“ MAH and JM are co-applicants on the RELEASE and RELEASE + trials in Australia, funded by the Medical Research Future Fund (MRFF) and the National Health and Medical Research Council (NHMRC), evaluating hyperbolic tapering of antidepressants against care as usual. MAH reports being a co-founder of and consultant to Outro Health, a digital clinic which provides support for patients in the US to help stop no longer needed antidepressant treatment using gradual, hyperbolic tapering; and receives royalties for the Maudsley Deprescribing Guidelines. JM receives royalties for books about psychiatric drugs, and was a co-applicant on the REDUCE trial, funded by the National Institute of Health Research, evaluating digital support for patients stopping long-term antidepressant treatment. MP and RL have no conflicts of interest to declare.”

I would caution those in this thread who have never seen or treated patients in any psychiatric clinic or hospital let alone a pediatric one to be careful assuming that they have adequate experience to make sweeping judgements on the utility of antidepressants in children.

Used to make burr holes so that the dura can be stripped away from the skull using the Penfield 3 instrument.

Then what's used is what's known as the B1 with footplate to create the bone flap - https://www.researchgate.net/publication/323134344_Exposure_...

Here is an example of the drill system - Midas Rex MR8 - https://www.ebay.com/itm/125960633809

Here's a video of a surgeon performing the pterional craniotomy, probably the most common craniotomy for things like aneurysms, - https://www.neurosurgicalatlas.com/volumes/cranial-approache...

Unfortunately this dataset doesn't include the, probably more frequent, severe TBIs. Surely wouldn't take many patients for the cost of a hemicraniectomy, 2 week neuro-ICU stay, trach/peg, and long term acute care stay to equal the cost of a few measures to slow drivers down. Not to mention lost earning/tax potential. Too bad it's not from the same budget.

Wear your seatbelt and a helmet and hopefully you can avoid the pain of your family having to have a surprise end-of-life discussion with me.

Can’t undo brain cuts. CNS neurons don’t repair themselves like peripheral neurons or your skin. Generally not cutting glioma brain tumors out per se more likely to use ultrasonic aspiration to suck the tumor out piecemeal. Depends on the tumor though.

Every dollar spent coming up with the next automated imaging diagnosis model would be better spent on a model that encourages people to get up and exercise 5x/week, quit smoking (or never start), and get their colonoscopy. Once the patient is presenting to the doctor with heart failure, coronary artery disease, carotid stenosis, COPD, colon cancer, etc. the battle is already lost.

Complain all you want about the healthcare system holding data back. You don't need the healthcare system to make the biggest impact on people's health.

—- I’ll add that your shamanism comment sounds like the typical bs that the 20-something software engineer, who thinks they know everything because they make more than 100k a year and have never had to go to a doctor for anything other than strep throat or generalized anxiety disorder let alone spent anytime in a hospital other than to visit family members, that are everywhere on this site loves to say about physicians or other healthcare workers to shit on them.

I don't have anything against NPs when the supervision is close, but more and more doctors are put into positions where they are acting as liability sponges for de-facto independent NPs/PAs.

Here are a few studies - (CRNA) We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. https://www.ncbi.nlm.nih.gov/pubmed/22305625

Comparing urgent care visits between MD/DOs and Midlevels. Doctors saw more complicated patients, addressed more complaints and deprescribed more. https://link.springer.com/article/10.1007/s11606-021-06669-w

NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states. https://pubmed.ncbi.nlm.nih.gov/32333312/

Both 30-day mortality rate and mortality rate after complications (failure-to-rescue) were lower when anesthesiologists directed anesthesia care. https://pubmed.ncbi.nlm.nih.gov/10861159/

Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. https://www.ncbi.nlm.nih.gov/pubmed/29710082

Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits. https://jamanetwork.com/journals/jamainternalmedicine/fullar...

Nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians in outpatient settings, and resident physicians were less likely to prescribe antibiotics. https://www.ncbi.nlm.nih.gov/pubmed/15922696

The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation. https://www.mayoclinicproceedings.org/article/S0025-6196(13)...

Resident teams are economically more efficient than MLP teams and have higher patient satisfaction. https://www.ncbi.nlm.nih.gov/m/pubmed/26217425/

I don't know if 500hrs of shadowing after a 2yr part-time online only program that you don't need any nursing degree or experience to enter would count as highly trained or skilled. Here's a list of direct entry nursing masters programs - https://nursinglicensemap.com/nursing-degrees/masters-in-nur...

Here's Johns Hopkins doctor of nursing practice program's curriculum - https://nursing.jhu.edu/academics/programs/doctoral/msn-dnp/... - where more than half of your classes are not medicine related and which requires an astounding 1000 clinical hours and less than 10 credits a semester before you can call yourself "doctor". Most medical students will have 1000hrs after 3 months in 3rd year, where they will be expected to diagnose and come up with treatment plans vs just shadowing, and they still have 9 more months of 3rd year, 4th year, and a minimum of 3 more years in residency. Doctors will likely end up with a minimum of 15000 hours of training. The difference really is that large, and I feel bad for the patients and for the NPs who have no idea how deficient their education is. PAs have 2000hrs of clinical experience. Here's a chart - https://i.imgur.com/Cj5z4f8.jpg