cfu28

I played around with it to build a little "intro to python" walkthrough on my blog a while back. It worked surprisingly well! I had a little trouble giving users the ability to ctrl-c if they accidentally wrote an infinite loop though lol (piodide supports it I just didn't implement it): https://cfu288.com/blog/2024-05_cwc-intro-to-python/

Case studies are used in medical decision making only when there is no better form of evidence available, or there is a gap in current evidence. It is not the first place to look

I think this is a misconception. The reason this phrase is so commonplace is because doctors, and particularly medical students, often consider esoteric disease they learn about in medical school and in part of their training. If doctors are always trained to check for the most common things, then the phrase would not be common in the first place no?

I know nothing about what happened in your fathers case, if it is exactly what you mentioned it sounds a little inappropriate but I’m wondering if something is lost in translation. You do mention he was admitted a few times to the hospital this year alone if I’m reading correctly, which is not normal and I am wondering if he is sicker than you are letting on in your comment.

Are these palliative care doctors and nurses engaging with the patient and your family? One thing they do is ask about code status (full code vs DNR/DNI) and clarify what the wishes of the patient are, help out with legacy planning, make sure everyone is aware of all the possible outcomes (not just death but reduction in QOL), and provide emotional support. Note that this job is not limited to a palliative team, but most patients and families don’t think about these things until it’s too late. CPR can have a pretty poor outcome in many elderly patients and can do more harm then good, so they may just want to make sure you have all the right information. It’s becoming the standard to engage in these talks sooner, not necessarily because they anticipate a poor recovery on this admission but you never know about the next one.

Just FYI and to tie this back to the original article, the physicians taking care of your father have no say in organ donation, it’s a conflict of interest for obvious reasons.

Sure tracking exists, but doctors do not hold back for a patient in comfort care in the inpatient setting, where a patient and their doctor are now optimizing for comfort not quantity of life.

Yes, really. I’ve had to restart my Citrix session to make it go away or dismiss it like the writer did.

You’ll get something like “sepsis criteria triggered by wbc 13, cr 1.5, hr 101, rr 22.” And that’s it - usually in the middle of a night on a new patient I just got a page for. Can’t open documentation to see the patients med history. It’s ridiculous. I’m not using Epic but I am using a major EMR.

To be fair I’ve written almost exactly what you mentioned out of sheer frustration once or twice but it’s not ideal

Most sepsis alert implementations ironically do block review of the data to see if the sepsis is real, what triggered the alert, and what treatments are appropriate. Part of the sepsis recommendations always proposed by the EMR is to give lots and lots of IV fluids, even if the patient is in decompensated heart failure which would make it worse

Have you been on the other side of this? I get dozens of sepsis alerts a day, usually on the same patient, and the criteria that triggers them is so broad and non specific they are functionally useless. Each alert locks down the entire system ironically preventing you from reviewing what triggered it in the first place. You cannot do anything until it is addressed and you are forced to commit to an action without all the data because of it like administer a medication or order fluids, which may not be appropriate. Lots of things mimic sepsis criteria including but not limited to decompensated cirrhosis, HF, cancers, leukemias. The worst is that they don’t even pop up at the right time, they usually pop up usually way after the sepsis has been treated. In the past year, I’ve only had about a half dozen appropriate sepsis pop ups among the hundreds I’ve received.

Obviously not every moment of every hour in a residents day is deep clinical thinking with high cognitive load, but we’re definitely not “zoning out” when making medical decisions. Patient statuses change very quickly and very often in the hospital, and every problem should be re-evaluated like it is a fresh concern. Decisions can be made quicker with more experience but you’re expected to be “on” all the time. Plus, lots of things contribute to cognitive load outside sheer medical decisions - social work, dispo issues, patient preferences, etc. Luckily my residency is closer to 60-70 hours a week but 100 is still common.

Remember - the 80 hour a week limit is not a max limit. It is the max hours per week AVERAGED OVER 4 weeks. You can easily work 100 hours this week if you do 60 the next.

I feel like I keep running into your comments on HN. There are dozens of us!

I struggled with this landscape a few years ago when building Mere Medical to manage my own medical records. To be fair, I was aiming for not just offline-first, but offline-only (user data was exclusively stored on device, not in any server). I got surprisingly far with RxDB, but it definitely felt like I was pushing these tools and the web platform to their limit.

There’s just an assumption that these client databases don’t need mature tools and migration strategies as “it’s just a web client, you can always just re-sync with a server”. Few client db felt mature enough to warrant building my entire app on as they’re not the easiet to migrate off of.

I also tried LokiJS which is mentioned in the OP. I even forked (renamed it SylvieJS lol) it to rewrite it in TS and update some of the adapters. I ultimately moved away from it as well. I found an in memory db will struggle past a few hundred mbs which I hit pretty quickly.

No matter what db you use, you’re realistically using indexed db behind the hood. What surprised me was that a query to indexed db can be slower than a network call. Like what.

While true, this is slightly overblown. I work at a liver transplant center where we treat patients with end stage liver disease and Tylenol is often the safest choice given these patients comorbidities. Granted, they’re getting their liver labs checked 1-2 times a day and are under close supervision but < 2g acetaminophen a day is considered fine. [I am not your doctor this is not medical advice]

I guess I’m confused, A1c is a measurement used for diabetes, not fatty liver/nafld. Can absolutely be correlated with diabetes and elevated A1c but those are two independent things we seem to be talking about

I mean, it is well known that A1c has a 3 month (usually) lag time assuming no hemolytic states. Could have been just caught early depending on what you mean by sugar test

Can't speak for them, but its not super common so they're isn't going to be one answer that represents all doctors in this niche.

For me: Got CS degree in undergrad, worked as a SWE full time for for 2 years, did OSS and some consulting work in med school (0-20hrs/week). Now my work is primarily clinical as a resident ~65 hrs/week, with just 5-10hrs/week on programming.

Yes, that’s why in the medical field we often discuss the sensitivity/specificity/PPV/NPV of these types of tests, and how to interpret them

Ha, I did something similar as a joke with https://aisiteoftheday.foureighteen.dev. Wondering if you did anything special for accessibility and contrast? I found in my examples gpt-4o struggles to generate good text contrast with any text overlaid on a photo.

It might be a prompting skill issue on my end though. Maybe if I cared a bit more I could make provide a tool to the LLM to calculate contrast between two colors and provide it as a tool?

Guessing you’re building off of US Core patient facing API’s for this use case? That’s what I ended up doing for www.meremedical.co

You can build directly with patient facing API’s (USCDI) directly with a patient’s EMR if you’re working with patient data/ building a patient app.

They’re not organ specific, they’re disease specific. Despite all being called cancer, they’re not really the same disease and each variant might express different targets or react differently to the same treatment.

80 hours a week, averaged over a month. So individual weeks can still easily go over to 100+

In the US, there is a cap for residents: 80hrs per week, but averaged over a 4 week period so individual weeks can go over

Re: the lack of a standard privacy policy, its a shame that the Model Privacy Notice (MPN) never really took off as a simple, easy to read, privacy policy standard for health apps.

https://www.healthit.gov/sites/default/files/2018modelprivac...

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The concept of creating a standard viral privacy policy that dictates how your data must be access/stored/secured is super intriguing. I'm imagining a future where this is combined with FHIR - you can link individual FHIR resources to a privacy policy/license, maybe sign the resources so they can't be easily modified. Downstream apps would need to respect the policies before using the data.

I do wonder who would actually push for this though - I care, privacy focused patients would care, but getting adoption might be tough?

https://www.hl7.org/fhir/provenance.html

Probably as part of the meaningful use policy in the US. Early adaptors were initially incentivized to move to EMRs off paper charts.

Today the incentive no longer exists. Instead theres a penalty in the form of reduced Medicare/medicaid reimbursement for practices that don’t comply.

Awesome progress, and incredible how much you’ve been able to do in the past year!

You’re required to do 2 semesters of physics in undergrad to apply for US medical school

I mean, it’s called a operating theater for a reason

That’s residency, which is after medical school.

It depends per school, but 4th year students usually fill their own schedules with electives and rotations. You can definitely fill it in a way to make it as intense for the first three years, but it would likely cause students to start burning out before residency instead of during it.

I am currently on my 4th year rotations and I find them to be some of the most educational, important, and interesting ones. YMMV of course

It was an increased rate of adverse effects due to drug mistakes, which is monitored and easily detected so unlikely due to just an increase in detection