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Comment The shotgun approach sucks (Score 1) 330

Whose going to look at and interpret all of that mostly worthless data? Bottom line is that there is no objective measurement of anything that would allow us to predict disaster any quicker than you yourself starting to feel sick would. Measuring things continuously (as opposed to periodic measurements for screening purposes) in someone who is healthy and doesn't have symptoms is a complete waste of time, unless all you're doing is collecting data on your control group.

Comment Re:Useless and redundant (Score 1) 330

We have the tech. You can monitor ICP continuously if you wanted to, and you could at least get a qualitative sense of the composition of someone's CSF from watching it come out of a lumbar drain. The thing is, are you really going to do a ventric or LP on everybody who falls down skiing and has a headache?

As far as MIs, though, quite possibly the greatest factor affecting your survival is how quickly you can get carted away to the cath lab, and I can't see how continuously monitoring anything is going to get you there any sooner than just paying attention to that crushing substernal pressure radiating to your left arm and calling 911.

Comment Re:Useless and redundant (Score 1) 330

(1) Troponin measurements are only helpful when repeated over a duration of time

(2) Even EKG changes aren't instantaneous. You'll have been having chest pain for quite some time before you start showing hyperacute T waves.

(3) But, finally, you have to target your measurements. Standard continuous cardiorespiratory monitoring is probably going to show you an increased heart rate and increased respiratory rate. Not very helpful. Continuous cardiac monitoring doesn't have the same resolution as an EKG; you're only probably going to get useful data if the patient is actually wearing a the full-12 lead set of electrodes, and again, see (2). And continuous troponin measurements would be extraordinarily low yield. I can't imagine what it would gain you over the usual q6h measurement, nor is there a point of measuring it when you're not symptomatic.

I can't think of anything we could've measured on Natasha Richardson that would involve a monitoring machine that she could've worn. Maybe if there were such a thing as a wearable CAT scanner, but would the radiation exposure be worth it? Probably the only thing helpful would've been continuous neuro checks, and you need a human being to do those.

Comment The system favors compliance over logic (Score 5, Informative) 1064

1. Private insurance will not pay for a woman's well visit if they don't have a Pap smear. They don't care that the woman doesn't have a cervix. If you don't do it, you don't get paid, and it's just easier to do it no matter how nonsensical it is than it is to get on the phone with someone who is not medically trained and argue that, yes, you did do a well woman exam even though you didn't do a Pap smear.

2. There is a case to be made for anal Pap smears, because HSV also causes anorectal cancer in people who participate in anal sex. Unfortunately, because it's not standard of care, private insurance won't pay for that either. (We don't even need to talk about Medicare or Medicaid because they don't pay for preventative visits.)

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