pragone

Sorry, I may not have been clear.

The point I was trying to make is that PVCs and afib are not mutually exclusive - they're just not related entities. The parent brought up sinus rhythm, and I wanted to make sure everyone was on the same page regarding the fact that PVCs and afib are very different things that can seem similar if the only data point you look at is regularity of the rhythm.

So it's worthwhile to make sure we all understand that we're talking about two different things: atrial fibrillation and sinus rhythm are two options in the same bucket: rhythm. You can have PVCs with afib, you can have PVCs with sinus rhythm. You can't simultaneously be in afib and sinus rhythm.

I'm guessing Apple is just looking at rhythm - it would be the most reliable datapoint, as opposed to trying to measure QRS duration or analyzing for presence of P-waves, both of which differ depending on which lead you're looking at. The lead being looked at depends on which two points on the body are used to produce the tracing as well, which is not something Apple can guarantee, so perhaps that's where the explanation lies, but I have no evidence or data to back up that conclusion.

Right.

I would argue it is possible for better classification; I don't have a reason why apple chose not to do this (especially if they're capturing the data) other than the algorithms are not as guaranteed as we would like and they don't want to assume that kind of liability. (ECG printouts include the computer's interpretation; a standard way of reading them is to completely ignore whatever the computer says, because it is not infrequently completely wrong. And those are the professional grade machines with 12-leads capturing 10 different points on the body)

Edit; As I thought more about this, I realized that analyzing QRS duration or presence of p-waves can be lead dependent, which can change based on which parts of the body are being used to generate the lead.

Determining PVCs vs afib is very trivial when you actually look at the strip. However, if Apple is only analyzing rate regularity and not actually doing analysis on the waveforms themselves they would be very difficult to differentiate.

If you're having so many PVCs that the watch thinks you're in afib, you should probably still see a doctor. As the grandparent noted, tens of thousands of PVCs in a couple day period is very unusual and should probably be seen by a specialist.

Unless of course you don’t live anywhere because you move every 4 weeks.

Turns out our society is really not designed for someone without a physical residence. It’s made for a frustrating year for me.

I’m not at all surprised.

As a semi retired software engineer and currently 4th year Med student, I still maintain a dream of building a usable EHR that puts the clinical, patient-focused side of things first. Currently implementations allow for increased billing recovery, but at a cost to both doctors and patients.

I just don’t know how you’d start in competing with something like Epic or Cerner, from a business side of things.

Well, point of care ultrasound (which is what the butterfly is for) can often lead to formal ultrasonography to be read by a radiologist. However, it can increase time to initial treatment, and depending on the level of skill of the user can sometimes prevent the need for formal ultrasound, but not always.

Yeah unfortunately that's an attitude that still exists in some places. Fortunately I'm going into a specialty (EM) that has much less of that, and my first priority is to find a group of people I like and that I want to go to work with every day.

That's a good way of putting it!

for sure! I hope to be able to incorporate my previous life into my future career. My real dream is to build an EMR designed for patient care, but is also able to do billing (all EMRs were designed and built for billing specifications, and is one of the reasons they all suck to use as clinicians). But I don't have the time or energy to pursue the enterprise sales apparently necessary for the field.

Thank you!

I was fortunate to have completed all prereqs through my bachelor's degree. I worked in software for 3 years or so, then left to go to med school.

Very interesting observation! I would say that that is definitely a stereotype - accurate, but not as common as you might think.

For me, the real difference is every patient's response - some (many?) doctors treat the job as a job. For me, this is a calling. I'm there to help every individual (in my case, in the emergency department). So every interaction is unique because every patient is unique. I go through roughly the same questioning and physical for most patients, but the interaction, their responses, how we get along, etc. is always, always different. I could see two patients with the same exact problem and do the same exact things, and take away two completely different experiences.

To analogize to computers, its as if you ran the same program on different computers and got a slightly different result each time. Or perhaps that each terminal responds slightly differently. Though I suppose in those contexts it'd just be annoying/frustrating... it's not a great analogy lol

Absolutely!

I found that I was spending an inordinate amount of time in front of a computer and not interacting with anyone. I also was extremely disappointed with a general lack of self-improvement; I think part of that was that I just graduated, where I was used to everyone constantly studying and working to improve themselves. These experiences may have also been in the minority in the industry, but they were my experiences.

I also had EMS experience in college, so I knew what it was like to treat patients, and I missed that very greatly. I've loved every day I've gotten to talk with patients here in medical school, and can't wait to start truly practicing medicine.

I do still do some web development work, including incorporating my current predicament - traveling the country interviewing for residency. I worked with two current residents to build Swap&Snooze (www.swapandsnooze.com)

I'm confused - what's the problem with the hamburger menu? What would the alternative be on small screens?

That's more or less it on the dot!

Edit: I'd add that type 2 is associated with increasing insulin resistance, causing the pancreas to work harder. Over time, this can cause the pancreas to essentially burn out, at which point exogenous insulin would be needed. Type 2 diabetics who are able to manage the associated risks - namely diet and exercise, almost universally focused on losing weight - can often improve or even reverse the disease altogether.

I'll also add that this is not the entire discussion of diabetes. There's an increasing recognition of forms of diabetes outside of the known definition of type 1 and type 2. A so-called "type 1.5" is being further delineated and may explain why some type 2s don't behave the way we think they should.

I'm not sure what number that's from - I think that's the undergrad tuition, not medical school tuition (https://www.augusta.edu/mcg/admissions/tuition-augusta.php)

In any case, that's tuition alone, and at one public medical school in one state (i.e. most people applying to medical school each year won't qualify for that price; caveat is other states with low prices, such as Texas medical schools, which are routinely the cheapest in the country, but also take >95% instate residents).

Also, my medical schools calculates another $30k in fees and living expenses per year.

Here's another datapoint for you: SUNY Upstate in New York. Tuition alone for instate residents: $43k. Taken from: http://www.upstate.edu/currentstudents/document/com_budget_y...

I'm actually curious now what the costs are for each states' public schools. I can't seem to find a single reference for that though.

> people going into 200k debt to become doctor's are mostly over paying

That's probably average combining undergrad and medical school. I go to one of the cheapest medical schools in the country, and it's > $240k in loans alone, let alone interest (plus the $130k from undergrad for me)

> [Cuban medical schools] graduate loads more doctors than the US

I'm guessing you mean per capita...?

> A doctor must have a Batchelor's because it was decided that nurses should have one

I'm not sure where you got that from. Nursing going to the BS model is extremely new compared to physicians doing so.

> open a few more medical schools to allow more doctors to be trained

The hold-up here is on training positions. New schools are opening every year, but that's just exacerbating the problem on graduation - we're getting to having (we might already be there, I'd have to check the numbers again) more graduates than we have training positions.

I always assumed this was because Amazon didn't want to have to pay the 30% or whatever cost to Apple for in-app purchases.

Seeing that always made me think that everything would be exaggerated, and the video was likely not worth my time; I also spend very little time on YouTube, so the two are probably related (namely that I don't like video-based content)

Or you just ended up with a lot of student loan debt...

Nope, got released 9/25

Like any intervention to the human body, there are risks. Properly maintained and adjusted, contacts carry very few risks.

Anecdotally, I've yet to find a pair of glasses that lets me function in the world as well as contacts. (My eyesight is poor enough that I cannot see the screen on my phone with both eyes open, as it has to be so close to one eye that it is too far from the other.) Wearing contacts lets me see the entirety of my world, not just the portion within the frame of my glasses.

> the half-life of depression is only a few weeks

Are you referring to a single major depressive episode? And presumably not referring to the various other depressive disorders that last months to years?

FWIW, this one of many things that makes treating "depression" challenging - there are many different forms of depression, and not infrequently the underlying pathology is quite different.

Is this referring to the same type of "sticker" I hear about in iMessage? Because I still have no idea what those are about, but I hear people talking about them all the time.

That would be awesome if you wanted to share it!

Thank you! That's the perfect tl;dr (too long; didn't research?) I was looking for

Care to expand on this?

Edit: Based on the downvotes, I'm guessing I wasn't really clear what I was going for - I hadn't heard about the International Committee before, so I was looking for some more information about how they differ.

It's not a cure, it's a treatment.

Ketamine, I do believe, is an animal tranquilizer. Not being a veterinarian, I don't know much about that application. However, in humans it has shown tremendous benefit as an analgesic and a dissociative agent, with a tremendous safety profile.

Er... "excited delirium" is both very real and very serious, a constellation of symptoms due to another underlying process (e.g., drugs, usually of the illicit nature). It can generally be treated well with Ketamine.