Some medications are prescribed with this taken into account actually.
For example if a medication has sedating effects (such as some antidepressants) it may be advised to be taken before bed so this side effect is turned into something generally beneficial (more sleep) and less prevalent during waking hours).
Statins (cholesterol lowering medications) are usually prescribed at night time as this is when your cholesterol catabolism is most active.
Pain relief is often varied around sleep schedules
Things like insulin may be driven by life events and as needed. But I'm talking about regularly scheduled medication.
Antidepressants may be advisable to take before bed as a rule, but it's an excellent example of drugs that are supposed to be taken at the same time every day. Irregularly moving around the hour you take the antidepressant makes them less likely to work.
That's why irregular sleep schedules aren't a good reason to move medication.
UK pharmacists are able to to do blister packs but this is a hugely labour intensive endeavour. Specific quantities of each medication need to be dispensed, placed in the correct pocket, checked and double checked. Compared to dispensing a factory sealed box of $X units. As a manual process it does not scale to providing this service for more than a small percentage of patients where the benefit is greatest (memory impairment, etc).
Also in my experience pharmacists dislike having to do this laborious process.
It's a different model to what you are used to and IMHO more flexible and powerful. If you try and keep operating in a manner learned on a different model you will inevitably be frustrated.
OK so now we have to issue a series of hotkeys (and then another series to undo them) in order to achieve what only requires half those actions on other systems.
There has been no evidence provided to show how this design is "more flexible and powerful," since all the same options exist on Windows, which ALSO offers other options that require half the steps to achieve app-switching.
That’s why I just cmd+(shift+)tab and cmd+(shift+)`. No need to use a mouse and it doesn’t bother me that the window stays in the background. Most apps run in full screen anyway. Same with windows: alt+tab (citrix…) is the way to go.
I haven’t minimised a window in months. For those special needs, there’s expose.
Many of these structures have concrete channels downstream of the weir which means that the stopper/keeper/recirculating water is equally strong across the width of the river. It can also be extremely hard to swim with any sort of accuracy due to being constantly recirculated and not-very buoyant due to the entrained air.
There are other subtleties in 3D as well; some weirs form a downstream-pointing V when viewed from above the dam - these are generally considered safer as the currents will (generally) move you to the middle of the river and downstream where the water is more likely to be escapable - see [1].
Others can form an upstream-pointing V which has the opposite effect where the currents will move you towards the middle of the river but upstream back towards the stopper/keeper/hydraulic.
What a bizarre comment. Every patient who goes under general anaesthesia for surgery (life saving or otherwise) is ventilated and usually without issue.
“Laying tubes into the trachea” I presume refers to tracheostomy.
Let’s be realistic here - if you are requiring a tracheostomy and ventilator, or ECMO the you are severely unwell. A blood transfusion, or small risk of infection is the least of your worries at that point.
As with everything in medicine there is a risk:benefit ratio. If you need ECMO you literally cannot oxygenate your own blood even with a ventilator. No ECMO = you die.
I think there are a significant number of general anesthesia patients who don't get intubated, but the big issue is that being intubated for four hours is very different from being intubated for two weeks, which is very likely to kill you. (And, yes, not breathing will also kill you. But intubation was working so badly that hospitals developed proning protocols for covid patients as a less fatal alternative which was less likely to kill them.)
If squirting oxygenated perfluorodecane up your ass for two weeks can keep you alive more often than proning or intubation, that'd be a great improvement. Could save a lot of lives. Buy Dow Chemical stonks.
In general it's true that being on a ventilator for two weeks carries a high mortality, but that's largely due to being sick enough to require ventilation for that duration. Presumably without effective oxygenation or airway protection, these people would have died before the two week mark. COVID pneumonia presents a special case. Early on the thinking was that noninvasive ventilation with bipap etc would promote spread of the virus, so the recommendation was to proceed earlier to intubation. In retrospect this did appear to lead to higher mortality, likely related to ventilator associated pneumonia and sedation and paralytic drugs. So we've returned to a more ordinary stance where intubation is a last resort. So, intubation is bad, but for most circumstances, it beats a trip to the morgue.
Getting in a car is fraught with peril. Every time somebody gets in a vehicle they're dicing with death.
I think it's important to contextualise the risk. The risk of dying from an anaesthetic is about 1 in 100,000. Compare with risk of dying in a car accident in a given year for example.
And again, it comes down to risk:benefit. Anaesthetics are not given out willy-nilly. The reason for the anaesthetic is considered along with the patient's co-morbidities and personal physiological parameter where relevant. Based on this a reasonable estimate of the personalised risks for that patient for that operation can be given for the patient to choose if they wish to proceed or not.
> Let’s be realistic here - if you are requiring a tracheostomy and ventilator, or ECMO the you are severely unwell.
Obviously. So why use these invasive procedures if a less invasive one could do the job with less risk?
> A blood transfusion, or small risk of infection is the least of your worries at that point.
Did you come straight from the 19th century or something? Hospital acquired infections kill hundreds of thousands of people every year. That's hardly a small worry.
> As with everything in medicine there is a risk:benefit ratio.
No shit. That's why there's interest in alternative procedures with less risk for the same benefit.
> If you need ECMO you literally cannot oxygenate your own blood even with a ventilator.
Unless… there's a new method that bypasses the lungs. Did you read the linked article?
Clearly if anal oxygen proves to be safer and as effective then it will be adopted. No one is disputing that.
My comment was regarding your expletive laden derision of devices which save hundreds of thousands of lives.
And you seem to have missed the point. I did. It say hospital acquired infections are not prevalent or problematic. My point was that every decision in medicine s based on risk and benefit. If you need ECMO you will almost certainly die without it. If you have ECMO there is a compratively small risk of infection that may kill you.
And yes thanks, I did read the article. I’m also a doctor and have spent many months working in ITU, anaesthesia, and operating theatres, and managing acutely unwell COVID-19 patients.
Let us all be glad you’re not making any treatment decisions.
> Clearly if anal oxygen proves to be safer and as effective then it will be adopted. No one is disputing that.
Could've fooled me with how dismissive you were.
> My point was that every decision in medicine s based on risk and benefit.
Then there should be no problem with highlighting the risks so people realise that alternatives are worth it not just as somehow inferior "second standard" as implied by the person I was replying to, but as equal or better solution.
To clarify for you (again), my comment was regarding your unfounded derision of existing, proven, lifesaving technologies—I was not dismissing of the technique proposed in the article.
I don't think _"F### ventilators. They damage the patient's lungs, and laying tubes into the trachea requires traumatic surgery and carries significant secondary infection risk"_ is really offering an informed or balanced discussion of the risks and benefits of intubation and ventilation hence my initial reply.
On the contrary, this offers an emotive, highly negative, and uninformed opinion with no balance. We are in a time of a global pandemic with the general public now aware of intubation, ventilation, ECMO, CPAP, BiPAP, and other respiratory interventions. Many people and/or their families are having to face or consider these interventions. Your comment is potentially harmful.
Against to be clear, the medical profession is (spoiler alert) acutely aware of the risks and negatives of ventilation, including extended ventilation, ECMO, surgical and percutaneous traches, and every other intervention that is offered. These risks are discussed with patients and families who often lack the domain expertise, it therefore being part of the role of the doctor to explain to the best of their knowledge what options the patient has before them and likely outcomes of the different options. Ultimately (ideally) the patient makes a decision for themselves based on this information.
You can be sure that the nuanced and balanced discussion is a little more informative than "F### ventilators".
If someone gets their health advice off Hackernews comments I'd say they need a psychiatrist first.
Yes, they're the least bad treatment options we have right now, I can still be hyped about potential improvements.
> You can be sure that the nuanced and balanced discussion is a little more informative than "F### ventilators".
I'd rather hope so. I've had to ask "so what health risks were you supposed to inform me about according to the form you want me to sign?" way too many times.
> Heavier, slower aircraft make stronger turbulence
Is it the weight of aircraft that contributes to the wake turbulence or the physical size? Presumably these usually correlate pretty well but just asking for clarity…
I'm a doctor, and whilst I despise carrying a pager it does have some benefits over more modern alternatives in some scenarios.
Mobile (cell) reception in hospitals is generally very poor and wifi connectivity is also generally poor. Trying to rely on either of those to deliver critical communication (e.g. bleeps to the crash team to respond to a cardiac arrest) is more unreliable than the hospital blasting a simple radio signal that any pagers within a few mile radius will always receive and decode appropriately.
For less critical communications (e.g. where you might bleep someone to contact them to a refer a patient to their specialty) there is a (slow) move towards messaging apps or email. These solutions do not yet have the immediacy and reliability of a simple pager for critical applications.
I'm curious about the use of pagers in healthcare. I work in an industry that would love to have pagers for on call events, but service has proven unreliable (especially indoors) unless you build out your own dedicated wireless infrastructure for every building you are working in.
We have alternative secure voice/data communication, but they tend to either be bulky or have strict storage and carry restrictions.
Would love a small reliable pager system to carry on our person that would simply let us know to check in.
All of the pager architecture in the US seems to have disappeared in the marketplace.
Seems like it'd be a plausible (small) business idea. A $10 SDR stick with a piece of wire as an antenna is enough to pick up pager signals, and I doubt you'd need a much more advanced setup to transmit. A 100 or 400 MHz license in the US costs maybe $500 for a decade. Mounted at the right spot, you wouldnt need much power to cover a large area with a single transmitter, though basements are always going to be trouble.
My point was the technology is cheap - there are certainly better dedicated, inexpensive chips that could be used to make a simple wireless messaging system.
I'm curious what personal health information would be transmitted via a pager anyway? I assume a doctor would only need to know a room number and maybe code or chief complaint in the page?
I see other commenters mentioning some PHI is being shared via pagers and I am unclear what that may be ?
In my experience (UK) there is no personal information transmitted. There are two main types of bleeps:
1. Sending the number of a telephone extension you want the recipient of the bleep to call. For example, if I need a cardiology opinion, I will bleep the cardiologist with a telephone extension and wait for them to (hopefully) call back while I am still but he phone and before it is called by anyone else. This data is not sensitive. These are the types of bleeps which are being replaced slowly by asynchronous communication via apps
2. Emergency bleeps which are designed to alert a specific group of people on the arrest team to respond to an emergency. These usually work quite differently. Instead of 1:1 they are 1:many and usually carry a different alert tone, followed by a (generally poor quality) audio alert of the operator saying something like "paediatric cardiac arrest inbound to ED, ETA, 5 minutes". Again these carry no sensitive data.
Pagers get used for PII, and if somebody thinks it doesn't happen, they're simply confident that their experience is representative. It happens, and quite frequently, in Canada.
Yeah what you linked me to talks about I believe the same case another user already linked to. It was more correct for me to say I was speaking more about the Ontario, Canada healthcare system as that is the one I work within. The healthcare systems are mostly run at the provincial level so it can be hard to talk about the countries healthcare as a whole as it can often vary province to province.
I’ve listened to pages in large Canadian cities in the past for fun. Pages at the local hospital often included patient names and diagnosis or analysis results.
Yeah from what it sounds like there were some incidents in the news in BC in 2019 and it sounds like a lot of hospitals may have adopted new procedures since then? Not sure if you've been listening to any recent ones?
It's kinda hard also to figure out which areas may be doing it and which aren't as the different provinces are kinda run independently.
Weird, as the other commenter mentioned their's in the UK don't have patient information in them. In fact the medical professional I know in Canada have pagers that give essentially the same information about the UK commenters. It's either an extension to call, or for a code.
Maybe countries like the UK and Canada are more strict about personal health information and have kept personal info out of pagers? I know working in healthcare systems in Canada I would get in trouble even if I used a medical software to look myself up in it.
Ah, interesting. The only people I've actually talked to before about the pagers were from Ontario and the healthcare is mostly managed at the provincial level. So not sure if this was a problem in Ontario or not. I am sure at some point all the hospitals were doing this and eventually switched over to the new way that doesn't do this.
However being a 911 dispatcher for the EMS system here I can say that our radios are not encrypted and can be listened to online by anyone. We mention addresses, chief complaints, and anything else that may be relevant for the paramedics. Patient names would not be given over radios nor would other private info like if the building has an access code. Anything that is private like that is indicated to the paramedics by saying something like "call for access code". Then they call the landline and get the info that way.
In my opinion though, knowing addresses and medical conditions going on can still be a bit sensitive in nature. The police here recently switched to encrypted radios. It was nice sometimes to listen to the scanner, but at the same time it's understandable why it's less than ideal having open radios.
Ah yes - sorry, I read that too quickly. The answer to that (at least limited to my experience of pagers in many UK hospitals) is that they don't carry any sensitive data at all.
There are a lot of other issues with them though. There are few companies supplying them so they are actually very expensive. Consequently in our publicly funded health service they are not replaced often and many are in a poor state with batteries held in by tape etc.
The main issues from perspective as a user is the synchronous model of communication that they enforce. Unless something is an emergency, it's an unnecessarily disruptive workflow.
There are usually a limited number of phones on a ward, which are usually very busy lines. Using pagers for routine communication means:
1. Physically move myself to a location with a phone
2. Wait for phone to be free
3. Call a number to send the bleep
4. Wait for a response (bearing in mind the recipient needs to be free, move to a phone, wait for that phone to be free, and call back)
5. Guard the phone from others using it until I receive the call
6. Hope that no one else calls the phone in the meantime
Bearing in mind that everyone is always busy in hospital this is a huge source of frustration and wasted time, hence the move towards secure messaging apps for these scenarios. Unfortunately these are mostly being built as silos rather than interoperable communication networks.
As mentioned above, for actually alerting a group of people to an emergency when you need an immediate response, pagers are still hard to beat.
For example if a medication has sedating effects (such as some antidepressants) it may be advised to be taken before bed so this side effect is turned into something generally beneficial (more sleep) and less prevalent during waking hours).
Statins (cholesterol lowering medications) are usually prescribed at night time as this is when your cholesterol catabolism is most active.
Pain relief is often varied around sleep schedules
Insulin is scheduled around meals and sleep
Etc etc.