Yes I work in rural healthcare and no, I have not seen a 'telemedicine' system worth the time, effort and money. In my rant, I'm not including a number of things that you rightly call telemedicine because that isn't how the technology is being pitched to hospitals. But you are quite right that radiology is telemedicine in the truest definition of the word. I'm hard pressed to call faxing EKGs 'telemedicine' because if you go that route, everything since the telephone is telemedicine. The stethoscope recorders are an example of a discrete part of an exam that can be transmitted remotely that has very limited clinical utility. Pretty much any cardiologist is going to ask for a echocardiogram which takes an expensive piece of equipment and a highly trained operator. So off the patient goes. So you can do it but it's really not helping the patient in any sort of coherent fashion.
The stroke protocol is interesting. They have managed to take a simple, six step checklist and create a wonderfully expensive device and system (that can be billed for, natch). Providence Anchorage loves the things but pretty much every neurologist will tell you that it's totally unneeded. Any rural facility that is capable of using clot busting agents is capable of having a trained paramedic / PA / nurse practitioner that can do the exam and then call the neurologist on the phone.
So my rant is devoted to those complex, expensive systems that are trotted out routinely that try to do very simple things (basically your examples) in complicated, typically proprietary fashion.
I actually think we agree more than disagree. As usual, it's semantics (is a video camera really telemedicine?) The low hanging fruit has been harvested and now the industry is trying to get on a rather intellectually shaky ladder.
And anybody who says that you can just 'connect' EHRs to deal with the patient's chart has never seen EHRs. Despite federal law and three decades of work, it takes custom programming, time and angst to get two different EHRs to talk to each other.
Which is exactly why this field is so annoying. We've had 'telemedicine' for decades. We have been able to have a remote physician look at and talk to a patient and the local provider ever since closed circuit TV was available. The idiot TFA basically wants to talk about other things - patents and point of care robots, but really does nothing to discuss the lack of ubiquity that evangelists have been promising. Every couple of years, some new company wanders in and tries to demo their 'new' and invariably proprietary gizmo that is typically a combination of Skype and a fax machine.
Every couple of years somebody gets a grant for these things, uses them for about six months and then stuffs them in a closet.
Telemedicine can work for a simple doctor / patient interview but falls apart for anything more complex because medicine is quite a bit more than simply a doctor / patient interview. The remote site typically doesn't have the diagnostic gear that the consultant needs. The consultant typically doesn't have access to all of the records. And the remote site may not have the staff or equipment to treat the patient, even if the diagnosis is clear.
So at anything other than the most basic level, it has been thrown together technological bits that have long sought out a reasonable use case. Yes, you can have remote teleoporated surgeries and other hi tech stuff if you really want to pay for it. No, that isn't going to make sense for anything other than edge cases for a very long time.
The other stuff TFA briefly mentions are devices to automate point of care - getting vital signs on a home bound patient, saying hi to them, checking on if they are breathing. All well and good but something that isn't exactly earth shattering and isn't going to cure cancer or bad breath.
Yes, sort of. But that turns out not to be a big deal (from the bacterium's point of view). Even when bacterial growth is metabolically limited, the increased metabolic cost of a couple of plasmids is quite small. Yes, mutations in the antibiotic resistant gene will essentially be silent and could be competed out, but with several hundred plasmids holding dozens of 'cassettes' of antibiotic resistance, this is a slow process.
So, this strategy does work to an extent but not as well as you would like and as soon as the antibiotic goes back on line, the problem restarts pretty quickly.
I'm still only 29, so I guess I have yet to need them, but I've taken anti-biotics once in my life and can't help but feel a tad angry at the misuse which could potentially cause my death one day.
Get ready for even more angst. Antibiotic misuse, increasing pollution, increasing occurrences of nano particles in the environment. Climate change. Plastics leaching hormonal analogs. The third - worlding of American medicine (assuming you live in the good ol USA). Nuclear proliferation. Kim Jun-Il. Donald Duck, er Trump.
We keep hearing about phage therapy being a possible replacement for antibiotics, but then the news never reappears as actual pharma development. Any idea why?
Because it doesn't really work. The idea is great in the test tube - a specific virus against a specific bacteria. But two problems pop up - we often don't know what the specific bacteria is for a couple of days (until it's grown in culture) or at all in many cases. Then, if you do have a good idea, you have to get this large (megadaltan) thingy into the innermost recesses of the body without said body saying "oh no you don't" and mounting an nice immune response (which can make the original infection worse, see 'cytokine storm').
Maybe, one of these days, researchers will manage to overcome these obstacles, but it has been a long slog with nothing to show for it so far.
Reuters also deals with video. Video files are so much larger than plain stills that worrying about such file sizes seems absurd. Next up: Reuters limits video files to 100 x 60 pixels?
No he's not missing a thing. It takes seconds to process a RAW file to JPEG. Seconds. It takes longer to figure out WHICH files to send than to process them.
As grcumb points out, this whole thing has a huge dose of cognitive dissonance. What Reuters says and what Reuters ostensibly wants are diametrically opposed.
Because it takes time for the photog to convert the image in off-camera RAW-to-JPG software. It is faster to just give them the JPG right off the camera. They even said why: IT IS FASTER TO GET THE IMAGES TO THE CLIENT.
Horsepucky. Even with a Nikon D800 - one of the highest megapixel 'professional' cameras out there, it takes perhaps 10-15 seconds for any reasonably spec'd laptop to process a RAW file into a JPEG. And as a further bonus, each RAW file carries a (smallish) JPEG built into it that can be extracted automatically.
So speed is not an important aspect of this argument.
I'm not so sure about the ACLU, although their funding drives are close. Pretty much anyone who has to deal with OSHA regulations on a regular basis ends up being treated for PTSD at one time or another.
Right. So where is the "surreptitious administration of drugs (especially LSD), hypnosis, sensory deprivation, isolation, verbal and sexual abuse, as well as various forms of torture"?
And eventually they're going to be flooded out of the market by Chinese manufacturers. There's already plenty of Chinese drones that are cheaper and work just as good as these expensive western made ones.
Yes, the fences will be hacked apart. Yes, you can bypass everything. And yes, you can fly in a red zone. At least, on a Phantom, just fly without the GPS. You shouldn't go far but puttering around your back yard will be fine.
What these restrictions WILL do is keep the MAJORITY of brain dead idiots (the 15 year olds that get a Phantom for Christmas) from mindlessly flying their new toy anywhere their multitasking-limited brains think is a good spur-of-the-moment idea. If you have enough brains to bypass the fences, either you are a terrorist or somebody you can trust to think past the next 30 seconds.
what a disaster this will be for the ocean life for hundreds or thousands of miles around the site surely, not to mention any coral and deep sealife in the direct area, and whales and other migratory sea animals will be affected too
Hyperbolic much? Hundreds or thousands of miles around the site? They're dredges, not hydrogen bombs. Yes, they will create a mess - as does mining everywhere. It will be fairly localized. And likely remain a rounding error in the grand scheme of horrible things we do to the ocean floor (e.g. trawler fishing).
According to TFA, just the dredger / cutter robots cost $30 million a piece. Plus a purpose built mothership. They are going to have to haul up a whole shitload of high grade ore to pay for those toys.
Slashdot Mirror
Was thinking the same thing - I wouldn't want to be in that capsule, check out the dust-ball when it smacks down!
- Walking the Walk -
Watch the Soyuz capsules when the land on the steppes of Mongolia. They do pretty much the same things.
Big badda boom.
first to actually manage a fully reusable rocket
Well, them and spaceship one a decade ago (I was there).
If you are thinking about the Shuttle, the only thing 'resusable' on that thing was the nameplate and some of the switches in the cabin.
Nah, won't be BASIC. Javascript maybe. Even C++, but not BASIC.
Yes I work in rural healthcare and no, I have not seen a 'telemedicine' system worth the time, effort and money. In my rant, I'm not including a number of things that you rightly call telemedicine because that isn't how the technology is being pitched to hospitals. But you are quite right that radiology is telemedicine in the truest definition of the word. I'm hard pressed to call faxing EKGs 'telemedicine' because if you go that route, everything since the telephone is telemedicine. The stethoscope recorders are an example of a discrete part of an exam that can be transmitted remotely that has very limited clinical utility. Pretty much any cardiologist is going to ask for a echocardiogram which takes an expensive piece of equipment and a highly trained operator. So off the patient goes. So you can do it but it's really not helping the patient in any sort of coherent fashion.
The stroke protocol is interesting. They have managed to take a simple, six step checklist and create a wonderfully expensive device and system (that can be billed for, natch). Providence Anchorage loves the things but pretty much every neurologist will tell you that it's totally unneeded. Any rural facility that is capable of using clot busting agents is capable of having a trained paramedic / PA / nurse practitioner that can do the exam and then call the neurologist on the phone.
So my rant is devoted to those complex, expensive systems that are trotted out routinely that try to do very simple things (basically your examples) in complicated, typically proprietary fashion.
I actually think we agree more than disagree. As usual, it's semantics (is a video camera really telemedicine?) The low hanging fruit has been harvested and now the industry is trying to get on a rather intellectually shaky ladder.
And anybody who says that you can just 'connect' EHRs to deal with the patient's chart has never seen EHRs. Despite federal law and three decades of work, it takes custom programming, time and angst to get two different EHRs to talk to each other.
Which is exactly why this field is so annoying. We've had 'telemedicine' for decades. We have been able to have a remote physician look at and talk to a patient and the local provider ever since closed circuit TV was available. The idiot TFA basically wants to talk about other things - patents and point of care robots, but really does nothing to discuss the lack of ubiquity that evangelists have been promising. Every couple of years, some new company wanders in and tries to demo their 'new'
and invariably proprietary gizmo that is typically a combination of Skype and a fax machine.
Every couple of years somebody gets a grant for these things, uses them for about six months and then stuffs them in a closet.
Telemedicine can work for a simple doctor / patient interview but falls apart for anything more complex because medicine is quite a bit more than simply a doctor / patient interview. The remote site typically doesn't have the diagnostic gear that the consultant needs. The consultant typically doesn't have access to all of the records. And the remote site may not have the staff or equipment to treat the patient, even if the diagnosis is clear.
So at anything other than the most basic level, it has been thrown together technological bits that have long sought out a reasonable use case. Yes, you can have remote teleoporated surgeries and other hi tech stuff if you really want to pay for it. No, that isn't going to make sense for anything other than edge cases for a very long time.
The other stuff TFA briefly mentions are devices to automate point of care - getting vital signs on a home bound patient, saying hi to them, checking on if they are breathing. All well and good but something that isn't exactly earth shattering and isn't going to cure cancer or bad breath.
Not much to see here, move along.
Yes, sort of. But that turns out not to be a big deal (from the bacterium's point of view). Even when bacterial growth is metabolically limited, the increased metabolic cost of a couple of plasmids is quite small. Yes, mutations in the antibiotic resistant gene will essentially be silent and could be competed out, but with several hundred plasmids holding dozens of 'cassettes' of antibiotic resistance, this is a slow process.
So, this strategy does work to an extent but not as well as you would like and as soon as the antibiotic goes back on line, the problem restarts pretty quickly.
I'm still only 29, so I guess I have yet to need them, but I've taken anti-biotics once in my life and can't help but feel a tad angry at the misuse which could potentially cause my death one day.
Get ready for even more angst. Antibiotic misuse, increasing pollution, increasing occurrences of nano particles in the environment. Climate change. Plastics leaching hormonal analogs. The third - worlding of American medicine (assuming you live in the good ol USA). Nuclear proliferation. Kim Jun-Il. Donald Duck, er Trump.
You're gonna be lucky if you make it 45.
We keep hearing about phage therapy being a possible replacement for antibiotics, but then the news never reappears as actual pharma development. Any idea why?
Because it doesn't really work. The idea is great in the test tube - a specific virus against a specific bacteria. But two problems pop up - we often don't know what the specific bacteria is for a couple of days (until it's grown in culture) or at all in many cases. Then, if you do have a good idea, you have to get this large (megadaltan) thingy into the innermost recesses of the body without said body saying "oh no you don't" and mounting an nice immune response (which can make the original infection worse, see 'cytokine storm').
Maybe, one of these days, researchers will manage to overcome these obstacles, but it has been a long slog with nothing to show for it so far.
And they looked like Sherman tanks and drove like them.....
Speak for yourself. It's raining.
No we could not have. Read Rei's comments above you.
TL;DR - research is hard, unpredictable and expensive. You only solved one of the issues.
We tell them Andromeda Strain was a documentary.
Reuters also deals with video. Video files are so much larger than plain stills that worrying about such file sizes seems absurd. Next up: Reuters limits video files to 100 x 60 pixels?
No he's not missing a thing. It takes seconds to process a RAW file to JPEG. Seconds. It takes longer to figure out WHICH files to send than to process them.
As grcumb points out, this whole thing has a huge dose of cognitive dissonance. What Reuters says and what Reuters ostensibly wants are diametrically opposed.
Because it takes time for the photog to convert the image in off-camera RAW-to-JPG software. It is faster to just give them the JPG right off the camera. They even said why: IT IS FASTER TO GET THE IMAGES TO THE CLIENT.
Horsepucky. Even with a Nikon D800 - one of the highest megapixel 'professional' cameras out there, it takes perhaps 10-15 seconds for any reasonably spec'd laptop to process a RAW file into a JPEG. And as a further bonus, each RAW file carries a (smallish) JPEG built into it that can be extracted automatically.
So speed is not an important aspect of this argument.
OTOH, their contributions to the pension fund tend to run a little light.
I'm not so sure about the ACLU, although their funding drives are close. Pretty much anyone who has to deal with OSHA regulations on a regular basis ends up being treated for PTSD at one time or another.
Right. So where is the "surreptitious administration of drugs (especially LSD), hypnosis, sensory deprivation, isolation, verbal and sexual abuse, as well as various forms of torture"?
I mean really, I haven't seen LSD in ages.
I think that already redirects to boating.com.
And eventually they're going to be flooded out of the market by Chinese manufacturers. There's already plenty of Chinese drones that are cheaper and work just as good as these expensive western made ones.
DJI is a Chinese company, you insensitive clod.
Yes, the fences will be hacked apart. Yes, you can bypass everything. And yes, you can fly in a red zone. At least, on a Phantom, just fly without the GPS. You shouldn't go far but puttering around your back yard will be fine.
What these restrictions WILL do is keep the MAJORITY of brain dead idiots (the 15 year olds that get a Phantom for Christmas) from mindlessly flying their new toy anywhere their multitasking-limited brains think is a good spur-of-the-moment idea. If you have enough brains to bypass the fences, either you are a terrorist or somebody you can trust to think past the next 30 seconds.
Think of it as a test.
Been reading those old Tom Swift novels again, have we?
what a disaster this will be for the ocean life for hundreds or thousands of miles around the site surely, not to mention any coral and deep sealife in the direct area, and whales and other migratory sea animals will be affected too
Hyperbolic much? Hundreds or thousands of miles around the site? They're dredges, not hydrogen bombs. Yes, they will create a mess - as does mining everywhere. It will be fairly localized. And likely remain a rounding error in the grand scheme of horrible things we do to the ocean floor (e.g. trawler fishing).
According to TFA, just the dredger / cutter robots cost $30 million a piece. Plus a purpose built mothership. They are going to have to haul up a whole shitload of high grade ore to pay for those toys.
When in trouble,
Or in doubt,
Run in circles,
Scream and shout.
-- Heinlein