk people, and I think the 1 year mortality is <3%

The things that go into making someone "high risk" in the STS (cardiac surgery) risk score are for the most part pretty obvious. If your heart muscle is super weak (or you need a machine to keep going before surgery), you have kidney failure, prior strokes, combined heart problems, bad liver or lung disease, etc etc. You can calculate a score, but you probably can guess it from the door of the room

I think there's a story about him beating a white kid from a rival private school in a boxing match

certainly unreliable reports of him doing well in informal rooftop bouts amongst the various Wing Chun students in Hong Kong

there are also stories of him getting his ass kicked by William Chung and Wong Shun Leung (others of Yp Man's students) and being a petty little bitch and getting kicked out of Yp Man's school

Who knows. It's all apocrypha at this point

There's an old saying in Alabama:

Q: What does a divorce and a tornado have in common? A: Someone gonna lose them a trailer

The application does present some data: 41% sensitivity, 92% specificity, but that's not the basis of approval, nor has it been published in a peer reviewed journal (or even with proper details like a table 1 or detailed description of control BP measurement methods, or even what "FDA approved" home device and protocol was used for reference)

Even assuming the device performs exactly as described (difficult to say given the paucity of presented data) the performance characteristics are the opposite of what you want in a screening test.

The hypertension feature was approved based on the pathway as being similar to the already approved Viz.ai software to detect hypertrophic cardiomyopathy by ECG analysis

That's not really the same thing at all

1) No, machine learning perfoms better than typical "risk scores" such as the RCRI (it was not tested against doctors clinical judgement)

2) Even so...so what? What we don't have is any reliable way to reduce surgical complications when the benefit outweighs the risk when the risk is elevated

The bacterial contribution to MACE has been an ongoing subject of investigation for decades

https://www.nejm.org/doi/full/10.1056/NEJMoa043526

still hasn't really panned out

you're correct

there's a small subset of people with more atherogenic triglycerides that ApoB picks up over and above just tracking with the LDL, but...you probably knew that just looking at them

agree

here on the other coast, with cheap gas and expensive electric, Prius would be about 6 cents/mi, Bolt costs me about 8 (on average winter/summer)

gas is $2.80/gallon, electric (with off peak program) $0.30/kWh. Bolt (fairly efficient EV) 3.8 mi/kWh (3.4- Winter 4+ summer)

that was my point

a) average age is 77

b) drugs cost a shitload (hundereds of thousands/yr) to extend lifespan by...months

c) only for ATTR (not AL) amyloidosis

d) the drive to diagnose and treat only really started after tafamidis (1st drug with any effectiveness) was marketed...hmmm

e) the dude in the article used as an example was probably helped more by treating his afib than by the fancy drugs

for sure there are some genetically transmitted younger patient for whom this is important. But there are a lot of frail older people who are getting diagnosed with wild-type ATTR amyloid for...questionable benefit at massive cost. IMO, the jury is still out

it's not clear if he had ATTR or AL amyloid

nah

I maintain my emacs config

the problem is if someone changes something, that immediately impacts my efficiency which slows me down, then the patient's are pissed, and the administrators are too (which is ironic since they're the ones who signed off on the change)

It has to be rote, no time for exploring

I guess you're smarter than I am

I can't remember all the details to a sufficient level that I feel comfortable that I'm not forgetting something

and how do you know the current vitals and medication list? When the pt tells you they saw Dr X for Y (that you didn't know about) do you not want to look at that in case it impacts your plan? I guess you go out and come back? If you rx a med that needs lab monitoring, did you memorize that too? What about trends in labs?

IDK, I need info while I'm seeing the pt

Y'all have no idea

I'd elaborate but it wouldn't be good for my mental health

edit: I'll give one example: my org can't even implement single-sign-on even though it's essentially all MS

you must print out old notes and test then and carry them into the room like you're pretending it's still in the paper chart days

which is fine until something comes up that you didn't anticipate and print out. Then you can a) fake it, end the visit and follow up with pt later after you've looked it up or b) log in and get the info

How do you have the pt's current med list? Does staff print it out after they've roomed the pt?

Also, how are you ordering test/procedure? Writing it down for staff to do later? Violates most org's "CPOE" policies. Otherwise pt leaves and your staff has to call to schedule later, including labs that maybe they could do before they leave.

You must have re-created a paper chart workflow in an EHR era which is only possible if your staff/org enables this for you

Most of us are just employed widgets in the health care factory, and don't have the pull to get staff to work with this kind of workflow

Nah

Atkinson Hyperlegible from the Braille institute is the way if we're going for fonts from vision experts

This is true. In fact if you have a heart attack and are treated relatively quickly, with no major injury and decreased function of the heart muscle, and continue to have regular follow up care and address risk factors, your mortality risk normalizes to those without history of a heart attack (but with CAD) and should have no functional limitations

no, healthy young people have more heart attacks with acute covid. And die (or at least did in 2020-2021 time frame)

Long covid isn't really associated with increased heart attack rates

No, heart disease still #1 (it's closer, like 680K vs 600K deaths)

If someone told you you were "five years from a heart attack" they lied

that's not how it works

in a stable person (ie, not actually having a heart attack) stents help symptoms (a little better than medicines, but even that is debatable -- see Orbita trial). Medicines and lifestyle changes prevent heart attacks -- see Courage and Ischemia trials

cath labs are in fact about keeping you from dying once you have a heart attack. The other stents for stable disease like you had are nice -- you feel better faster with fewer medicines that without, but not main thing

source: not going to appeal to authority. See trials mentioned above, or ACC guidelines on management of CAD

Were you born before 1983? It seems that makes it easier

Have you looked at Guix?

wait what?

CHS lost millions of records, was fined a few million (out of profit of 1.2 billion) UCLA similar. Bunch of others I don't think even got fined like Ascension recently lost all data in a ransomware attack

It's useful going after a rogue employee, but on an org level it's security theater

They also should be specific to ask you to say it, not confirm what they say

Because I have literally seen this go wrong: “Mr John Smith, you’re here for procedure X, yes?” “Yes” Some other provider overhears: “I thought that was Mr Jones for procedure Y” “Are you Mr smith or Mr Jones?” “Mr Jones” “Then why did you say yes when I asked if you were Mr Smith” “I assumed you knew best”…

People do weird things in healthcare settings

doc first, old linux hacker second

Epic sucks. It only sucks marginally less than all the others. As a corp, they are expert at abusing mechanisms for lock-in as well as network effects

If you all were forced to use tools as shitty as the EHR's, no one would be a software engineer

A re-write of VistA would be the way to go, but someone paid off someone, and the VA is doing a disaster of a changeover to Oracle's Cerner

tl;dr Healthcare software is a steaming pile of shit