2. nobody will control all of the checklists in the world; medicine already has processes for developing and disseminating best practices and then on an institution-by-institution basis incorporating those into formal policy. Some such processes include medical journals, seminars, consultants, base studies, and so on.
Er. No. See: CMS. Case in point: blood cultures before antibiotic administration in sepsis. That is an absolute requirement for the Sepsis bundle and yet there is NO evidence that two sets of cultures does diddly squat to help outcomes. In fact it may theoretically worsen outcomes because you are dicking around waiting for labs to be drawn before you can give the patient with a BP of 70 and a temp of 104 the IV antibiotics they need.
Doctors won't make these rules, the government will (and has so far in the form of payment incentives and penalties courtesy of CMS.)
Yeah, but doctors are paid metric assloads of money to not make mistakes at least the mistakes that can cost someone their life.
Counting direct patient care and charting time, but not counting required continuing medical education, teaching, administrative work, and other things related to my job that aren't direct care, I make $80/hour pre-tax. Of course I work 60 hours a week in clinical and charting time so I make a decent wage. Though I have taken exactly one vacation of over 4 days in duration since I finished residency in '02 since I support my spouse and his elderly parents. And I still pay $400/month in loans.
That doesn't really seem like a 'metric assload' to me. Its certainly comfortable, and compared to the abject poverty that I was raised in, its fantastic. However, if I were in it for the money, I don't think I would have ever entered medicine. Of course the motivation to be as perfect as possible isn't really the money anyway. If it were, you wouldn't want to be my patient.
It is possible to ensure people do things much more accurately through a system of redundancy. More than one person checking off on a procedure (when time permits). More checks and balances. Automation of arithmetic for calculating dosages. Automation in diagnostics so that a doctor can check he hasn't missed a possible cause for a condition etc.
Great. And your health care costs will rise commensurately.
Though I have no idea what you mean with regards to automation in diagnostics? How the heck do you suggest that this happen given that diagnosis is largely a directed interview with a person augmented by a few elements of the physical exam and sometimes a few lab or imaging studies? I would love the medical Tricorder that they have on Star Trek, but as yet I haven't found that ap for my GPhone.
Also differentiate between petty stuff that will mean a patient is inconvenienced and stuff that will kill a patient.
And that is easy to work out retrospectively. Not so much prospectively. Getting your turkey sandwich with cheese, tomato, and a side of OJ can kill a dialysis patient. So is delivering the right tray to Ms Smith in 201B rather than Ms Jones in 202B a 'big thing' or a 'petty thing'?
They reflexively cry out against 'cookbook' medicine and 'socialized medicine' while ignoring sound scientific advice.
Huh? WTF has concerns about cookbook medicine to do with the need for universal access to health care? I am one of those physicians who reflexively cries out FOR universal health insurance. Of course I don't call that 'socialized medicine' because its not different than our 'socialized' school, EMS, Fire, Police, and Highway systems to name a few.
And while I think that there are a lot of potential problems with 'cookbook medicine' there are also a lot of potential benefits. Its like any tool that can be used to help or hinder the practice of medicine. For example, an EMR that reminds me my diabetic patient is overdue for annual eye screen and should be on an ACE-Inhibitor is a great idea. However if the same system forces my hand on the ACE-I when I know that patient has had multiple episodes of fainting due to low blood pressure (which an ACE-I would exacerbate) its a problem. Similarly, if I spend all my time inputting data into the EMR it becomes more of a hindrance than a help.
In the case of ICU checklists, nurses every year are required to do more and more documentation (an average of 18 pieces of paper for a new non-ICU admission to my hospital) and every checklist or additional page you add to that is taking time away from patient care. So what sounds like a great idea may in fact cause worse outcomes because it puts the nurses focus on a paper rather than their patient.
Of course what I always find to be funny is the very same people who have zero tolerance for any risk or error and decry doctors for an untoward fear of cookbook medicine are the first ones to ask you to depart from standard practice for their personal special case... the antibiotics they want for a virus, the expensive lab test or MRI that is really not necessary, the pricey new drug on TV they want when a safer older drug with a proven track record works just as well. That innate lack of trust of health care providers and assumption of laziness or ill will translates to their own relationships with their physician in different but recognizable ways.
Imagine if the brakes on your car failed just 1% of the time. For every 100 times you brake 1 time you'd just keep going. How many times do you brake on an average 1 hour trip? Sometimes for mission critical systems even 99.999% isn't good enough. It's not just mission critical systems though. What about computers. If they made errors once in 10000, with several billion cycles per second, they'd be unusable.
You are comparing apples to... well not even oranges... to manhole covers. With a computer or a mechanical device it is possible to ensure that failures don't happen 99.999% of the time. With human beings taking actions that is much less reasonable.
Though if you think that is possible, go an entire day without making one single mistake. No misplacing your keys. No forgetting the milk at the store. No traffic tickets. No wrong turns while driving. No spelling mistakes while you are typing. No truthfulness when your girlfriend asks you if she looks fat in this dress. Not. One. Single. Mistake.
Of course one might argue that if something important like a life is on the line, people should be much more careful than they are while shopping or typing a reply on/. That is a reasonable question, but again as soon as there are no more motorcycle accidents, no more drunk drivers, and Vista is taken off the market we can then expect a human being to do any task with 99.9999% perfection.
So when you represent a one-sided view of the argument in your original post it was okay, but when someone presented the other side in a follow-up in a conversation-style thread it's somehow biased?
Presenting one's opinion on a given subject is exactly what you are supposed to do in a conversational thread. However when you say 'I'm not actually going to discuss this' and then do just what you said you weren't its disingenuous and an old rhetorical technique to silence the other side.
"He stated what principles anti-abortion people tend to base their stance on. Doing so is not innately pro or anti abortion. It's just stating a fact,
Ah, that's the Faux news paradigm. Simply state the arguments of one side and you are providing a 'fair and balanced' report. Since of course you only said 'X people believe Y' rather than 'I believe Y.'
The scary part is that conservative whacknuts actually believe that distancing oneself while presenting one sided enumeration of arguments is all one must do is have an unbiased presentation of information.
Absolutely. And I also agree that guns are necessary. But not owned and control by individuals.
I think the police and the military need guns. I even think that hunting rifles may have a place under strict regulation. However just as I don't think that I should be able to create my own standing army, I also don't think that I should be able to own a handgun.
"Equating the killing of an innocent human for no other reason than a desire to do so to the killing of a person threatening ones own life requires either dishonesty or sub-moron intelligence."
And pregnancy absolutely incontrovertibly places the life and health of the mother at risk. The maternal death rate in the US is 1 in 10,000. Pre-eclampsia occurs in 5-8% of pregnancies which can result in stroke, heart failure, kidney failure, and other permanent disabilities. And we know through good epidemiological studies that the risk of abortion is far less.
So even if you consider abortion to be murder, by your own arguments it should be allowed because pregnancy always presents a risk to the life and health of the mother.
"Now I don't care to argue the merits of an abortion."
That's funny, because you do just that. In addition your innocent claim that you don't want to argue the points is a slimy rhetorical technique intended to at best hamstring the opposing view and at worst force that view to be suppressed.
Of course such sophomoric rhetoric is often used by people who can't win an argument based on the merits of their argument alone.
So given that your starting volley is rhetorically sleazy as well as being a logical fallacy extravaganza, I won't debate you on that point. Credulous wingnuts are simply not worth the time.
Well I'm a liberal and I'm not anti-war. I think WWs I and II were a good idea. The US Revolutionary and US Civil War were also necessary and justly undertaken.
I'm just anti-stupid-wars. Like say for example, Iraq.
War is a tool that can be used to good or bad ends. Saying that someone is anti-war is like saying that someone is anti-screwdriver.
Actually that is awesome. And somewhat badass. Though not fraking badass and awesome.
Fraking badass and awesome would be for example when Dr Leonid Rogozov removed his own appendix at Vostok Station in Antarctica in 1961. Of course when your own ass is on the line, your ability to perform suck fraking badass and awesome feats generally increases exponentially.
Er... personally I am always amazed that conservatives heads don't explode from the massive cognitive dissonance.
A kid raped by her father who gets an abortion is a despicable murderer. But... we should arm more people with guns whose only real purpose is to kill another human being.
Life is sacred 'till you're born. Then you're fair game?
There are different definitions of death, though brain death I will agree is the most important. Though perhaps a more important concept is when does brain death occur. Like everything in medicine its not a binary despite the fact that we'd like it to be. People who I would consider brain dead now may perhaps in 20 years be recoverable (through treatments that decrease the reperfusion injury and oxidative stress after return of spontaneous circulation after cardiac arrest.) That speaks to there being a spectrum and a process of death even when you define death as brain death.
Here's a better question: When do you think anyone in their right mind will ok that procedure?
You'd never ok that procedure any more than you would ok having CPR performed. (Though you might leave an advanced directive to prevent it in certain situations.) Its likely something that would be done should you have cardiac arrest in a medical setting (or with fast enough EMS response if it becomes a field treatment.)
Its also likely something that would be done in order to facilitate transfer of a patient who will die quickly without specialized care unavailable at a given facility. For example, you get whacked on the head in an assault an sustain an epidural hematoma (big assed bleeding inside your skull outside your brain that can kill you rapidly by compressing your brain and causing your brainstem to be squeezed out the base of your skull). I diagnose that at my small community ER and plan to transfer you to the big tertiary care center 50 miles away. However as we await the helicopter you suddenly begin to show signs of brainstem herniation. At that point you are dead in minutes without a neurosurgeon. So I place you in suspended animation and we ship you to the surgeon who evacuates your hematoma and then you are reanimated.
Pretty nifty. Though your HMO will probably deny payment because its 'experimental' or only allowed for epidurals on the right side of your head, not the left.
Flu shots haven't been shown to be effective, bicycle helmets seem to increase injuries. You can't plan for random events, you can't even imagine how it's going to go down. Work in a tall building? What's the plan? Have a parachute at work and practice your base-jumping I guess.
Please provide some sources for your wildly inaccurate statements.
Flu vaccination is quite efficatious. Helmets are shown to significantly reduce the risk of injury. And the tall building argument is a poorly conceived strawman. However the plan for working in a tall building might include knowing the best route out and practicing it a few times as well as ensuring that you exercise weekly to have adequate physical fitness to promptly exit the building. Though you aren't the first one to suggest parachutes.
Come on, these pandemic scares happen every fall and it's boy crying wolf at this point.
Wow. I remember that same thing when I lived in New Orleans from 2002-2005. Every time there was a hurricane in the gulf people would be asked to evacuate and idiots like you would decide to stay, since its just the government crying wolf.
You could also make that same argument for using seatbelts. Or helmets. You could point out that 99.9% of the time its totally useless. As an ER doctor, I hear that argument all of the time.
Generally from people on whom I am reducing a fracture or sewing a laceration or prepping for the OR so they can be rid of their pesky little spleen.
The whole point for disaster preparedness and injury prevention is to have something you don't need 99.9% of the time so you can save lives when the time comes that you do need it. You may think its crazy or paranoid, but having been the ER chief resident in Brooklyn's largest trauma center on September 11, 2001 and having narrowly missed Katrina call me an overcautious kinda guy... But I've seen the results of shitty planning and blase attitudes like yours before.
So stop whining, get your flu shot, wear your seatbelt and helmet, and make sure you have a personal plan for when the shit hits the fan. You don't have to encase your house in plastic sheeting and duct tape, wear a tin foil hat, and have a mound of guns in your fallout shelter basement. But having a plan and a small emergency kit is a good idea for anyone.
Well first, you can outlast epidemics by hiding long enough. For you to get be likely to get infected you need a certain amount of the bug in circulation. If you wait till that strain has gone through you may dodge the bullet. (Think about people who are thirty who get a primary varicella (chicken pox) infection. They dodged that bullet for many years (often by chance) even though VZV is always out there.
Given the example of avian influenza, the time that you get infected also changes the likelihood that you will die. If there is a major first wave that kills large volumes, that would be the time to definitely want to avoid infection. First off, we have less chance of knowing the best treatments early on in an epidemic. Treatment of a new (or newly changed) illness is developed as we gain experience with it. For example, survival in the first wave of the AIDS epidemic was abysmal while now it is markedly better.
Secondly, when there are high volumes of patients in the initial wave, your chance of getting that ICU spot, omseltavir, or a ventillator should you need one are slim. If you get it later when the demand is less, you stand a better chance of having the resources necessary to give you the best chance of survival. In addition, until you get a cadre of health care providers who survived the infection, people will be less willing to get 'up close and personal' to provide you care.
So there is a definite advantage of not being in the middle of the big bulge of sick folks. Even if your infection is inevitable, you'd like to get it when we know more and have more resources mobilized. Plus if you wait long enough we might just get an effective vaccine.
Titanium is very cool (and is what my band is made out of), and don't believe the FUD about it, it is safe, emergency rooms have equipment to cut through it if needed (they don't have to cut off your finger as one jeweler claimed....)
No. Believe the FUD. I cut off a titanium band once before. It broke my ring cutter and two others and took about a half hour total time (not including getting the fire department to cough up theirs) to get it off.
It doesn't mean you shouldn't get one, but know what you are getting into. Also, if you wear a titanium band carry a small packet of antibiotic ointment in your wallet. If you clobber your finger or hand, get the ring off immediately and don't wait for the swelling to set in. If it won't come off, use the ointment to help. (The antibiotic part doesn't help. Its the vaseline that does the greasing, but they make small packets of the antibiotic ointment you can stuff in your wallet.)
How can a study that shows significance have too small a sample size? That makes no sense whatsoever!
If the statistically significant difference is a clinically insignificant measure.
Let me give you an example. We test two drugs for hypertension to see if we find a difference in efficacy. We find that there is a statistically significant difference in the mean systolic BP in these two groups. Drug A gives a mean SBP of 120 and Drug B gives a mean of 125. This 5mmHg difference is significantly different because we did a study with n=1000.
However, when we look at clinically significant endpoints (stroke, heart disease, renal failure, which is what we are trying to prevent by controlling BP) we find that there is no statistically significant difference between the groups.
So that study had significant power to prove a significant difference between a clinically insignificant surrogate endpoint but was underpowered to find a statistically significant difference in a clinically significant endpoint.
And while surrogate endpoints can be suggestive they can be misleading. For example when I was in med school I remember being taught that estrogen was protective against heart disease in post menopausal women because it improved the lipid profile (a surrogate endpoint for heart disease.) However when we finally did a study of estrogen in post menopausal women that was adequately powered to show a difference in the real endpoint of heart disease, we found that estrogen actually slightly increases the risk.
In this case they found a statistically significant difference in a surrogate endpoint, but when you look at clinically significant endpoints (death, permanent disability) there was no difference. I don't give a rats ass what the number of the reading of your BP is. I care whether you have a heart attack or stroke. So yes, it was underpowered.
That's about as correct as trickle down economics. If you spend your money on copycat drugs and drugs for obesity and erectile dysfunction, the research on TB, HIV, and new antibiotics doesn't get done. The money goes where the $ is.
The problem is that this is not really a good demonstration of the efficacy of telemedicine, because they picked a treatment for which there is a marginal benefit for a very small proportion of people. In order to get thrombolytics for stroke, you have to meet a certain set of criteria that in my experience few meet: no recent trauma or surgery, normal blood pressure, no history of stroke in the past 3 months (or hemorrhagic stroke ever), no current ulcer disease, no diabetic retinopathy, no seizures, deficit is more than minor but not too major, certain onset of symptoms in under 3 hours (and it will take an hour to get you imaged and blood tests done after you get to the ER), and a lot more.
In addition, if we give you thrombolytics for your stroke (and you are an ideal candidate) you get a 13% greater chance to recover with minimal or no deficit, but you have a 7% greater chance of your stroke getting phenomenally worse by becoming a hemorrhagic stroke which more often than not leave you dead or in a permanent vegetative state (in addition to all the other problems you can get from being completely incapable of clotting for a good 24 hours.)
What they should do is demonstrate this where it could be really useful: with a NP or PA way off in the hinterlands or in underdeveloped countries. But that isn't snazzy, doesn't pay well, and drug companies that sell gazillion dollars a pop medicines don't sponsor it.
There has never yet been a 13-locus match seen between unrelated people in the national database- despite the 5 million or so profiles currently in it. I'm sure the average Slashdot reader can manage to work out how many pairwise comparisons that is. (Hint- it's a pretty fucking big number.)
Well it seems that your statement of 'never' is simply because that comparison has not been run, since the FBI is doing everything possible to prevent testing of that theory. If its so unimaginably rare, it would seem that the FBI would be all for doing these searches to bolster the value of their evidence. However the results in MD would seem to challenge that dogma.
A 9-locus match between unrelated people is not surprising. That's why we don't sue only 9 loci, idiots!
Well it seems that California prosecutors are idiots and were using a 9 locus match to prosecute a man for a 2 decade old murder. From TFA: "Its implications became clear as she prepared to defend a client accused of a 20-year-old rape and murder. A database search had found a nine-locus match between his DNA profile and semen found in the victim's body. Based on FBI estimates, the prosecutor said the odds of a coincidental match were as remote as 1 in 108 trillion." So just to explain why we 'idiots' would use a 9 locus match: DNA collected at a crime scene is not a complete genome. Often it is only fragments. You may not have a full 13 loci to check because the fragment you have would not cover all 13 loci. There is, however a statistical nicety here that you've completely side-stepped in your haste to call us morons (which TFA mentions). The likelihood of finding matches of 9 of the 9 you have in your genome fragment is far less than the likelihood of finding any two people in a database with 9 of any 9 of 13 loci that match.
Slashdot Mirror
Er. No. See: CMS. Case in point: blood cultures before antibiotic administration in sepsis. That is an absolute requirement for the Sepsis bundle and yet there is NO evidence that two sets of cultures does diddly squat to help outcomes. In fact it may theoretically worsen outcomes because you are dicking around waiting for labs to be drawn before you can give the patient with a BP of 70 and a temp of 104 the IV antibiotics they need.
Doctors won't make these rules, the government will (and has so far in the form of payment incentives and penalties courtesy of CMS.)
Counting direct patient care and charting time, but not counting required continuing medical education, teaching, administrative work, and other things related to my job that aren't direct care, I make $80/hour pre-tax. Of course I work 60 hours a week in clinical and charting time so I make a decent wage. Though I have taken exactly one vacation of over 4 days in duration since I finished residency in '02 since I support my spouse and his elderly parents. And I still pay $400/month in loans.
That doesn't really seem like a 'metric assload' to me. Its certainly comfortable, and compared to the abject poverty that I was raised in, its fantastic. However, if I were in it for the money, I don't think I would have ever entered medicine. Of course the motivation to be as perfect as possible isn't really the money anyway. If it were, you wouldn't want to be my patient.
Great. And your health care costs will rise commensurately.
Though I have no idea what you mean with regards to automation in diagnostics? How the heck do you suggest that this happen given that diagnosis is largely a directed interview with a person augmented by a few elements of the physical exam and sometimes a few lab or imaging studies? I would love the medical Tricorder that they have on Star Trek, but as yet I haven't found that ap for my GPhone.
And that is easy to work out retrospectively. Not so much prospectively. Getting your turkey sandwich with cheese, tomato, and a side of OJ can kill a dialysis patient. So is delivering the right tray to Ms Smith in 201B rather than Ms Jones in 202B a 'big thing' or a 'petty thing'?
Huh? WTF has concerns about cookbook medicine to do with the need for universal access to health care? I am one of those physicians who reflexively cries out FOR universal health insurance. Of course I don't call that 'socialized medicine' because its not different than our 'socialized' school, EMS, Fire, Police, and Highway systems to name a few.
And while I think that there are a lot of potential problems with 'cookbook medicine' there are also a lot of potential benefits. Its like any tool that can be used to help or hinder the practice of medicine. For example, an EMR that reminds me my diabetic patient is overdue for annual eye screen and should be on an ACE-Inhibitor is a great idea. However if the same system forces my hand on the ACE-I when I know that patient has had multiple episodes of fainting due to low blood pressure (which an ACE-I would exacerbate) its a problem. Similarly, if I spend all my time inputting data into the EMR it becomes more of a hindrance than a help.
In the case of ICU checklists, nurses every year are required to do more and more documentation (an average of 18 pieces of paper for a new non-ICU admission to my hospital) and every checklist or additional page you add to that is taking time away from patient care. So what sounds like a great idea may in fact cause worse outcomes because it puts the nurses focus on a paper rather than their patient.
Of course what I always find to be funny is the very same people who have zero tolerance for any risk or error and decry doctors for an untoward fear of cookbook medicine are the first ones to ask you to depart from standard practice for their personal special case... the antibiotics they want for a virus, the expensive lab test or MRI that is really not necessary, the pricey new drug on TV they want when a safer older drug with a proven track record works just as well. That innate lack of trust of health care providers and assumption of laziness or ill will translates to their own relationships with their physician in different but recognizable ways.
You are comparing apples to... well not even oranges... to manhole covers. With a computer or a mechanical device it is possible to ensure that failures don't happen 99.999% of the time. With human beings taking actions that is much less reasonable.
/. That is a reasonable question, but again as soon as there are no more motorcycle accidents, no more drunk drivers, and Vista is taken off the market we can then expect a human being to do any task with 99.9999% perfection.
Though if you think that is possible, go an entire day without making one single mistake. No misplacing your keys. No forgetting the milk at the store. No traffic tickets. No wrong turns while driving. No spelling mistakes while you are typing. No truthfulness when your girlfriend asks you if she looks fat in this dress. Not. One. Single. Mistake.
Of course one might argue that if something important like a life is on the line, people should be much more careful than they are while shopping or typing a reply on
Presenting one's opinion on a given subject is exactly what you are supposed to do in a conversational thread. However when you say 'I'm not actually going to discuss this' and then do just what you said you weren't its disingenuous and an old rhetorical technique to silence the other side.
"He stated what principles anti-abortion people tend to base their stance on. Doing so is not innately pro or anti abortion. It's just stating a fact,
Ah, that's the Faux news paradigm. Simply state the arguments of one side and you are providing a 'fair and balanced' report. Since of course you only said 'X people believe Y' rather than 'I believe Y.'
The scary part is that conservative whacknuts actually believe that distancing oneself while presenting one sided enumeration of arguments is all one must do is have an unbiased presentation of information.
Very Scary.
Absolutely. And I also agree that guns are necessary. But not owned and control by individuals.
I think the police and the military need guns. I even think that hunting rifles may have a place under strict regulation. However just as I don't think that I should be able to create my own standing army, I also don't think that I should be able to own a handgun.
"Equating the killing of an innocent human for no other reason than a desire to do so to the killing of a person threatening ones own life requires either dishonesty or sub-moron intelligence."
And pregnancy absolutely incontrovertibly places the life and health of the mother at risk. The maternal death rate in the US is 1 in 10,000. Pre-eclampsia occurs in 5-8% of pregnancies which can result in stroke, heart failure, kidney failure, and other permanent disabilities. And we know through good epidemiological studies that the risk of abortion is far less.
So even if you consider abortion to be murder, by your own arguments it should be allowed because pregnancy always presents a risk to the life and health of the mother.
"Now I don't care to argue the merits of an abortion."
That's funny, because you do just that. In addition your innocent claim that you don't want to argue the points is a slimy rhetorical technique intended to at best hamstring the opposing view and at worst force that view to be suppressed.
Of course such sophomoric rhetoric is often used by people who can't win an argument based on the merits of their argument alone.
So given that your starting volley is rhetorically sleazy as well as being a logical fallacy extravaganza, I won't debate you on that point. Credulous wingnuts are simply not worth the time.
Well I'm a liberal and I'm not anti-war. I think WWs I and II were a good idea. The US Revolutionary and US Civil War were also necessary and justly undertaken.
I'm just anti-stupid-wars. Like say for example, Iraq.
War is a tool that can be used to good or bad ends. Saying that someone is anti-war is like saying that someone is anti-screwdriver.
What it is is fraking badass and awesome.
Actually that is awesome. And somewhat badass. Though not fraking badass and awesome.
Fraking badass and awesome would be for example when Dr Leonid Rogozov removed his own appendix at Vostok Station in Antarctica in 1961. Of course when your own ass is on the line, your ability to perform suck fraking badass and awesome feats generally increases exponentially.
Er... personally I am always amazed that conservatives heads don't explode from the massive cognitive dissonance.
A kid raped by her father who gets an abortion is a despicable murderer. But... we should arm more people with guns whose only real purpose is to kill another human being.
Life is sacred 'till you're born. Then you're fair game?
I'd confidently wager that you wouldn't be living if your brain did not work at all.
President Bush is a zombie?!?
There are different definitions of death, though brain death I will agree is the most important. Though perhaps a more important concept is when does brain death occur. Like everything in medicine its not a binary despite the fact that we'd like it to be. People who I would consider brain dead now may perhaps in 20 years be recoverable (through treatments that decrease the reperfusion injury and oxidative stress after return of spontaneous circulation after cardiac arrest.) That speaks to there being a spectrum and a process of death even when you define death as brain death.
Here's a better question: When do you think anyone in their right mind will ok that procedure?
You'd never ok that procedure any more than you would ok having CPR performed. (Though you might leave an advanced directive to prevent it in certain situations.) Its likely something that would be done should you have cardiac arrest in a medical setting (or with fast enough EMS response if it becomes a field treatment.)
Its also likely something that would be done in order to facilitate transfer of a patient who will die quickly without specialized care unavailable at a given facility. For example, you get whacked on the head in an assault an sustain an epidural hematoma (big assed bleeding inside your skull outside your brain that can kill you rapidly by compressing your brain and causing your brainstem to be squeezed out the base of your skull). I diagnose that at my small community ER and plan to transfer you to the big tertiary care center 50 miles away. However as we await the helicopter you suddenly begin to show signs of brainstem herniation. At that point you are dead in minutes without a neurosurgeon. So I place you in suspended animation and we ship you to the surgeon who evacuates your hematoma and then you are reanimated.
Pretty nifty. Though your HMO will probably deny payment because its 'experimental' or only allowed for epidurals on the right side of your head, not the left.
Flu shots haven't been shown to be effective, bicycle helmets seem to increase injuries. You can't plan for random events, you can't even imagine how it's going to go down. Work in a tall building? What's the plan? Have a parachute at work and practice your base-jumping I guess.
Please provide some sources for your wildly inaccurate statements.
Flu vaccination is quite efficatious. Helmets are shown to significantly reduce the risk of injury. And the tall building argument is a poorly conceived strawman. However the plan for working in a tall building might include knowing the best route out and practicing it a few times as well as ensuring that you exercise weekly to have adequate physical fitness to promptly exit the building. Though you aren't the first one to suggest parachutes.
Come on, these pandemic scares happen every fall and it's boy crying wolf at this point.
Wow. I remember that same thing when I lived in New Orleans from 2002-2005. Every time there was a hurricane in the gulf people would be asked to evacuate and idiots like you would decide to stay, since its just the government crying wolf.
You could also make that same argument for using seatbelts. Or helmets. You could point out that 99.9% of the time its totally useless. As an ER doctor, I hear that argument all of the time.
Generally from people on whom I am reducing a fracture or sewing a laceration or prepping for the OR so they can be rid of their pesky little spleen.
The whole point for disaster preparedness and injury prevention is to have something you don't need 99.9% of the time so you can save lives when the time comes that you do need it. You may think its crazy or paranoid, but having been the ER chief resident in Brooklyn's largest trauma center on September 11, 2001 and having narrowly missed Katrina call me an overcautious kinda guy... But I've seen the results of shitty planning and blase attitudes like yours before.
So stop whining, get your flu shot, wear your seatbelt and helmet, and make sure you have a personal plan for when the shit hits the fan. You don't have to encase your house in plastic sheeting and duct tape, wear a tin foil hat, and have a mound of guns in your fallout shelter basement. But having a plan and a small emergency kit is a good idea for anyone.
Well first, you can outlast epidemics by hiding long enough. For you to get be likely to get infected you need a certain amount of the bug in circulation. If you wait till that strain has gone through you may dodge the bullet. (Think about people who are thirty who get a primary varicella (chicken pox) infection. They dodged that bullet for many years (often by chance) even though VZV is always out there.
Given the example of avian influenza, the time that you get infected also changes the likelihood that you will die. If there is a major first wave that kills large volumes, that would be the time to definitely want to avoid infection. First off, we have less chance of knowing the best treatments early on in an epidemic. Treatment of a new (or newly changed) illness is developed as we gain experience with it. For example, survival in the first wave of the AIDS epidemic was abysmal while now it is markedly better.
Secondly, when there are high volumes of patients in the initial wave, your chance of getting that ICU spot, omseltavir, or a ventillator should you need one are slim. If you get it later when the demand is less, you stand a better chance of having the resources necessary to give you the best chance of survival. In addition, until you get a cadre of health care providers who survived the infection, people will be less willing to get 'up close and personal' to provide you care.
So there is a definite advantage of not being in the middle of the big bulge of sick folks. Even if your infection is inevitable, you'd like to get it when we know more and have more resources mobilized. Plus if you wait long enough we might just get an effective vaccine.
Titanium is very cool (and is what my band is made out of), and don't believe the FUD about it, it is safe, emergency rooms have equipment to cut through it if needed (they don't have to cut off your finger as one jeweler claimed....)
No. Believe the FUD. I cut off a titanium band once before. It broke my ring cutter and two others and took about a half hour total time (not including getting the fire department to cough up theirs) to get it off.
It doesn't mean you shouldn't get one, but know what you are getting into. Also, if you wear a titanium band carry a small packet of antibiotic ointment in your wallet. If you clobber your finger or hand, get the ring off immediately and don't wait for the swelling to set in. If it won't come off, use the ointment to help. (The antibiotic part doesn't help. Its the vaseline that does the greasing, but they make small packets of the antibiotic ointment you can stuff in your wallet.)
How can a study that shows significance have too small a sample size? That makes no sense whatsoever!
If the statistically significant difference is a clinically insignificant measure.
Let me give you an example. We test two drugs for hypertension to see if we find a difference in efficacy. We find that there is a statistically significant difference in the mean systolic BP in these two groups. Drug A gives a mean SBP of 120 and Drug B gives a mean of 125. This 5mmHg difference is significantly different because we did a study with n=1000.
However, when we look at clinically significant endpoints (stroke, heart disease, renal failure, which is what we are trying to prevent by controlling BP) we find that there is no statistically significant difference between the groups.
So that study had significant power to prove a significant difference between a clinically insignificant surrogate endpoint but was underpowered to find a statistically significant difference in a clinically significant endpoint.
And while surrogate endpoints can be suggestive they can be misleading. For example when I was in med school I remember being taught that estrogen was protective against heart disease in post menopausal women because it improved the lipid profile (a surrogate endpoint for heart disease.) However when we finally did a study of estrogen in post menopausal women that was adequately powered to show a difference in the real endpoint of heart disease, we found that estrogen actually slightly increases the risk.
In this case they found a statistically significant difference in a surrogate endpoint, but when you look at clinically significant endpoints (death, permanent disability) there was no difference. I don't give a rats ass what the number of the reading of your BP is. I care whether you have a heart attack or stroke. So yes, it was underpowered.
There are, Look at Google Scholar, and google yeast infrecion, otitis medicne, sinusitis, etc
That's about as correct as trickle down economics. If you spend your money on copycat drugs and drugs for obesity and erectile dysfunction, the research on TB, HIV, and new antibiotics doesn't get done. The money goes where the $ is.
But not because of this.
The problem is that this is not really a good demonstration of the efficacy of telemedicine, because they picked a treatment for which there is a marginal benefit for a very small proportion of people. In order to get thrombolytics for stroke, you have to meet a certain set of criteria that in my experience few meet: no recent trauma or surgery, normal blood pressure, no history of stroke in the past 3 months (or hemorrhagic stroke ever), no current ulcer disease, no diabetic retinopathy, no seizures, deficit is more than minor but not too major, certain onset of symptoms in under 3 hours (and it will take an hour to get you imaged and blood tests done after you get to the ER), and a lot more.
In addition, if we give you thrombolytics for your stroke (and you are an ideal candidate) you get a 13% greater chance to recover with minimal or no deficit, but you have a 7% greater chance of your stroke getting phenomenally worse by becoming a hemorrhagic stroke which more often than not leave you dead or in a permanent vegetative state (in addition to all the other problems you can get from being completely incapable of clotting for a good 24 hours.)
What they should do is demonstrate this where it could be really useful: with a NP or PA way off in the hinterlands or in underdeveloped countries. But that isn't snazzy, doesn't pay well, and drug companies that sell gazillion dollars a pop medicines don't sponsor it.
There has never yet been a 13-locus match seen between unrelated people in the national database- despite the 5 million or so profiles currently in it. I'm sure the average Slashdot reader can manage to work out how many pairwise comparisons that is. (Hint- it's a pretty fucking big number.)
Well it seems that your statement of 'never' is simply because that comparison has not been run, since the FBI is doing everything possible to prevent testing of that theory. If its so unimaginably rare, it would seem that the FBI would be all for doing these searches to bolster the value of their evidence. However the results in MD would seem to challenge that dogma.
A 9-locus match between unrelated people is not surprising. That's why we don't sue only 9 loci, idiots!
Well it seems that California prosecutors are idiots and were using a 9 locus match to prosecute a man for a 2 decade old murder. From TFA: "Its implications became clear as she prepared to defend a client accused of a 20-year-old rape and murder. A database search had found a nine-locus match between his DNA profile and semen found in the victim's body. Based on FBI estimates, the prosecutor said the odds of a coincidental match were as remote as 1 in 108 trillion." So just to explain why we 'idiots' would use a 9 locus match: DNA collected at a crime scene is not a complete genome. Often it is only fragments. You may not have a full 13 loci to check because the fragment you have would not cover all 13 loci. There is, however a statistical nicety here that you've completely side-stepped in your haste to call us morons (which TFA mentions). The likelihood of finding matches of 9 of the 9 you have in your genome fragment is far less than the likelihood of finding any two people in a database with 9 of any 9 of 13 loci that match.