Aesculapius

I enjoy listening to morning edition - usually through the app. I also contribute to NPR monthly. They have to stop the on air fundraising campaigns. It really drives listeners away. At least give those that already contribute an alternative feed.

Physician here.
Medicine is one of the few professions in which capital is tied to labor (at least of the licensed independent clinicians). Hospitals, clinics, etc., can’t run any test, provide any service, perform any surgery, without a physician (or other licenses clinicians) order.

Health systems rely on their physicians to drive clinical practice. Physicians are the experts after all. It’s a mutually beneficial relationship, but at its core, it is a partnership. This partnership certainly has it’s ups and downs. But this is what happens when the health system forgets that it is a partnership.

Be sure to drink your ovaltine

Here is the correct quote from Winston Churchill: “If you’re not a liberal at twenty you have no heart, if you’re not a conservative at forty, you have no brain.”
Also, conservatism in Churchill’s era is absolutely NOT what conservatism is now.

Most tests had their expiration dates extended.

In order to be worthwhile, rail needs to be faster and cheaper than a car. To do so, it would need to be fairly high speed as well. The capital expenditure for something like that would be enormous and the return on investment would take decades. Not to mention all the eminent domain issues. That type of project can only really be done via public dollars.

This is great!

Right now there is a serious issue with discharging patients from the hospital environment into skilled care. Since COVID, many nursing homes don’t take admissions over the weekend, limit admissions to long term care (as opposed to transitional care which is short term - and better reimbursed), and often have wait times. This has the effect of increasing the length of time a patient is in the hospital unnecessarily, thus decreasing hospital capacity.

Yes, the nursing homes have staffing issues, but they pay for shit. Many of them pay less than $20/hour. You need to goto school to get your CNA license which isn’t free. You can get many other jobs for better pay without the investment of education.

Source: I am a hospitalist physician. I work with nursing homes a great deal and my wife used to work at one as a CNA.

Physician here. The best marker we have of covid prevalence is wastewater testing. With the availability of home kits (and no reporting) and people refusing to test when symptomatic, the old markers of positivity rates and number of positive tests aren’t as valid. Even hospitalization numbers can fluctuate for multiple reasons. Municipal wastewater testing truly gives a sense of covid in a population.

Do the police compare DNA to genealogy databases? The odds the person used one is low, but maybe a family member?

I am also waiting to see what comes of the difference in memory sizes between Cleon I and the clones. What is being edited out of their memories? Is Demerzel the caretaker of this (assuming this was Cleon I’s design). Or, is Demerzel playing the long game. I suspect she may be behind the genetic tainting of the line and perhaps even the assassination attempt.

Tellem and the Emporer are not dissimilar when it comes to the ruthless way they are enacting their vision. This is reflected in the hand gesture that Tellem Bond uses to incapacitate Salvor (not sure it actually killed her). Almost identical to how Empire gives the command to execute someone.

I agree. Fundamentally, these folks that support him now are not doing well. It’s not the same for everyone. Some are feeling disenfranchised from parts of daily life, some are experiencing undesired change, some are terribly unhappy and don’t know where to point their frustration, etc. Trump isn’t a likely cult leader. He isn’t very charismatic like we normally associate cult leaders. But he came with the right message at the right time and for a very large segment of our population, that message made sense to them. It gave them a REASON for how they were feeling, even if they didn’t understand their own feelings in the first place.

When the day comes that the spell is broken, society must be ready to re-engage with these people in a meaningful way. Otherwise we are doomed to repeat it with the next person to show up and given them another reason.

For those wondering about nuclear options, Wired did a nice write up recently.

Good! Providing a cheap service at the cost of the staff doing the work is not acceptable.

This is all just grandstanding anyway. They may leave, but likely they will just increase their rates.

One of the issues you are touching on is what we refer to as Medication Reconciliation. At least in the US, the standard of care is to verify the current medications a patient is taking at every visit - whether it be an office visit, ED visit, or a hospitalization. Our local pharmacies also play a part in checking for medication interaction. This does not extend to over the counter medications however.

The US is the same in that the patient owns their own information. However, private entities are charged with the responsibility with holding and securing that data. Unfortunately, there is no central repository for it here.

More advanced systems in the US do allow for data access via phone. But it is not uniformly available or applied.

Physician here. Masks absolutely reduce transmission and the chance of contracting COVID.

Here is the definitive study on the subject.

Here is a video of a presentation by one of the authors along with some demonstrations and explanations.

TLDR: Here is the Abstract:
There is ample evidence that masking and social distancing are effective in reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. However, due to the complexity of airborne disease transmission, it is difficult to quantify their effectiveness, especially in the case of one-to-one exposure. Here, we introduce the concept of an upper bound for one-to-one exposure to infectious human respiratory particles and apply it to SARS-CoV-2. To calculate exposure and infection risk, we use a comprehensive database on respiratory particle size distribution; exhalation flow physics; leakage from face masks of various types and fits measured on human subjects; consideration of ambient particle shrinkage due to evaporation; and rehydration, inhalability, and deposition in the susceptible airways. We find, for a typical SARS-CoV-2 viral load and infectious dose, that social distancing alone, even at 3.0 m between two speaking individuals, leads to an upper bound of 90% for risk of infection after a few minutes. If only the susceptible wears a face mask with infectious speaking at a distance of 1.5 m, the upper bound drops very significantly; that is, with a surgical mask, the upper bound reaches 90% after 30 min, and, with an FFP2 mask, it remains at about 20% even after 1 h. When both wear a surgical mask, while the infectious is speaking, the very conservative upper bound remains below 30% after 1 h, but, when both wear a well-fitting FFP2 mask, it is 0.4%. We conclude that wearing appropriate masks in the community provides excellent protection for others and oneself, and makes social distancing less important.

The issues you bring up are well known and I couldn’t agree more. Interoperability needs to be better. See my comment further up.

Right now US privacy laws aren’t compatible with one overarching centralized healthcare record.

Short of that, however, would be an interoperable system. Epic, which is the largest US medical record system, allows for different facilities on the same platform to share information. It is up to the specific facility if a records release is required. Most systems in a given region will have that worked out ahead of time and build it into their general consent for treatment (a form everyone signs). It works quite well. Where I practice, I am able to get all the information I need from across the country, assuming they are on the same platform at the time I am seeing the patient.

For other platforms, it’s more mixed. Federal law requires certain interoperability, but it is fairly limited and not real time. Generally it involves a flash drive with the info on it.

As for the comment about changing platforms in a similar system, that is a struggle. Hospitals are required to keep patient information forever. When they first started going up on electronic systems, they only went back so many years as the scanning costs were huge. As time has moved forward, many systems are bringing all the information over to the new system so they don’t have to maintain more than one electronic system for archive purposes.

Source: I am a physician and chief medical officer.

We use Fluency Direct, but you are correct. Dragon is quite popular too.