joshgel

This is definitely a part of standard follow up for small findings and part of the guidance for incidentally detected lung nodules smaller than <8mm.

I think mammography is a great example. Many people are quite surprised to hear that the Positive Predictive Value of a screening mammography is only in 10-15% range. This despite mammography being a pretty sensitive test. This is because despite good test performance characteristics, applied across a large population of relatively health people, the 2-5% false positive rate is a large number of people.

I love the line on the landing page with a link back to hn:

> That must be worst website ever made.

the level of confidence (this is a second time founder after all) to put that on their website gives me confidence that they can make this work

very rare diseases may be an exception, especially in known geographic locations. that can become identifiable (and is governed by HIPAA in the US)

I threw this into ChatGPT and got a lot of the way there in one shot. Then had to go back and add in some stuff like the wordle answer and captchas…

Ya, internist here.

For some context, the USMLE is taken during medical school. The amount I have learned about actually practicing medicine since graduating is probably an order of magnitude more than everything I learned in medical school! I still learn stuff, all the time, and I’m not just talking about new research.

So, while impressive and clearly part of the future world, we shouldn’t get too far ahead of ourselves with the current models.

I’m curious what problems you’ve applied this to. Would love to chat if you are open. (My email is in my profile)

> You have to hope your hospital uses CPT codes and not, say, DRG coding, or something else entirely, otherwise you'll need to look up those codes too.

This is a bit of a misunderstanding. CPT codes are part of professional services billing, while DRGs are exclusively for inpatient acute care billing. If you are admitted to a hospital, you’ll probably have to deal with both.

Err it’s more that tick-borne diseases cause anemia.

There are lots of things that cause anemia! And someone with unexplained anemia deserves a complete work up (especially with hemoglobin levels in the 4-5 range), including for tick-borne illnesses, especially if they have been in an endemic area. But lots of other things worth checking too, many more dangerous than tick-borne illnesses.

Just want to point out that Atrial Fibrillation and Atrial Flutter are (usually) very benign, chronic conditions. Many people have for years without symptoms.

Ventricular fibrillation, ventricular tachycardia and torsades are acutely deadly. You have seconds to minutes to get a normal rhythm back.

The charts colors made me feel like they were implying a-fib was the worst rhythm listed. (Though they list the severity in the descriptions in small text)

Looking for a Senior/Lead full stack engineer

SmarterDx | Competitive salary + equity + benefits | NYC or Remote | Full-time | Experience: 3+ years

## Why SmarterDx

1. *We solve an important problem.* The cost of transactions for healthcare in the U.S. exceeds $350B a year. That’s not the cost of care; that’s not what is paid to doctors or nurses; that is just the friction of collecting payments from insurance companies (so not a cent of that provides value to patients)! SmarterDx improves this process and ensures payments are more accurate. 2. *We have real traction.* Our product directly ties to customer revenue. As a result, our founding team was able to grow the business to over $1M in contracted revenue without raising. But we believe we can 10X that in the next 1.5 years and have raised $5.7M from Floodgate, a top-tier SV fund, and Flare Capital, a top-tier Healthcare fund, to drive that growth. 3. *We are a close-knit team that cares about your growth.* All three founders are technical (two are physicians who code, and the third led quant engineering at a global investment bank). We select for mission-oriented teammates who are deeply thoughtful while being biased towards action; and who can disagree with others (a side effect of having novel viewpoints) while being genuinely nice and respectful. In return, we will do our best to help you grow your career and achieve a great personal outcome.

## About the role

We are looking to hire a *Senior or Principal Full Stack Engineer* to join our small but growing team. As an early employee, you’ll have an opportunity to work with awesome people (like an ex Apache board member!) and your work will influence all aspects of the product and business. You will also help shape our core engineering culture and grow the team.

As such, you'll have to be willing to get your hands dirty with (and learn) everything across the stack: healthcare data, APIs, frontend, backend, data engineering, algorithms, analytics, bug reporting, etc. (but the codebase is still small and we will do our best to give you time to dive deeply into specific areas).

## Our stack

- React & GraphQL - NextJS & Python - AWS

Interested? Please send your resume to hiring (at) smarterdx.com

It's really amazing to see travel nurses come back to work at a place they just left. They are now doing the same job as before, are getting paid almost twice as much with better schedules and are working next to people that they know and are friends with.

It's honestly surprising that more haven't taken the jump and is really shocking that hospitals aren't doing more to retain critical staff.

“JAFFA, March 10 (Reuters) - Israel’s parliament on Thursday passed a law denying naturalization to Palestinians from the occupied West Bank or Gaza married to Israeli citizens, forcing thousands of Palestinian families to either emigrate or live apart.”

Abhorrent but not about preventing marriages, at least not directly

I've thought about building an API that integrates Twillo with the HN API. Lots of planes/airlines have free messaging wifi, but not free wifi. But, if you could text a number and get the top n stories, then read the comments and perhaps the text of the stories (?) would be pretty nice way to pass some time. Alas I haven't done it yet...

Isn’t the fact that they got cut in half (and other examples, peloton for example) evidence that this isn’t a bubble. There are companies that are exploding in value, yes, but also companies just getting crushed left and right. If you’re growing, your value is very high, but miss your targets and boom, bye bye froth.

Sorry that happened to your aunt.

Doctors aren’t reimbursed for prescribing medications directly (except chemotherapy infusions). Was the physician selling the medication directly? That’s not commonplace.

Clinicians may financially benefit from not refusing their patients requests and thus losing the patient to another doctor that will acquiesce. But that’s a tricky topic to untangle.

Like cigarettes? I have no sense of whether FB is physically addictive like smoking.

But, if a company directly contributes to decline in civil discourse and harms democracy, and thereby harms the users, then isn't it a government role to step in? And isn't this the governments role even if users can't see the harm at the micro-level of their daily interactions with the company? I guess that is the argument at least. Really its a balance between values: individual freedom and the collective good.

Not GP, but anecdotally know that there are way more respiratory viruses now (summer in the US) than usual.

For data, you might look at RSV trends compared to usual. (Usual is winter spike).

https://www.cdc.gov/surveillance/nrevss/rsv/state.html#NY

Don’t they just both correlate with socio economic status?

Can’t read actual methods to check if this was adjusted for…

I’ve been trying to decide whether to move a Django-DRF API to one of these.

yes! I'd probably argue that a majority (or at least significant plurality) of acute care (hospital care) in the US is the direct result of the failure of social services. I include in this mental health issues directly resulting in poor health, inability to access primary care (so minor/treatable issues become severe), housing issues, drug issues, lack of elder care options, etc.

It’s actually mandated now that providers allow free, on-demand, API access to patients for their medical data.

The GI side effects of metformin are usually short lived. They tend to last about a week or so after starting the drug or increasing the dose. Some people do have longer lasting side effects, but metformin is one of the best tolerated drugs we have.

I think what you are assuming is that early intervention in infection is good. Very likely to be true. And that we can reliably detect early infection. Much less likely to be true.

The biggest issue is the costs of false positives, which with any early intervention protocol are likely to be high and, questionably, on balance a net negative.

CRP can’t really confirm an infection. It’s a marker of inflammation. Inflammation often correlates with infection but not always. Can be lots of other things too, including a lot of the things that are false positives on these sepsis algos.

Ultimately doctors have to take the whole clinical picture into account instead of relying on a couple markers or vital signs.

You’re right that a big problem is the inability of our system to do testing at home, which might greatly expand the scope of the clinical picture. But it still wouldn’t be a cure-all

Basically everyone admitted to the hospital is at some level or risk from sepsis which is why the proxy markers become important.

Sepsis is pretty well defined between SIRS and qSOFA. But the definition has a subjective component which has very poor inter-rater reliability. And you’re 100% right that the definition overlaps with other very common conditions, such as pain or having just had an operation.

can you share what group you work with?