There's also BedJet, who makes a fancy-pants bed blower for between your sheets. It's running on an esp32 inside of itself to control the heater and the blower and the remote control, but they didn't quite make it as smart as I'd like.
I think any reasonable interpretation of the comment you’re replying to is not “sleep is always good” but rather “sleep is good, on the whole”, which is absolutely true.
Both studies you linked indicate correlation not causation
Personally I use it more as a reminder than an official reference. So, for example, reminders of less common diagnoses or less common presentations of common diagnoses that I’ve learned and know but may not remember the details of but will come back to me with some prodding. If I actually need to dive deep, I usually use UpToDate
Not sure where you went to med school, but couldn't be different for me for med school and residency. Very little of being a doctor has to do with money. If I wanted money, I would have stayed in software and not gone another half a million in debt.
Determining PVCs vs afib is very trivial when you actually look at the strip. However, if Apple is only analyzing rate regularity and not actually doing analysis on the waveforms themselves they would be very difficult to differentiate.
If you're having so many PVCs that the watch thinks you're in afib, you should probably still see a doctor. As the grandparent noted, tens of thousands of PVCs in a couple day period is very unusual and should probably be seen by a specialist.
No it's not. It's trivial to recognize a PVC if you see one, but it's a lot harder to rule out AFib.
To recognize a PVC at the frequency mentioned, you'd need to see much less than a minute of ECG data. You could see AFib in the same length of data, if the data is of good quality, but it can occur episodically, so the 24 Hour ECG is the right call.
I have only limited cardiological knowledge, especially regarding Humans, but at least in my model of cardiac pathology PVCs and AFib aren't mutually exclusive.
The point I was trying to make is that PVCs and afib are not mutually exclusive - they're just not related entities. The parent brought up sinus rhythm, and I wanted to make sure everyone was on the same page regarding the fact that PVCs and afib are very different things that can seem similar if the only data point you look at is regularity of the rhythm.
Yes, maybe just looking at RR intervals maybe. Otherwise AFib leads to irregular undulations, at about the amplitude of a p-wave, whereas PVCs are longer and weird looking QRS complexes.
AFib is a "supraventricular" Tachycardia, whereas PVCs are more of a ventricular Tachycardia. Though I'm not sure if AFib always leads to significant Tachycardia at all.
The reason I brought up “normal sinus rhythm” and “atrial fibrillation” a few posts up is because those are two of the four possible results produced by the Apple Watch EKG app, the other two being “low and high heart rate” and “inconclusive”.
Yeah, I’m currently going through the rounds of testing - just had the echocardiogram a week ago. Fortunately, that turned out normal. They gave me metoprolol, but that doesn’t seem to help. My potassium was kind of low, so they gave me a supplement for that, but it didn’t help either. If these PVCs keep up at the current rate, I suspect they will suggest ablation. Not really looking forward to that...
Anyway, I’m not sure exactly how Apple is analyzing the data. I’ve performed probably 15 EKGs with only one or two PVCs present, and it reported a normal sinus rhythm every time. It only reported afib once, and there were quite a few PVCs in that capture. I can email it to anyone interested.
Apparently, occasional (a few a day) PVCs are very common, so I imagine Apple had to encounter this situation during development.
So it's worthwhile to make sure we all understand that we're talking about two different things: atrial fibrillation and sinus rhythm are two options in the same bucket: rhythm. You can have PVCs with afib, you can have PVCs with sinus rhythm. You can't simultaneously be in afib and sinus rhythm.
I'm guessing Apple is just looking at rhythm - it would be the most reliable datapoint, as opposed to trying to measure QRS duration or analyzing for presence of P-waves, both of which differ depending on which lead you're looking at. The lead being looked at depends on which two points on the body are used to produce the tracing as well, which is not something Apple can guarantee, so perhaps that's where the explanation lies, but I have no evidence or data to back up that conclusion.
I would argue it is possible for better classification; I don't have a reason why apple chose not to do this (especially if they're capturing the data) other than the algorithms are not as guaranteed as we would like and they don't want to assume that kind of liability. (ECG printouts include the computer's interpretation; a standard way of reading them is to completely ignore whatever the computer says, because it is not infrequently completely wrong. And those are the professional grade machines with 12-leads capturing 10 different points on the body)
Edit; As I thought more about this, I realized that analyzing QRS duration or presence of p-waves can be lead dependent, which can change based on which parts of the body are being used to generate the lead.
As a semi retired software engineer and currently 4th year Med student, I still maintain a dream of building a usable EHR that puts the clinical, patient-focused side of things first. Currently implementations allow for increased billing recovery, but at a cost to both doctors and patients.
I just don’t know how you’d start in competing with something like Epic or Cerner, from a business side of things.
Speaking as someone still working at a big non-epic/cerner EHR company-that-might-have-just-gone-private: it's not easy. When the money is controlled by large insurers who care about government and billing minutiae, and big hospital/health-care groups choose which software solutions to use, it's an uphill battle to make stuff that is really, truly patient centric.
Everyone I work with cares really strongly about making a really good product. We have great designers/UXers, a lot of experience in building different pieces of the workflows that tens of thousands of doctors and hundreds of thousands of nurses, MA, PAs, front-office staff _and_ patients, but when you spend a whole year readying for ICD-10 and then some yokels in DC push the deadline back a year... I belabor my point.
Engineers wanting to start a health care company should try working for a big EHR company first. Then go start somewhere else using modern technology, modern development practices with just a little more wisdom. Maybe.
Epic lets you change provider context to Emergency department, internal medicine, etc. I think they just need to make the provider context suck a whole lot less. Epic Haiku (mobile) is a pathetic joke as well. Nevermind, I think you're right actually, the whole thing needs to be burned to the ground and built completely different. The only thing Epic has going for it is that it's not Cerner.
I worked for a little bit with these guys on this product called phrHero which focuses on making these EHRs more much more patient-friendly using the new FHIR protocol. https://www.phrhero.com/
I don't work with them anymore due to some fundamental differences (it's been almost a couple of years) but thought it was related to what you're talking about and possibly something you'd be interested in.
Possibly the only way you could compete with Epic or Cerner is to innovate on things in a way that can't be denied. It wouldn't be the first time slow giant companies fall because they did not advance, but it is much harder because the barrier to entry is absolutely enormous.
Dont beat them, join em. Build a solution to a problem and integrate it into one of their html5 modules. Both systems offer breadth, not depth when it comes to solving problems.
Healthcare is a heavily regulated industry and as such only large companies are able to successfully navigate the bureaucracy. The only way to usurp coercive monopolies is by creatively destroying it (e.g. uber)
It's more nuanced than that. I've spent 13 years working for two successful healthcare/biotech companies, both having attained FDA clearance (one class I and two class III devices) while I was there. I was brought on as the 21st employee and then the 17th employee. At no time could these have ever been considered large companies.
Products like LIMS and hospital systems are hard to replace because of vendor lock in and the cost to replace it all, not regulatory hurdles.
The regulatory requirements for security and interoperability are all things that every EHR vendor ought to be doing anyway. Regulations aren't a significant obstacle to new market entrants.
Well, point of care ultrasound (which is what the butterfly is for) can often lead to formal ultrasonography to be read by a radiologist. However, it can increase time to initial treatment, and depending on the level of skill of the user can sometimes prevent the need for formal ultrasound, but not always.
As a night shifter it’s completely life changing in allowing me to sleep comfortably during the day. 100% worth the price to me