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wathe

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Everything posted by wathe

  1. We are big thermos users for lunch: chili, stew, soup, butter chicken, curry, hotdogs (in hot water, send bun separately), pasta etc. You want a vacuum food jar. You get what you pay for with these. Cheapie "insulated" food jars do not keep food properly hot, which IMO is a food safety issue. We have both the Thermos King, in 2 different sizes, and the Stanley Adventure. Both are excellent.
  2. I think this thread is specific to men with stay-at-home wives? The men's economic blindness described in this thread isn't something I've experienced. But there are very few families with stay-at-home wives/moms in my personal bubble. I think I know more families with SAHD's than SAHM's, and the SAHD's all seem to keep a toe (or half a toe) in the work world, working at their own small work-from-home business projects and/or staying connected/networked with their before-kids work life still-working buddies. Men in my bubble know what things cost because they participate in the shopping and are involved in the household finances, and understand how much work it takes to run a household be cause they are sharing in the labour (not 50/50 necessarily, but at least enough to have a clue). I don't think that my bubble is rare or unusual. Working at a hospital does mean that I know an awful lot of working wives and mothers, though, so maybe?
  3. Adding: doctor confidentiality is one way. MD can't share a patients information with family without consent, but can gather collateral history from anyone. Concerned family can share their concerns with their family member's doctor, who then has to make a decision about reporting.
  4. Reporting by doctors, nurse practitioners and optometrists for prescribed medical conditions (including cognitive impairment, motor and sensory impairment, sudden collapse, visual impairment, substance use and psychiatric illness), functional impairment and visual impairment is mandatory here and duty to report prevails over confidentiality. Doctors, nurse practitioners and optometrists also have discretionary reporting authority for "a person who is at least 16 years old who, in the opinion of the prescribed person, has or appears to have a medical condition, functional impairment or visual impairment that may make it dangerous for the person to operate a motor vehicle", which also prevails over confidentiality. The medicolegal consequences are thorny. Mandatory duty to report means you have to report even if the person voluntarily agrees to stop driving. Even if the person doesn't have a license etc. In theory, we should be reporting pretty much every nursing home patient who comes through the ED. And the law does not distinguish temporary impairment from long-term impairment; we should in theory be reporting right lower limb injuries and upper limb injuries like sprained ankles and broken wrists. We use common sense, but in doing so, absolutely depend on our patient's common sense (which isn't always so common) and open ourselves to liability.
  5. I've had the same thought. Analog clocks are still plentiful in public spaces here (hospitals, schools, train stations, city hall clock tower etc), but seem to be disappearing in private spaces. When our kids were toddlers, we realized that we didn't have a single analog clock in the house! Fixed that with a quick trip to IKEA 🙂
  6. Regarding Tamiflu: Different medical culture, mostly. Tamiflu has only ever really been used here for high risk patients. Nursing homes and hospitalized patients, mostly. The official criterial were/are broader than that, but never really gained traction in practice. EBM trained MD's especially never really warmed up to it. Prescribing peaked in 2009 with the H1N1 scare, then trickled off. Patients almost never presented within the 48h window. Also, flu tests didn't (still don't usually) result in the lab until the next day, sometimes longer for community labs. We were advised generally not to test, and instead to make a treatment decision based on clinical presentation if flu was known to be circulating. (We did test inpatients so we knew who we could cohort, so circulation data did exist). Patients here hadn't been "trained" by the media or medical estalishment to ask for it either. Then, with covid, flu went away. We're only really seeing it back this season, and clinically it's impossible to tell the difference between covid and flu. Lab testing for flu is still slow. The infuriating thing with paxlovid is that the good data already exists, but it's not accessible. It's being hidden. On purpose. For profit.
  7. In my province, senior drivers have to do a senior driver renewal every 2 years, starting at age 80, comprising: • A vision test. • A driver record review. • A 45-minute group education session (GES). • Two, brief, written (non-computerized) screening exercises. • Taking note of and then completing any required follow-up items for the MTO driver improvement counselor. The "screening exercises" are cognitive tests: Clock drawing test and single letter cancellation test. It's a pretty good system.
  8. Re personal anecdotes from individuals who believe that paxlovid worked for them: It's not actually possible to know. The trouble with illnesses that are generally self-limited (like acute mild covid illness), is that the acute symptoms were going to go away on their own anyway; for most mild acute covid cases, it's a matter of when, not if. For any individual, it's impossible to know if symptoms went away when they did because of the paxlovid, or if they were going resolve on their own at that time anyway. We really, really need prospective, properly blinded RTC to establish efficacy. The trial has been done (EPIC-SR). Symptom alleviation was a primary end-point. It did not achieve statistical significance (the paxlovid didn't work to alleviate symptoms). Unfortunately, the trial outcome has been "published" by press release only. The trial has not been formally published or peer-reviewed. It was funded and run by the drug manufacturer --- who has $$$$$$$ to lose by publishing a negative trial. Maintaining a state of uncertainty for as long as possible is good for their bottom line. This is a serious problem: this data is incredibly important, important on a population level, important enough to society that it should be a public good, yet it is being hidden by a drug company who stands to gain by hiding it, because that's just the way the scientific publishing and drug company research works in our system. IME, it's akin to fraud (Pfizer is promoting and selling a drug that I strongly suspect they know doesn't work), but it's business-as-usual. It't all very reminiscent of tamiflu. My prediction: Independent research will eventually establish lack of efficacy (or maybe I will be surprised and they will demonstrate efficacy, but I highly doubt it). There will be investigations. Pressure will mount, and the EPIC-SR trial data will come out eventually -- perhaps it will require legal action to make it happen. Governments who spent $$$$$ on this drug (like mine) will seek damages. It won't matter, because it will all be tiny drop in the bucket compared to profits made. And the cycle will repeat. Disclaimers: 1) I am talking about acute covid illness here. Long covid is a whole different discussion. For which the data pool is even worse. 2) EPIC-HR did show efficacy in preventing covid-associated hospitalization and death in patients who were high-risk and unimmunized and covid-naive (with lots of methodological tricks to favour a postive outcome, I might add). That population essentially doesn't exist anymore. EPIC-SR is the study we need to see published, because it the population it studied matches the population for which we prescribe paxlovid.
  9. Also, I just love that it incorporates the Birds Aren't Real satirical CT into its gameplay. Made me smile.
  10. This board game, "Lizards and Lies" was briefly shown on a recent national news segment on disinformation and deep fakes and concerns about how social media disinformation might derail elections specifically and democracy in general. It is a PhD student creation, and looks interesting: "As a research project that grew out of classwork, Lizards & Lies works to clarify the idea that social media operates as an ecosystem, with many different actors and many different spaces, each influencing the other." "...the game explores the widely held supposition that the spread of conspiracy theories and misinformation online constitutes a new front in a global war on truth. It’s a precept that he feels is oversimplified and skims past the vitally important role human users play in propagating fake news, willingly or not." The print-and-play version is free. Very nice-looking physical copies are also available, but $$$. I thought it might be of especial interest to game-schooling boardies. I think I might print it out and play it through with my teens.
  11. Paxlovid evidence: still very little reason to prescribe A summary and analysis of the current state of the evidence, by one of my favourite Canadian emergency medicine EBM people.
  12. Max Kermanator is named for a member of a local band, who campaigned for the name on social media. Icekee Wee Wee is a play on the Hamilton Tiger-Cats Football team's traditional fan cheering chant "Oskee Wee Wee" HAMBONI is a portmanteau or Hamilton and Zamboni ice surfacer machine.
  13. I remember when this was in the local news last year. The 10 winners of the plow naming contest. There is a new plow naming contest open for 2024. You all have a chance to name a Hamilton plow :)
  14. My family is all boosted, and none of us have been sick. Plenty of exposure. At the hospital, we are admitting lots of elderly for covid. Very , very much disproportionately unboosted (relative to community fall-booster base-rate of 47% for >65 yo in my community). From what I am seeing, this booster is definitely working to keep vulnerable people out of hospital.
  15. I had never heard of prolotherapy for knee OA until this thread. It seems to involve injecting sugar into the joint in order to purposefully induce an inflammatory response. I'm skeptical. Firstly, injecting bacteria-food into a space where bacterial infection can be catastrophic just seems like a bad idea. Septic arthritis is very, very serious. Secondly, inflammation is part of the pathology of OA; purposefully increasing inflammation seems backwards. Lastly, evidence-based clinical guidelines recommend against it. (I had heard of it for tendinopathy - totally different indication)
  16. I thought that this treatment had gone out of fashion. It is my understanding that best available evidence shows that it doesn't work. Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review of the Evidence Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. " In patients with knee osteoarthritis, viscosupplementation is associated with a small and clinically irrelevant benefit and an increased risk for serious adverse events." 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee "Intraarticular hyaluronic acid injections are conditionally recommended against in patients with knee and/or first CMC joint OA and strongly recommended against in patients with hip OA."
  17. 'Try not to let moose lick your car,' warns Parks Canada The article, of course, makes perfect sense. But the headline got my attention for sounding just ridiculous!
  18. Overkill, but absolutely excellent: Leatherman Raptor Rescue: Glass-breaker, belt cutter, ring cutter (also works on fishhooks) and the best trauma shears ever.
  19. I agree that the paragraphs you've quoted are really bad advice. Stopping a statin is usually no big deal, but some other meds can't be safely stopped. And others might be OK to stop individually, one at a time, but stopping a combination of them all at once may turn out to cause harm. Especially since the evidence for paxlovid is so poor to start with --- the only population with RTC data that showed benefit pretty much no longer exists (unvaccinated and high-risk and no previous covid exposure) Stopping meds with known benefit in order to take a med with unknown/unproven benefit seems unwise. I do think it's worth making a distinction between meds taken for long-term prevention (statins for CAD to prevent future MI, thinners for a-fib to prevent future stroke, ace-inhibiter for long-term renal protection diabetics) and meds for treatment of active conditions (thinners for existing clots, anti-convulsants for active seizure disorders etc, antihypertensives for severe essential hypertension). I wouldn't be so worried about holding the former, but would be much more concerned about holding the latter, even though in some cases they might be the exact same medication, the very same meds can be used for different indications. The indication matters, I think.
  20. Would a pastor let parishioners with housing insecurity use their address for mail? I really have no idea if this is a thing or not, but it came to mind as a potential explanation. Or renting a room. Or a family where spouse and kids all have different last names -- definitely not rare in blended families.
  21. Adding to above post: DNA fragments in vaccines is not a new thing. Multiple vaccines have residual DNA from host cells, both human and animal. Live attenuated vaccines that contain DNA viruses (Chickenpox, mpox and smallpox vaccines) will also, by definition, have quite a lot of viral DNA in them. Philadelphia Children's Hospital has a nice info page on this, with some references. Vaccine Safety: Myths and Misinformation Our bodies deal with foreign DNA all the time. Every time you eat or have any kind of viral infection. It is true that some viruses are oncogenic, but this is in the context of infection. I haven't seen any robust evidence to support vaccine oncogenesis from approved vaccines. Quite the reverse, actually -- e.g. we vaccinate for HPV to prevent cancer, quite successfully. I am much more worried about covid infection as a cause of cancer than I am about covid vaccine. I think it's plausible that covid vaccine may actually turn out to prevent cancer if covid turns out to be oncogenic in the long run. We have no idea what this virus has in store for us in terms of long-term sequellae.
  22. -2 R1, I think. dividend = divisor * quotient + remainder -5 = 3(-2)+1 (It's been a while since I've had to think about this!)
  23. Additional points to consider: Surgery and anesthesia necessarily entail risk, even with the very best team -- even the very best surgeons, anesthesiologists and OR teams all have bad outcomes sometimes. It is wise to optimize non-surgical options (physio, bracing, medication) first, and then consider surgery only if/when they fail. Don't get too hung up on numerical outcome data. Surgeons with the very best outcome data tend to be surgeons who are choosiest about who they operate on in the first place; surgeons who only take easy cases have great looking data, but may not be the best fit for you. Surgeons who take hard cases have numbers that look worse, but might actually be better overall and may be a better fit for you. So take outcome data with a large grain of salt. Your PCP should be able to help you choose a surgeon who is the best fit for your particular needs.
  24. Yes, it does work, thank goodness. My personal anecdotal evidence: I work in a very overcrowded ED and am steeped in resp virus every shift --- up close with sick people, doing high risk procedures etc. I am diligent with my n95, and I have not yet caught a viral resp illness from work. I lasted 3.5 years, and finally got covid during international travel, on a trip where eating indoors with others in crowded spaces and sleeping indoors in shared spaces was unavoidable. ETA: vast majority of colleagues can also trace their covid infections to outside-of-work social contact. Usually their kids bring it home from school, or acquired during travel.
  25. Another strategy to add to masking is to ventilate assertively and filter the air. Open windows. Run a HEPA air cleaner or a Corsi-Rosenthal box. Tougher in winter, but still do-able -- even just cracking a couple of windows in common areas while you are together can make a big difference.
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