@pash22 Thanks for posting!
Although we found that >850 characters had high specificity for trouble, I can unofficially say that more than about 150 contiguous characters copied and pasted was problematic (and the record was over 3,000!)
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Toby Gilbert
14.4K posts
Toby Gilbert
@DrTobyGilbert
General and Acute Physician / 🇮🇪 in 🇦🇺
South Australia Katılım Aralık 2011
2.8K Takip Edilen4K Takipçiler
Copying in medical documentation: developing an evidence-based approach
onlinelibrary.wiley.com/doi/10.1111/im… via @DrTobyGilbert et al
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Why I believe the quest for artificial general intelligence will profoundly disappoint the utopian fantasies of the techno-optimistic
open.substack.com/pub/buildcogni… via @benjaminjriley
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@irishelt @misskaren1981 They spend a month prior robbing pallets and tires from industrial estates and then try their first E at the bonfire?
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Whether it’s liberal observers describing Trump’s Madison Square Garden campaign event as a Nazi rally or conservative attendees of the same event describing it as a Nazi rally, both sides agree that the event was a Nazi rally.
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@WalshmrG Hours of distraction when I'm meant to be studying. Top drawer.
I played squaredle.com 10/20:
70/70 words (+15 bonus words)
🎯 In the top 32% by accuracy
🔥 Solve streak: 12
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I played squaredle.com 10/20:
70/70 words (+12 bonus words)
🎯 In the top 28% by accuracy
🔥 Solve streak: 9
Fingal, Ireland 🇮🇪 English
@casertron3000 @n_equals_42 @apsmunro Absolutely correct
If only they knew about the pharmacokinetics of codeine
Oxycodone has moved into this space, I believe for this very reason
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Here is your periodic reminder that if you prescribe someone codeine you’re just prescribing them morphine without knowing if they’re getting zero morphine or loads of morphine because codeine only acts by being converted to morphine in amounts that highly vary by individual
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@simonmarkdaley @n_equals_42 @apsmunro I think it's because morphine/oxycodone/hydromorphone etc are "strong" opioids
Morphine costs pennies
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@DrTobyGilbert @n_equals_42 @apsmunro Interesting. Oramorph does work much more reliably and consistently for me than codeine, and as for Tramadol, nightmare. That takes about 12 hours to start working and then sends me loopy for another 12.
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Higher adverse events have been linked to higher levels of DNA contamination in the vaccines although this is preliminary. Also, higher levels of circulating spike protein has been seen in those with myocarditis. Additionally vaccine-derived S1 protein has been demonstrated in atypical monocytes in those with chronic long “vaccine” symptoms up to a year post injection.
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@DrJ_surgeon Thanks! Has a different immune response and/or side-effects been linked to differing levels of spike protein produced yet?
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The mRNA in the vaccine enters cells and produces spike protein. Nobody knows how much spike protein and for how long. It could be weeks to many months, and it is different from patient to patient. The Pfizer vaccine plasmid DNA (the precursor to the mRNA) has been found in colon Ca cells 1 year post injection. Some spike protein made is fragmented. Additionally, other proteins are manufactured due to frame shifting. The immune response changes and is different with different doses.
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@n_equals_42 @apsmunro Think about it as safety vs efficacy.
If the fast metabolisers get a safe dose, the normal metabolisers might be under-dosed and the slow metabolisers very under-dosed.
Raises the question why not just give a small dose of morphine instead?
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@katiewiskar @ross_prager If the chest sounds better than yesterday, the patient may go home
I always find these discussions on the utility of different aspects of physical examination lack an appreciation of what you're going to do tomorrow
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Couldn’t agree more with another fabulous thread from @ross_prager.
As an internist, I very rarely physically examine for the JVP (‼️)
But I ALWAYS think about RAP/CVP and use sonographic parameters to inform this
Ross Prager@ross_prager
10/10) Things that are not routinely part of my exam. JVP - difficult to assess and a static marker of right atrial pressure which does not inform whether to give fluids. It is not an oil dip stick. Bowel sounds - simply stop. Carefully palpating for splenomegaly or liver - if you care enough to examine in detail (e.g. it would actually change your ddx) then do a POCUS or other imaging modality to quickly and way more accurately diagnose. Heart Auscultation - rarely does this change management. If you have a patient that you are considering a valvulopathy (and it is potentially meaninfully impacting management), you should just do a critical care echo or formal echo. Lung Auscultation - this can be useful to listen for wheezes, but if you have a high enough pre-test probability for pulmonary pathology that you are basing decisions on something you hear, you should get a CXR +- lung ultrasound
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I do know that Sleeping Beauty or possibly Snow White fell asleep because of a spindle, so you should always be very careful around them
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The term 'fusiform' means 'spindle-shaped'
This means pointy at the top and bottom and wider in the middle
Many structures in the body can be described as fusiform
I don't actually know what a spindle is or what it does
But I do know when stuff is fusiform and so should you
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@GregC62966809 @P_dknight @USAisAok_ @boldnewme1 She was presumably "commissioned" rather than "enlisted"
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@P_dknight @USAisAok_ @boldnewme1 So what you’re saying is she went in as a Colonel? When she joined,one before retiring she agreed she could be recalled.
military.com/join-armed-for…
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Today, I got the most awful call in the world. My little sister is gone. The lights have gone off. Everything is darkness. You are not supposed to outlive your baby sister.
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@kb18951452 @goalskii @gavzilla @Being_PreeTy @NewsM101 I'm now down the rabbit hole. Join me.
Looks like the complication rate probably runs at about 1-2% for neonatal circumcision, much higher for child circumcision. Again, not brilliantly studied.
pubmed.ncbi.nlm.nih.gov/20158883/
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@kb18951452 @goalskii @gavzilla @Being_PreeTy @NewsM101 There are no randomised studies
Observational studies in neonates do show a lower rate of UTI, but are confounded because, for instance, preterm infants are not circumcised and are more likely to get UTIs
Rate of UTI in uncircumcised neonates is only ~1%
pubmed.ncbi.nlm.nih.gov/18316994/
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Got back from my run and my daughter snapped a hair clip onto my back hair
How's everyone else's middle aged Saturday morning?
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