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@doc_DMP

Cardio de ville. Quel parti politique pour les soignants ?

Universalisme Katılım Kasım 2019
802 Takip Edilen530 Takipçiler
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Dr Jean-Jacques Fraslin
Je rappelé qu'on peut quand même faire la FSE en cliquant ici
Dr Jean-Jacques Fraslin tweet media
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doc_DMP
doc_DMP@doc_DMP·
@birisepepito @r_yljh Il ne sait pas non plus que sur les 30 euro, 20 servent à pouvoir l'accueillir.
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birise 🇺🇦 🇫🇷
birise 🇺🇦 🇫🇷@birisepepito·
@r_yljh Ça s’appelle l’égoïsme. Je ne lui souhaite pas mais j’espère qu’il comprendra si un jour ça lui arrive, et qu’il tombera sur un médecin qui prendra le temps.
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doc_DMP
doc_DMP@doc_DMP·
@Alibaba_Qwen How do we switch off thinking ? (very good but too long)
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doc_DMP
doc_DMP@doc_DMP·
@dr_a_julienne Qwen3.5 réfléchit 5 minutes pour fournir la bonne réponse à salut !. Inutilisable en local sur mac
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doc_DMP
doc_DMP@doc_DMP·
@DocGSYJ @mon_caillou Il y a le répondeur téléphonique et maintenant les IA vocales. Il faut les libérer de cette corvée et les occuper mieux
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DocG
DocG@DocGSYJ·
@mon_caillou Il faut défendre ses secrétaires, récidive = on rend le dossier.
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mon caillou dans la chaussure
mon caillou dans la chaussure@mon_caillou·
Nos secrétaires au bout du chemin parce que tous les jours les patients leur parlent mal voire les insultent au téléphone. Phénomène épisodique au début de ma carrière qui est devenue banalité. Toutes les couches de la société même ceux qui se croient bienveillants.
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doc_DMP
doc_DMP@doc_DMP·
Ces 3 posts sur les variations du revenu disponible à la retraite en fonction de l'année d'arrivée sur le marché du travail contiennent plus d'éducation financière que je n'en ai jamais eu. Les Français sont maintenus dans l'obscurité, des boomers à la gen Z. Nullité éco ...
Jesús Fernández-Villaverde@JesusFerna7026

I am always amazed that most people saving for retirement (or designing optimal Social Security systems) rarely take sequencing risk seriously. Simply put, sequencing risk is the risk associated with the order in which returns arrive over one’s lifetime. Sequencing risk hits you twice: while you are working and accumulating wealth, and again while you are retired and drawing it down. Today, I will focus on the first part. The retirement phase warrants its own discussion, and I will address it in a subsequent post. Let me walk you through an exercise I ran yesterday using actual historical U.S. stock market data from the past 80 years to illustrate how important sequencing risk is. I took the annual total returns of the S&P 500 (including reinvested dividends) from 1945 to 2024. The source is the dataset maintained by Aswath Damodaran at NYU Stern, a standard reference for long-run U.S. equity returns. I then deflated each year’s nominal return by the CPI-U inflation rate published by the Bureau of Labor Statistics to obtain real total returns, i.e., returns in constant purchasing power. Over this 80-year period, the S&P 500 delivered a geometric mean real total return of about 7.5% per year. That is an impressive number. But this average return masks a lot. Imagine a worker who starts investing at age 22 and retires at age 68. That gives them 46 years of contributions. In their first year, they contribute $1. Each subsequent year, they increase their contribution by 1% (roughly keeping pace with real wage growth). Every dollar is invested in the S&P 500. They never touch the money until retirement. No panic selling, no market timing, no strategy switching (and no management fees!). Textbook investing and waiting. I ran this exercise for every possible cohort for which the data allow. The first cohort starts investing in 1945 and retires in 1991. The second starts in 1946 and retires in 1992. And so on, all the way to the last cohort, which starts in 1978 and retires in 2024. This yields 34 cohorts, each investing for 46 years, making the same contributions and investing in the same index. The only difference among them is which 46-year slice of historical returns they happen to live through. The most fortunate cohort, the one that started investing in 1954 and retired in 2000, had $607 on the day of retirement (remember, all in real terms), with a real annual return of 8.82%. The unluckiest cohort, the one that started in 1963 and retired in 2009, accumulated $210, with a real annual return of 4.83%. Same contributions. Same index. Same strategy. Same investment horizon. Yet the luckiest retiree ended up with 2.9 times more wealth than the unluckiest. Why? The 1954 cohort had a spectacular final decade. The late 1990s delivered some of the best equity returns in American history, and those returns compounded on a large portfolio built over decades. They retired at the peak, at the end of 1999, before the dot-com crash. The 1963 cohort was not so fortunate. They spent their last working years running straight into the 2008 financial crisis. The S&P 500 lost over 36% in real terms in 2008 alone. That loss hit their portfolio when it was at its largest, right before retirement, with no time left to recover. Clearly, sequencing risk is not about the average return. Both the 1954 and 1963 cohorts experienced roughly similar average returns over their 46-year periods. The difference is when the good and bad years occurred. For the 1954 cohort, the bad years came early (when the portfolio was small) and the good years came late (when the portfolio was large). For the 1963 cohort, the opposite was true. In fact, sequencing risk is even worse because poor returns in the stock market are correlated with weak labor markets: you have a much higher probability of losing your job (or seeing your wage income fall) precisely when the market is doing poorly, preventing you from saving when prices are low and equities are most attractive. However, let me set that point aside today to simplify the exposition. The standard response of the financial planning industry to sequencing risk is the so-called glide path. The idea is simple: when you are young, you hold mostly equities. As you age, you gradually shift toward bonds. By the time you are near retirement, most of your portfolio is in bonds. A common implementation is a linear rule: start with 90% in stocks at age 22 and reduce the equity share steadily until you reach 20% in stocks at age 68. This is roughly what target-date retirement funds do. The logic is sound in principle. You reduce your exposure to equities precisely when a crash would hurt you most. If 2008 happens when you are 65 and 80% of your portfolio is in bonds, the equity crash barely affects you. I applied this glide path strategy to the same 34 cohorts, using historical real returns on the S&P 500 for the equity portion and real returns on 10-year U.S. Treasury bonds (from Damodaran) for the bond portion. Each year, the portfolio is rebalanced to the glide path weights. The glide path does what it is intended to do: it reduces dispersion. The gap between the best and worst cohorts narrows from 2.9x under pure equities ($607 vs. $210) to 1.6x under the glide path ($292 vs. $178), but so does the upside. The best equity cohort (1954–2000) earned a geometric mean real return of 8.82% per year. The best glide path cohort (1975–2021) earned 6.59%. That is a 2.2 percentage point gap. Over 46 years of compounding, a 2.2 percentage-point annual yield yields an enormous difference in terminal wealth: the best glide-path outcome ($292) is less than half the best equity outcome ($607). In other words, the cost of this insurance is substantial. In fact, the median cohort ends up meaningfully poorer under the glide path than under 100% equities. You are not trimming a bit of upside. You are forgoing a substantial share of your expected wealth at retirement. This should not be surprising. Over the long run, equities have outperformed bonds by a wide margin. The equity risk premium is one of the most robust facts in finance. Every year you shift a dollar from stocks to bonds, you accept a lower expected return. Do this for 25 years of your career (roughly the back half, when the glide path has you increasingly in bonds), and the cumulative cost from foregone compounding is very large. But the part that makes me most uncomfortable with the standard glide path advice is that bonds are not safe. People hear “bonds” and think “safe.” They are not. Bonds carry two risks that are easy to forget when inflation is low and interest rates are stable. The first is inflation risk. A conventional bond pays you a fixed nominal coupon (yes, there are TIPS and similar instruments, but they have their own problems, so let me skip them for today). If inflation rises above the market’s expectations when the bond was issued, the real value of those payments declines. The cohorts that retired through the 1970s learned this the hard way. In the data, the real return on 10-year Treasuries was negative in multiple years during the 1970s. The second is interest rate risk. When interest rates rise, the market value of existing bonds declines. The longer the maturity of your bond, the larger the hit. In 2022, the Bloomberg U.S. Aggregate Bond Index declined by approximately 19% in real terms. If you were 65 and had just shifted most of your portfolio into bonds following the standard glide path advice, you would have lost nearly a fifth of your “safe” allocation in a single year. And here is the real sting of 2022: equities fell, too. The S&P 500 lost about 24.5% in real terms that year. The glide path assumes bonds will be there to cushion you when stocks fall. In 2022, both fell together. The cushion was not there. This is not some once-in-a-century event. Stocks and bonds have moved in the same direction before: the 1940s, the 1970s, and in 2022. The negative correlation between stocks and bonds that many investors take for granted is a feature of the disinflationary period from roughly 1982 to 2020. It is not a law of nature. Let me be clear: I am not saying the glide path is wrong. For many people, it is the right choice. If a 30% equity crash near retirement would force you to sell assets at the worst possible time to cover living expenses, the insurance is worth paying for. However, you should know what you are paying. The glide path (or variations of it that I am skipping in the interest of space) is not free. It entails substantial costs in expected returns. Worse, the insurance itself can fail. Bonds can lose money in real terms for extended periods. Bonds can fall at the same time as equities. The glide path reduces sequencing risk. It does not eliminate it. It also introduces risks of its own. The deeper lesson from this exercise is that a substantial part of your retirement outcome depends on when you are born. You can do everything right (save diligently from your first paycheck, invest consistently, stay the course through every crash, never panic sell) and still end up with vastly different results than someone who did the same thing a decade earlier or later. The 1963 cohort did nothing wrong. They just had the misfortune of turning 68 in 2009. No allocation strategy eliminates this. Even under the glide path, the best cohort ends up with substantially more than the worst. Sequencing risk is, to a significant extent, a matter of luck. Next time: what happens when sequencing risk hits you in retirement, when you are drawing down instead of building up. The math there is, if anything, even more unforgiving.

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doc_DMP@doc_DMP·
@dr_a_julienne C'est le verrou psychologique du HIPAA et du RGPD qui a sauté chez lui...
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Antoine Julienne
Antoine Julienne@dr_a_julienne·
Les verrous techniques qui empêchaient les médecins de développer des applications sont en train de sauter.
Michał Podlewski@trajektoriePL

Cardiologist wins 3rd place at Anthropic's hackathon. Out of 13,000 applications. Built in 7 days by Michał Nedoszytko MD. Coded day and night - in the hospital, in the cloud, while flying from Brussels to San Francisco. A few years ago, it would have been impossible for a doctor to build this alone in just a couple of days. AI changed that. The project is called postvisit.ai. It is an AI agentic care platform for patients. Including reverse AI scribe it is a companion that guides the patient from the moment they leave the doctor's office. Powered by the massive context window of Opus 4.6, it allows patients to explore their full medical history, connected devices, Evidence Based resources and external data sources — all in one place. Today, the barrier to entry has vanished; even a practicing physician can build an application from scratch.

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doc_DMP@doc_DMP·
@cosinus33 @Fraslin Y a Nabla, le premier sur le marché. J'ai bidouillé un truc maison qui marche en local, mais flemme de le diffuser
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Dr ortho 33 #vacciné #jesuisdyslexique
Existe t il des IA rgpd compatible qui écoute la consult et en fond la transcription idéalement en dehors de logiciel métier je suis à l hopital vive le copié colé @Fraslin si tu a des idée de collègue a tagué ? Pour ceux qui ont fait cette expérience qu en pensez vous?
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doc_DMP@doc_DMP·
@GuiSimonin @tolquen Et si l'employeur est médecin ou dentiste , la taxe sur les salaires : un bon 13ème mois...
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Guillaume Simonin
Guillaume Simonin@GuiSimonin·
Le vrai coût du travail en France pour un salaire brut de 3500 €/mois Cout employeur : 4 763 € / mois Salaire net après impôt : 2 525 € / mois Le salarié perçoit seulement 53% du coût employeur
Guillaume Simonin tweet media
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doc_DMP@doc_DMP·
@Anthropolegiste N'importe quel médecin libéral rendrait la sécu créditrice en un an. Que ce soit 300K ou 250 Mds , il y a des bons principes de gestion. Ils font les importants à dire que c'est très compliqué...
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Psycholégiste ⚖️🧠
Psycholégiste ⚖️🧠@Anthropolegiste·
Eh bah faut faire comme tout le monde et bouffer des benzos hein, quoi d'autre ? Une polysomnographie ? En France ?
Psycholégiste ⚖️🧠 tweet media
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doc_DMP@doc_DMP·
@alifmunim Hi again ! Installed it on a mac to test inference (yes, cpu only). I cannot find the lvef probe. Is it available somewhere ? Thank you in advance.
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doc_DMP@doc_DMP·
@alifmunim Congratulations ! Dumb doc here : can I run it on a macbook/mac studio ? Can I use it as a basis for non conventional echo findings ? Thank you
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Dr Jean-Jacques Fraslin
Dr Jean-Jacques Fraslin@Fraslin·
"L'un des antihypertenseurs les plus courants, l’hydrochlorothiazide, vient d’être classé risque de Classe 1 pour le cancer de la peau et des lèvres (en particulier le carcinome épidermoïde, un peu moins le basocellulaire et peut-être pour le mélanome)… si vous l’utilisez ou si vos patients l’utilisent, la meilleure option est de le remplacer par un autre médicament. Risque cutané aussi avec le voriconazole, un antifongique et le tacrolimus, un immunosuppresseur…"
Orlando RPN@OrlandoRPN

🚨 ALERTA 🚨 uno de los Antihipertensivos más comunes, la Hidroclorotiazida, acaba de ser catalogada de Riesgo Clase 1 para Cáncer de Piel y Labios… si tu lo usas o tus pacientes, la mejor opción es cambiarlo por otro medicamento lo mismo con el Voriconazol y el Tacrolimus…

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doc_DMP@doc_DMP·
@GaetaneRibeyre En instantané, je demanderais plus à perplexity qu'à twitter... Le trando est un peu ancien (c'est du 2 dans le Tarka) et sujet à ruptures. pour du durable, j'ai tendance à passer au perindo
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Gaetane Ribeyre@vaccinée!!! 💉 X 3! + 🦠…
@doc_DMP J’ai mis 1/2 verapamil L P 240 + trando 4 et je verrai ! Le souci est quand la pharmacie appelle en pleine consultation avec un autre patient et qu’il faut donner des consignes tout de suite car le patient sous tarka attend son traitement !
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TheFrenchPOCUS
TheFrenchPOCUS@TheFrenchPOCUS·
Aux Urgences, la CRP est un signe de gravité dans la pathologies suivantes : Voilà, c'est tout.
TheFrenchPOCUS tweet media
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doc_DMP@doc_DMP·
Connaissez-vous la différence entre une voiture neuve et un échographe premium dernier cri neuf ? La voiture neuve, vous pouvez la revendre 2 ans plus tard à 50% de son prix d'achat. L'echographe, impossible. Pensez-y avant de signer des leasings sur 5 ans.
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doc_DMP@doc_DMP·
@phbdr @barriere_dr Et le menu obligatoirement dans le DMP, sinon sanction des restaurateurs
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phbdr
phbdr@phbdr·
@barriere_dr Et je suggère aussi la carte Vitale Sassoon pour les coiffeurs. (un peu capillotractée celle-là)
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