cfu28 · HackerTrans

قبل 4 أشهرdiscuss

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/

cfu28

قبل 4 أشهرdiscuss

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

cfu28

قبل 4 أشهرdiscuss

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?

cfu28

قبل 8 أشهرdiscuss

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.

cfu28

قبل 9 أشهرdiscuss

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.

cfu28

قبل 9 أشهرdiscuss

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

cfu28

قبل 9 أشهرdiscuss

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

cfu28

قبل 9 أشهرdiscuss

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.

cfu28

قبل 10 أشهرdiscuss

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.

cfu28

قبل 10 أشهرdiscuss

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

cfu28

قبل 11 شهرًاdiscuss

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.

cfu28

قبل 11 شهرًاdiscuss

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]