mikecsh
People write tutorials on what they are interested in, what they have knowledge of, and what they want to share.
Accessibility is an important topic, to be sure, and is clearly of particularly high importance to you. Others might complain that they didn't include how to create a high performance table view, or embed an OpenGL view. I think most people, however, will take it as what it is - a well written, helpful contribution.
Your comment specifically asked if you were being harsh, and the consensus appears to be "yes". Perhaps if you worded things differently you might get a different response.
For example if a medication has sedating effects (such as some antidepressants) it may be advised to be taken before bed so this side effect is turned into something generally beneficial (more sleep) and less prevalent during waking hours).
Statins (cholesterol lowering medications) are usually prescribed at night time as this is when your cholesterol catabolism is most active.
Pain relief is often varied around sleep schedules
Insulin is scheduled around meals and sleep
Etc etc.
Also in my experience pharmacists dislike having to do this laborious process.
https://www.macrumors.com/how-to/ios-16-4-beta-how-to-automa...
It's a different model to what you are used to and IMHO more flexible and powerful. If you try and keep operating in a manner learned on a different model you will inevitably be frustrated.
There are other subtleties in 3D as well; some weirs form a downstream-pointing V when viewed from above the dam - these are generally considered safer as the currents will (generally) move you to the middle of the river and downstream where the water is more likely to be escapable - see [1].
Others can form an upstream-pointing V which has the opposite effect where the currents will move you towards the middle of the river but upstream back towards the stopper/keeper/hydraulic.
[1] https://assets.atlasobscura.com/media/W1siZiIsInVwbG9hZHMvcG...
I don't think _"F### ventilators. They damage the patient's lungs, and laying tubes into the trachea requires traumatic surgery and carries significant secondary infection risk"_ is really offering an informed or balanced discussion of the risks and benefits of intubation and ventilation hence my initial reply.
On the contrary, this offers an emotive, highly negative, and uninformed opinion with no balance. We are in a time of a global pandemic with the general public now aware of intubation, ventilation, ECMO, CPAP, BiPAP, and other respiratory interventions. Many people and/or their families are having to face or consider these interventions. Your comment is potentially harmful.
Against to be clear, the medical profession is (spoiler alert) acutely aware of the risks and negatives of ventilation, including extended ventilation, ECMO, surgical and percutaneous traches, and every other intervention that is offered. These risks are discussed with patients and families who often lack the domain expertise, it therefore being part of the role of the doctor to explain to the best of their knowledge what options the patient has before them and likely outcomes of the different options. Ultimately (ideally) the patient makes a decision for themselves based on this information.
You can be sure that the nuanced and balanced discussion is a little more informative than "F### ventilators".
I think it's important to contextualise the risk. The risk of dying from an anaesthetic is about 1 in 100,000. Compare with risk of dying in a car accident in a given year for example.
And again, it comes down to risk:benefit. Anaesthetics are not given out willy-nilly. The reason for the anaesthetic is considered along with the patient's co-morbidities and personal physiological parameter where relevant. Based on this a reasonable estimate of the personalised risks for that patient for that operation can be given for the patient to choose if they wish to proceed or not.
Clearly if anal oxygen proves to be safer and as effective then it will be adopted. No one is disputing that.
My comment was regarding your expletive laden derision of devices which save hundreds of thousands of lives.
And you seem to have missed the point. I did. It say hospital acquired infections are not prevalent or problematic. My point was that every decision in medicine s based on risk and benefit. If you need ECMO you will almost certainly die without it. If you have ECMO there is a compratively small risk of infection that may kill you.
And yes thanks, I did read the article. I’m also a doctor and have spent many months working in ITU, anaesthesia, and operating theatres, and managing acutely unwell COVID-19 patients.
Let us all be glad you’re not making any treatment decisions.
“Laying tubes into the trachea” I presume refers to tracheostomy.
Let’s be realistic here - if you are requiring a tracheostomy and ventilator, or ECMO the you are severely unwell. A blood transfusion, or small risk of infection is the least of your worries at that point.
As with everything in medicine there is a risk:benefit ratio. If you need ECMO you literally cannot oxygenate your own blood even with a ventilator. No ECMO = you die.
Is it the weight of aircraft that contributes to the wake turbulence or the physical size? Presumably these usually correlate pretty well but just asking for clarity…
There are a lot of other issues with them though. There are few companies supplying them so they are actually very expensive. Consequently in our publicly funded health service they are not replaced often and many are in a poor state with batteries held in by tape etc.
The main issues from perspective as a user is the synchronous model of communication that they enforce. Unless something is an emergency, it's an unnecessarily disruptive workflow.
There are usually a limited number of phones on a ward, which are usually very busy lines. Using pagers for routine communication means:
1. Physically move myself to a location with a phone 2. Wait for phone to be free 3. Call a number to send the bleep 4. Wait for a response (bearing in mind the recipient needs to be free, move to a phone, wait for that phone to be free, and call back) 5. Guard the phone from others using it until I receive the call 6. Hope that no one else calls the phone in the meantime
Bearing in mind that everyone is always busy in hospital this is a huge source of frustration and wasted time, hence the move towards secure messaging apps for these scenarios. Unfortunately these are mostly being built as silos rather than interoperable communication networks.
As mentioned above, for actually alerting a group of people to an emergency when you need an immediate response, pagers are still hard to beat.
1. Sending the number of a telephone extension you want the recipient of the bleep to call. For example, if I need a cardiology opinion, I will bleep the cardiologist with a telephone extension and wait for them to (hopefully) call back while I am still but he phone and before it is called by anyone else. This data is not sensitive. These are the types of bleeps which are being replaced slowly by asynchronous communication via apps
2. Emergency bleeps which are designed to alert a specific group of people on the arrest team to respond to an emergency. These usually work quite differently. Instead of 1:1 they are 1:many and usually carry a different alert tone, followed by a (generally poor quality) audio alert of the operator saying something like "paediatric cardiac arrest inbound to ED, ETA, 5 minutes". Again these carry no sensitive data.
I'm a doctor, and whilst I despise carrying a pager it does have some benefits over more modern alternatives in some scenarios.
Mobile (cell) reception in hospitals is generally very poor and wifi connectivity is also generally poor. Trying to rely on either of those to deliver critical communication (e.g. bleeps to the crash team to respond to a cardiac arrest) is more unreliable than the hospital blasting a simple radio signal that any pagers within a few mile radius will always receive and decode appropriately.
For less critical communications (e.g. where you might bleep someone to contact them to a refer a patient to their specialty) there is a (slow) move towards messaging apps or email. These solutions do not yet have the immediacy and reliability of a simple pager for critical applications.
For example:
1a Community acquired pneumonia 1b Mesothelioma 1c 2 ischaemic heart disease and type 2 diabetes mellitus
It could, but it's not there yet. I was trying to illustrate the enormous chasm which AI has yet to cross. Even if an AI model is trained to interpret all head CT pathologies, that is an absolutely minuscule part of practicing medicine.
Let me be clear that I agree that many of the functions of doctors are theoretically replicable with technology. I just have radically different view to the timescale that this will be on compared to many HN-ers who seem to equate treating patients with analysing a computer program, a comparison which is woefully inadequate.
The advances in image interpretation AIs in medicine are a bit misleading as they are literally the lowest of the low hanging fruit. There are huge amounts of data to mine with both normal results and pathological ones, and the data is already in a relatively consistent and nice format for the model to be trained on.
And yet it's 2020 and we don't even have accurate computerised diagnostics for ECG interpretation which is essentially 12 arrays of floats.
I relish the advances in tech, but the chasm between what "robo-doctors"/"AI" etc can actually achieve right now to benefit patients and what a doctor even just out of medical school can do on a day to day basis is vast. The progress in "potential doctor replacements" we have seen from the technology sector is hugely hyped but realistically has a minuscule effect on patient outcomes at present.
I understand people become very frustrated with inadequate healthcare systems and especially when mistakes are made. The go-to answer of "doctors are scumbags, they don't do anything anyway and AI will replace them in a decade" is facile and ill-informed.
Yesterday I walked past a patient who was vomiting fresh blood. She needed urgent wide bore IV access, bloods, blood transfusion, review from upper GI surgeons and head and neck surgical oncology and immediate return to theatre to open up her neck and explore what was going on to hopefully fix it. There is not the slightest hint of a technological solution to this managing this single random example of which I could have picked many thousands more.
Last week I was called to ED to review a patient who had had an industrial accident with heavy machinery and had an almost complete degloving of his arm and almost complete amputation of the same. The diagnosis is easy in this case, but which software is going to keep the man alive and try and save his arm?
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Diagnosis may not be "creative" but as another commenter points out it is nuanced. I've commented about this before but the main challenge with tech for diagnosis is data collection. It's easy to train and run models on numerical data such as CT scans and blood results because the data collection is easy. Even then the tools we have are pretty useless at present. In my hospital we have an automatic warning if the system suspects a patient has sepsis, which is great. However, it's also often wrong. Which, were it allowed to and able to manage the patient would be a complete disaster. ECGs provide automated interpretation which are usually complete BS.
However, patients are not numbers, or programs; eliciting the information you need to make the diagnosis is the hardest part and that is significantly more challenging than a flowchart. E.g. patient found unresponsive at 3am by a canal, no further info. Where is the AI solving this right now?
Once you have a diagnosis, or at least a working diagnosis, you then need to be able to actually instigate the management for that patient. I have yet to see anything that can automatically take blood, cannulate a patient, intubate a patient, perform a ring block with local anaesthetic, run a cardiac arrest, etc.
The chasm looks small from a distance but when you get up close, it's actually really big.
Good luck with that, I'm sure you will be much happier and healthier when the current AI tries to decide whether you are acutely dying of hypercalcaemia or a cardiac tamponade and Marshalls the robots to save you.
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For all the faults and failings of doctors (read: humans), I find many Hacker Newsers vastly oversimplify what doctors do and vastly overinflate what AI is able to do now, or will be able to do in the next ten, twenty, or even 30 years.
It's great that we not have some AI that can diagnose a stroke better than a radiologist on a CT scan. But it can't tell you the scan also shows a space occupying lesion. Or hydroencephaly. Or an extra dural haematoma. Or any other intracranial pathology. And that's about the state of the art.
I welcome new diagnostic aids as I think most clinicians do, but I would take the fleshy system we have of human healthcare providers and suspect that will be the case for a good while yet.
Disclaimer: am doctor and engineer
Some Trusts were attempting to make this the first line treatment as an off-license prescription as it was cheaper and the pharmaceutical companies were trying to sue the Trusts for "not providing NICE approved medications and therefore disadvantaging patients" while simultaneously not seeking to license Avastin for wet AMD.
This was a few years ago so I may have misremembered some details.