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Comment: Re:Suck it up. (Score 1) 510

by AgentPaper (#42511749) Attached to: Ask Slashdot: Should Employers Ban Smartphones?

Not everyone works at a desk.

True. Moreover, even if you do have some company-provided means of contact for your non-desk job, that number may not remain the same from day to day, or even throughout your day. Case in point: as a staff nurse in a large, busy emergency department, I might be issued any one of twenty-four SpectraLink phones at the start of my shift. Each phone, ideally, goes with a job assignment (e.g. "RN #2, Blue Team"). Thus, if you change assignments in mid-shift, as frequently happens (and frequently with little or no notice), you turn in the phone associated with your old assignment and pick up a new. In any given twelve hours, I might switch between team service (we run four teams), Ambulance Bay, Float, Triage, and/or Resuscitation. Overhead page only works if you're in the department (not a given, particularly if you're on float service, as that means you're usually assigned to transport the real sickies to whatever flavor of Critical Care they'll be occupying next). Moreover, we are routinely admonished by Admin not to use the overhead paging system, as it's considered a noise hazard and detrimental to patient well-being. (See also: Press Ganey happy horsepuckey, but I digress.) Call forwarding isn't an option since, as previously mentioned, the phones are tied to jobs - you need to know you'll always be talking to the Ambulance Bay if you call that number, for example.

Given a system like that, the likelihood of an outside party being able to successfully get hold of you at work, without the assistance of multiple operators and several failed attempts, is pretty slim. Somehow, I don't see the staff at Sometown Elementary being able to reason their way through a parent contact sheet that says "On Mondays from 11A-3P, call 555-1212. From 3-7, call 555-1222. On alternate Tuesdays between 7A and 11A, call 555-1223, unless it's the third Tuesday of the month, in which case I'll be at 555-1335 until 1P," etc.

To that end, our administration runs a fairly benevolent policy on personal cell phones: they have to be silenced while you're on the unit, you can't make calls or use text-based communication in patient care areas, and the phone has to be completely off and stowed (i.e. even "airplane mode" doesn't count) if you work in a no-electronics unit (i.e. Electrophysiology, Interventional Radiology, Critical Care). Phone cameras, and any other form of recording device, are all lumped under the existing regulations on patient and visitor privacy. Luckily we don't have too many issues with phone impairment of productivity, as the nature of the job makes it quite evident when someone isn't working...

Comment: Re:Question: (Score 1) 439

by AgentPaper (#41873583) Attached to: Massachusetts May Soon Change How the Nation Dies

Sorry, no. You're thinking of a PCA (patient controlled analgesia) pump, which has very rigorously programmed lockout settings to prevent accidental overdose. PCAs, in most hospitals, also require the use of a two-person physical lock to change the settings, neither of whom can be the prescribing physician - so now your hypothetical doctor has to have at least two nurses employed at that hospital and on that unit who are willing to be complicit in his/her scheme, and who will also be willing to risk their jobs, licenses and felony jail time by reprogramming the PCA, which may or may not also involve falsifying medication administration records. Finally, a PCA can only be used by a patient who is awake, alert and has sufficient dexterity to push the dosage button. (We routinely catch family members of patients on PCAs pushing the button for their sick relatives, in the well-intended but misguided belief that they are relieving the patient's pain. First-time offenders are escorted from the premises by Security and barred from the patient's room unsupervised. Do it again and the police get involved. That kind of incident is also quite likely to earn the hospital a visit from the "friendly" local DEA field office, with hordes of federal agents crawling over every flat surface in search of even a nanogram of potentially unaccounted-for drugs. Hence, hospitals have ZERO sense of tolerance for PCA follies.)

Incidentally, Jack Kevorkian's original suicide machine was largely based on the PCA pump concept. The problem was, most of his patients were so far gone that they couldn't push the button themselves, so he had to do it for them... which neatly hopped over the border from "assisted suicide" to "homicide." Oops.

That said, there are scores if not hundreds of ways you can die in a health care setting. Unfortunately, the vast majority of them A) take an extended period of time, B) are acutely painful or distressing to the patient or those around him/her, and/or C) involve the use of life support systems with built-in alarms, the tampering of which would be rapidly caught by staff, who are then duty bound to resuscitate the patient. Those that are rapid, painless and effective (for example, most hospital staff would tell you they'd pick IV insulin for their hypothetical final exits - you lose consciousness within minutes and go into PEA/asystole shortly thereafter) also require the cooperation of a medically trained and licensed outside party to effect - for which, see also "homicide." Back to square one...

Comment: Re:Magnets in your body? That's nice. (Score 1) 228

by AgentPaper (#40006095) Attached to: Subdermal Magnets Allow You To Wear an IPod Like a Watch

That's because surgical steel (316L) is non-magnetic and poorly conductive. The same material is used for sternal wires, joint implants and orthopedic stabilization hardware (pins, plates, screws, et al). Titanium is another common, non-magnetic material for implantables.

We do scan people with implanted items, but the catch is that we need to know exactly what the implant is, what it's made of, and to what extent it'll react under a magnetic field. (Say for example you had your knee replaced in some developing country with a "DePew" or "Striker" * joint implant, then later require an MRI for diagnosis of head pain or back pain. Cue a very messy trip to the MR room and us writing your lawyer a very large check.) Hence the radiologist review if anything on your safety form pops up positive. Being as we know when your wire was installed and what it's made of, this would not pose a problem - but for the patient in the example, we're not scanning until we get the records from wherever and figure out what exactly is in that knee.

* cf. DePuy or Stryker, internationally known makers of orthopedic hardware - implying that the example joint is a counterfeit made of common, magnetic steel.

Comment: Re:Magnets in your body? That's nice. (Score 2) 228

by AgentPaper (#39996353) Attached to: Subdermal Magnets Allow You To Wear an IPod Like a Watch

For MRI, anything that might be even remotely magnetic is a no-go. Medical MRI systems start at 1.5 T and go up to 3 T, so anything in, on or near your body that can be affected by a magnetic field, will be. We have a two-page-long MRI safety form that we walk patients through prior to an MRI - if anything on the form is positive, you're not getting your scan until a radiologist reviews precisely what the offending item is and approves or denies the scan. (This includes tattoos, BTW - some tattoo pigments are ferrous, and the pigment particles can heat up enough under the MRI field to cause burns.)

In the surgical environment, we're usually not dealing with magnets, but electrosurgery (i.e. Bovie pen) is ubiquitous, and implanted metal can do unpleasant things within the return circuit. Hence, if it isn't a known surgical implant (i.e. if we don't know precisely what its electrical and thermal conductive properties are), you're not going to the OR with it.

Hope this helps!

Comment: Re:Yeah nothing works anymore (Score 4, Interesting) 622

by AgentPaper (#33329860) Attached to: Throwing Out Software That Works

Short answer: It depends on what unit you're in.

Long answer: In medical-surgical units (your basic, low-acuity "floor nursing" kind of places), nobody much cares because none of those patients have any kind of fancy monitoring going on, and most of them are stable enough to go home within a day or so anyway. Hence, everybody and their brother has mobile phones, netbooks and the like, and some hospitals even go so far as to provide free WiFi on those floors. That isn't the case in critical care. In ICU and its sub-variants (medical, surgical, neonatal and so forth), since every patient has a pile of invasive care systems (ventilators, arterial lines, Swan-Ganz catheters, Vigileos, CRRT, IABP, ECMO, etc) and half a dozen pumped drips, you will see signage EVERYWHERE warning you not to bring in any active electronics, and the staff will hunt you down if they suspect you might be "carrying." I very nearly got kicked out of a PICU a year and a half ago for having a Palm m515 (!) with my copies of Lexi-Comp, Harriet Lane and Mosby's Critical Care Nursing, and we wrote up a doctor who brought an iPhone to the CV-SICU in my preceptorship.

Emergency is kind of a mixed bag. Some places ban electronics entirely in the fear of compromising critical patients' monitoring and treatment systems, others realize it's a losing endeavor and just try to separate the critical from the walkie-talkies as much as physically possible. (I dare you to walk into a room full of combative drunks and tell them you're confiscating their mobile phones because they're interfering with the Vigileo on the sepsis patient two doors down. Let me know how many stitches you require afterward.)

Does all that rigmarole actually save lives? Probably not. I think a lot of it is throwback to the days of bag phones, when doctors and other big shots routinely walked around with what amounted to unlicensed nuclear accelerators on their shoulders, and the electronics really WERE that sensitive to interference. On the other hand, I've seen monitoring equipment go haywire when patients' family members attempted to make cellular calls, and return to normal function once the offenders were escorted off the unit. In any case, we'll always err on the side of caution - better safe than sued.

Comment: Re:Yeah nothing works anymore (Score 3, Informative) 622

by AgentPaper (#33328032) Attached to: Throwing Out Software That Works

In certain environments, such as hospitals and healthcare facilities, ANY wireless functionality can interfere with patient equipment. Doesn't matter if your smartphone uses 3G, WiFi or sub-etheric holowave - either your hospital's Biomedical Engineering department will have to take it apart and certify it for use (good luck with that), or you can't have it. This is why we still use one-way pagers when 99.44% of the world has moved on to SMS, and why the only mobile phone you can have on a unit is a $600 SpectraLink that looks and acts like a throwback to 1995. There are also lots of workplaces that restrict wireless connectivity for security purposes, in which just disabling the functionality isn't good enough.

Niche market, to be sure, but there still is a market for non-wireless PDAs.

Comment: Re:Hmm (Score 2, Informative) 105

by AgentPaper (#26134699) Attached to: Injectable Artificial Bone Developed

You're right - for a product to be considered "absorbable" or "degradable" in patient care, the product has to eventually break down to compounds that the body naturally metabolizes. Classic example: Vicryl (tm), polyglactin 910 (90% glycolide/10% lactide polymer) suture. Water causes it to break down into glycolic acid and lactic acid, usually over the course of 56 days in tissue (unless it's placed in a wet environment, in which case it breaks down faster.) Both compounds are things your body generates and metabolizes on a daily basis, and no trace of the suture remains in the body once it's been broken down, hence the suture is "absorbable." Absorbable products can be made of synthetic compounds (Vicryl and other synthetic absorbable sutures, hyaluronic acid preparations) or of naturally occurring substances (plain and chromic gut sutures, various preparations of collagen).

Back to TFA, this stuff doesn't look a whole lot different from demineralized bone matrix, which is already fairly common (although expensive as hell). DBX doesn't really provide any immediate structural strength to compromised bone, since it's only bone protein with no mineral structure. It just provides a scaffold for the body's own osteoblasts to build on - it allows them to skip a step in fracture repair, in other words. Calling it "injectable bone" might be a bit of a stretch.

(Full disclosure: The author is a former surgical rep turned nursing student.)

Comment: Re:good luck getting support (Score 4, Informative) 341

by AgentPaper (#26127601) Attached to: Chinese Automaker Unveils First Electric Car

What's so hard about supporting an electric car?

Quite a bit, if you think about it:

1) Educating and qualifying mechanics to work on the car. Your average Joe at the gas station isn't going to be able to service this thing right off the bat, nor will he be able to open the hood and figure it out after a few minutes' inspection. At least for the first two or three years this car is on the market, you'll be forced to rely on dealer service, simply because there won't be trained mechanics anywhere else. And if you break down someplace where there isn't a dealer handy, you're hosed. A hobbyist owner might be able to repair the car, to a greater or lesser extent, but those repairs might void the warranty, or in some states may disqualify the car from street service entirely.

2) Availability of parts. There is lots and lots more that goes into an electric car, or indeed any car, besides a few hundred feet of wire, an electric motor and a few batteries. If your alternator dies, if you have to replace a transmission or some other drivetrain component, if your windshield cracks, all of those require many more parts to complete beyond the obvious part that's malfunctioning. The problem is compounded if you have multiple systems damaged at once, as in the context of an accident. You'll have to have some mechanism in place to get those parts from their Chinese manufacturers to a U.S. dealer service department, quickly and efficiently. (This is harder than it sounds; as a personal example, I can confirm that for a certain well-known German luxury manufacturer, a replacement front bumper fascia took three weeks to ship from Stuttgart, where replacing the same part on an American vehicle took two days.)

On a related note, you also have to worry about the general lack of infrastructure. Right or wrong, as it stands right now the entire transportation infrastructure in the US is set up to deal with internal combustion vehicles. Changing over to an electric infrastructure is going to take time, at least two or three years and probably more like five or seven, during which time the drivers of electric vehicles are going to be at a major disadvantage. You won't be able to charge most places, won't be able to get service most places, might not be able to drive on freeways or other limited access roads (at least here, freeways are restricted to internal combustion vehicles with engines greater than 125 CC displacement, which can't be powered farm equipment, and must be able to maintain a minimum speed of 55 MPH). Those restrictions might be enough to put people off electrics entirely, or at the very least slow their adoption. It'd be a damned shame if that happened, but it's a very real risk. In the meanwhile, everyone who bought these electric cars will be in the lurch, and if the manufacturer folds, the vehicles will be little more than hobby pieces.

Nintendo

+ - Nintendo's Market Value Exceeds Sony's->

Submitted by
AgentPaper
AgentPaper writes "Today's Japan Times reports that Nintendo Ltd.'s market capitalization exceeded that of Sony Corp. (the parent company, not just Sony Computer Entertainment!) for the first time, despite the fact that Sony generates eight times Nintendo's revenue on average per year. Record-high share prices on the Nikkei stock exchange pushed Nintendo's value to 6.57 trillion yen against Sony's 6.48 trillion. Financial analysts pointed to strong sales of Nintendo's Wii console and DS handheld as the cause of the surge, noting that the Wii has outsold Sony's flagship Playstation 3 by a 5:1 margin in Japan and in North America and is forecast to continue doing so through year's end."
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The trouble with the rat-race is that even if you win, you're still a rat. -- Lily Tomlin

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