No, these patients were not seen by 'their' doctors. They were seen by a hospitalist who probably has never seen the patient before. The US is moving to the same model as a number of other countries with a distinct separation between inpatient and outpatient sectors.
It's an observational study. MOST observational study conclusions end up failing to be reproduced in prospective studies - for reasons you point out.
The end point was 30 day mortality. Readmit rates were unchanged. The latter is typically a better discriminator for 'bad care' - if the patient has to come back to the hospital in a month for the same reason, you can argue that you should have done something different (doesn't always work, but it seems to be a valid generality).
30 day mortality suggests (but does not prove) that a strong possibility is that older doctors where less likely to be aggressive. That can be appropriate or inappropriate care depending on the patient and condition.
All in all, this is *very* preliminary (as the authors duly point out). Unfortunately, it seems to be on the road to the the Medical News de jour and will be plastered about the Internet as the unvarnished truth.
There is a big difference between $3000 (moderate DSLR) and $30000 (base electric vehicle). Your analogy also falls a bit flat in that there are lots of other bits of the transportation infracstructure that work off of petroleum rather than electrons. In eight years your aren't going to see electric based container ships, 18 wheelers and aircraft.
Will electric make deep inroads into consumer driving? Sure. Eventually. Will automated driving replace meatbags? Probably. Eventually.
Not in a decade. Maybe 20 or 30 years but not in a decade.
Anything from 2013 to 2015 can be upgraded to 16 GB - not the ultimate of 32 or 64 but it IS a laptop.
16 GB in my 2015 MBP is fine. 8 is really limiting the machine. YMMV.
But come on, a minimal processor refresh is not particularly exciting nor unexpected. Maybe some ports this time. Or at least a custom sleeve with dongle pockets.
Yes, having all of your medical records in one place sounds wonderful and lifesaving and all that but the reality is that you are unlikely to die from a doctor not having your old records. You might take a medication that didn't work before (or did), you might get a CT scan you didn't really need and the doctor might have a better idea of who you really are medically, but these don't translate into life or death issues.
Even the scary 'allergy' issue isn't all **that** important. First off, most people's description of allergies are incorrect. Several studies have indicated that the most common misdiagnosis in American medicine is 'penicillin allergy'. Even if you are allergic to a drug, we can reverse those problems pretty quickly. And you can always be allergic to a drug that you've never had or even one you've had before so you still have to be on the lookout for problems.
Secondly, even the imperfect recollections of patients are often enough to get you on the right track. If they aren't, there is the fax machine and the phone. Not sexy, but functional.
Frankly, the way we've implemented EHRs has been a nightmare. Yes, you can give the nice new ER doc all of the information - all 200 pages of useless verbiage about who did the test and when they signed off on it. After. Each. Fucking. Test. Result. Copypasta of histories so you have six of the same stories on paper. Did anyone actually read them? Did anyone other than the original author actually talk to the patient? No useful summation, just a core dump of whatever is on the database.
That's when the computers are actually working....
Atrial fibrillation is characterized by being 'irregularly irregular'. It is really pretty easy to identify, at least for humans and even EKG machines. The mathematical algorithms are well known and well characterized. The major difficulty that the iWatch has is that it is only using one EKG lead.
But even three lead monitors have no problems with that.
But yes, it has some useful medical implications. "Paroxysmal" atrial fibrillation is when the underlying rhythm is normal but occasionally jumps into afib. That is medically important since the heart doesn't pump normally and the patient can feel weak and tired and it increases the likelihood of a blood clot. The rate of strokes (due to blood clots) from paroxysmal afib is no where near 15% but it is a large number because it's a common abnormality. Having your watch warn you of that is potentially useful.
Of course, I'm going to tell you to take one aspirin and call me in the morning.
Oh, he's close. Just missing things by a few blocks. Down the street from Amazon is the Allen Brain Institute.
Brain. Institute.
Once they take your brain (for science, of course), your only options are either the homeless shelter or politics. The vast majority of people, even after being pithed, would apparently prefer homelessness rather than politics.
Wait, you mean there's more to going to mars than just building big rockets and putting people in them? Going to mars is more complicated than anyone knew.
No, that's healthcare. Going to Mars is easy compared to rejiggering the American Medical Industrial Complex.
Of course, it won't work - the arrays aren't specced for Martian distances. I doubt you can put much acceleration on the frame - it wasn't designed for that. But there has got to be a better way of utilizing the thing besides burning it up in in the atmosphere.
The Air Force had their fingers deep in the Shuttle program - mostly to it's detriment. Cross-range landing capability, payload size and a host of other goals were stuffed into the project making it one of the largest human kludges ever designed.
Now they get to play with their own toys. If we're very nice, they might let NASA take a peek. But probably not. There are both valid reasons for keeping the military technologically ahead of the civilian space program and some institutional / paranoia reasons.
Hopefully everyone remembers enough of the Shuttle program to not try to make a one size fits all high technology vehicle.
Slashdot Mirror
How very 20th Century...
No, these patients were not seen by 'their' doctors. They were seen by a hospitalist who probably has never seen the patient before. The US is moving to the same model as a number of other countries with a distinct separation between inpatient and outpatient sectors.
It's an observational study. MOST observational study conclusions end up failing to be reproduced in prospective studies - for reasons you point out.
The end point was 30 day mortality. Readmit rates were unchanged. The latter is typically a better discriminator for 'bad care' - if the patient has to come back to the hospital in a month for the same reason, you can argue that you should have done something different (doesn't always work, but it seems to be a valid generality).
30 day mortality suggests (but does not prove) that a strong possibility is that older doctors where less likely to be aggressive. That can be appropriate or inappropriate care depending on the patient and condition.
All in all, this is *very* preliminary (as the authors duly point out). Unfortunately, it seems to be on the road to the the Medical News de jour and will be plastered about the Internet as the unvarnished truth.
Sigh.
There is a big difference between $3000 (moderate DSLR) and $30000 (base electric vehicle). Your analogy also falls a bit flat in that there are lots of other bits of the transportation infracstructure that work off of petroleum rather than electrons. In eight years your aren't going to see electric based container ships, 18 wheelers and aircraft.
Will electric make deep inroads into consumer driving? Sure. Eventually. Will automated driving replace meatbags? Probably. Eventually.
Not in a decade. Maybe 20 or 30 years but not in a decade.
Anything from 2013 to 2015 can be upgraded to 16 GB - not the ultimate of 32 or 64 but it IS a laptop.
16 GB in my 2015 MBP is fine. 8 is really limiting the machine. YMMV.
But come on, a minimal processor refresh is not particularly exciting nor unexpected. Maybe some ports this time. Or at least a custom sleeve with dongle pockets.
So, the homeopathic approach to hallucinogens?
Hunter S. Thompson wound not approve.
You're downvoted but really, that's something like 0.00005% of the population.
More people probably drown in their bathtubs.
It acts like it more often than not.
Israel technically denies that it has nucs. Nobody believes them but that is the official line.
Nobody wants 'Lil Kim anywhere near them.
I've got this rock....
Only if you don't open it.
Yeah, everyone would probably be forced to wear red pantsuits.
The horror.
I suspect that the perps are doing it for money.
Always follow the money.
Ah, a hardware abstraction abstraction layer.
Yet Another Abstraction layer?
It's layers all the way down?
Hey, that's the combination to my luggage!
And I'd wager you are wrong.
Yes, having all of your medical records in one place sounds wonderful and lifesaving and all that but the reality is that you are unlikely to die from a doctor not having your old records. You might take a medication that didn't work before (or did), you might get a CT scan you didn't really need and the doctor might have a better idea of who you really are medically, but these don't translate into life or death issues.
Even the scary 'allergy' issue isn't all **that** important. First off, most people's description of allergies are incorrect. Several studies have indicated that the most common misdiagnosis in American medicine is 'penicillin allergy'. Even if you are allergic to a drug, we can reverse those problems pretty quickly. And you can always be allergic to a drug that you've never had or even one you've had before so you still have to be on the lookout for problems.
Secondly, even the imperfect recollections of patients are often enough to get you on the right track. If they aren't, there is the fax machine and the phone. Not sexy, but functional.
Frankly, the way we've implemented EHRs has been a nightmare. Yes, you can give the nice new ER doc all of the information - all 200 pages of useless verbiage about who did the test and when they signed off on it. After. Each. Fucking. Test. Result. Copypasta of histories so you have six of the same stories on paper. Did anyone actually read them? Did anyone other than the original author actually talk to the patient? No useful summation, just a core dump of whatever is on the database.
That's when the computers are actually working....
Atrial fibrillation is characterized by being 'irregularly irregular'. It is really pretty easy to identify, at least for humans and even EKG machines. The mathematical algorithms are well known and well characterized. The major difficulty that the iWatch has is that it is only using one EKG lead.
But even three lead monitors have no problems with that.
But yes, it has some useful medical implications. "Paroxysmal" atrial fibrillation is when the underlying rhythm is normal but occasionally jumps into afib. That is medically important since the heart doesn't pump normally and the patient can feel weak and tired and it increases the likelihood of a blood clot. The rate of strokes (due to blood clots) from paroxysmal afib is no where near 15% but it is a large number because it's a common abnormality. Having your watch warn you of that is potentially useful.
Of course, I'm going to tell you to take one aspirin and call me in the morning.
Along with the open Telnet and FTP servers.
Right.
Oh, he's close. Just missing things by a few blocks. Down the street from Amazon is the Allen Brain Institute.
Brain. Institute.
Once they take your brain (for science, of course), your only options are either the homeless shelter or politics. The vast majority of people, even after being pithed, would apparently prefer homelessness rather than politics.
There is some hope for mankind.
Man is not a rational animal.
He is a rationalizing animal.
- RAH
"- attach boosters to ISIS and SEND THEM TO MARS."
FTFY. Two birds, one stone.
Ack no. Didn't you see Prometheus?
Wait, you mean there's more to going to mars than just building big rockets and putting people in them? Going to mars is more complicated than anyone knew.
No, that's healthcare. Going to Mars is easy compared to rejiggering the American Medical Industrial Complex.
But it's already in orbit.... That means a lot.
Of course, it won't work - the arrays aren't specced for Martian distances. I doubt you can put much acceleration on the frame - it wasn't designed for that. But there has got to be a better way of utilizing the thing besides burning it up in in the atmosphere.
How do you determine a bot's age?
The Air Force had their fingers deep in the Shuttle program - mostly to it's detriment. Cross-range landing capability, payload size and a host of other goals were stuffed into the project making it one of the largest human kludges ever designed.
Now they get to play with their own toys. If we're very nice, they might let NASA take a peek. But probably not. There are both valid reasons for keeping the military technologically ahead of the civilian space program and some institutional / paranoia reasons.
Hopefully everyone remembers enough of the Shuttle program to not try to make a one size fits all high technology vehicle.
Like the F-35.
Sigh.