Jump to content

Recommended Posts

15 hours ago, LT_Oneal_PAC said:

Please don’t confuse my passion for dispelling misinformation as me having any feelings for you Tim. I’m equally passionate at work against people who endanger patients with misinformation and poor evidence. You’ve presented zero evidence and not countered any presented. So if you don’t, this conversation is over.

p100 are easier to breath through with their improved seal and higher particle filtration? Again, you spouting facts without evidence. I wear a p100 at work and while easy to breath through it definitely takes more effort than a n95.

lots of people are wearing p100s. I wear it. Many people do. I’m not sure how a higher level filter is easier to breath through though?

you keep moving the goal posts. First it’s “oh I’m not talking about cloth.” Then “oh I’m not taking about the higher filters.” Are you Goldie locks? The situation has to be just right for your argument to work?

the mask does not filter the virus but filters their vehicle, droplets. This has been demonstrated over and over easily. As you like to point as evidence, look at the YouTube videos of all the microbiologists coughing, sneezing, talking at various distances with and without clothe mask at a culture medium. While not fool proof protection from airborne, it’s better than nothing as it will still minimize droplets that definitely contain the virus. Also, as was said before, it’s really the least you can do. 
 

you have provided no evidence that masks are harmful. No definitive evidence that masks do not decrease transmission. No definitive evidence of any of your claims. No willingness to accept explanations of the data. You’ve shown either compete disregard or ignorance of reverse isolation https://www.liscript.com/neutropenic-precautions/

there has been ample evidence presented to you, some you even requested, yet no response. 


Post something of substance,  man, so we can know some wheels are turning.

Not moving goal post no reason for me to. You just want to wish and think I am. There is no evidence on the masking that's what I am saying! Everyone wants us to wear them but there is no EBM. Do you not get that. That's my entire point plus the death rate has been declining but the numbers are soaring oh lordy. No duh cause we are testing more people....p100 are easier to breathe through as they have more valves....simple. so getting a vaccine (and no I am not against a vaccine or vaccines) will magically stop one from being able to carry the virus? So one wont be able to spread the virus being asymptomatic carrier way in their little nose? So when do we stop wearing these mask? Is there proof that you can show me that the vaccines makes me not able to carry that virus in my mouth or nose or lungs etc? For the other person posting below about CO2 retention. Do you know anything about mask? Oxygen mask? Ever heard of a venturi mask or simple mask? There are minimum flow rates on those OPEN mask so you dont cause CO2 retention. Look it up. So how is it not possible with a tight fitting mask? How about hypoxia? I think so. We need studies on these are practice what you guys all preach and what we learn in school EBM, prior to putting everyone on tight fitting mask without knowing the risk for all ages.

  • Downvote 1
Link to post
Share on other sites
  • Moderator
4 hours ago, camoman1234 said:

Not moving goal post no reason for me to. You just want to wish and think I am. There is no evidence on the masking that's what I am saying! Everyone wants us to wear them but there is no EBM. Do you not get that. That's my entire point plus the death rate has been declining but the numbers are soaring oh lordy. No duh cause we are testing more people....p100 are easier to breathe through as they have more valves....simple. so getting a vaccine (and no I am not against a vaccine or vaccines) will magically stop one from being able to carry the virus? So one wont be able to spread the virus being asymptomatic carrier way in their little nose? So when do we stop wearing these mask? Is there proof that you can show me that the vaccines makes me not able to carry that virus in my mouth or nose or lungs etc? For the other person posting below about CO2 retention. Do you know anything about mask? Oxygen mask? Ever heard of a venturi mask or simple mask? There are minimum flow rates on those OPEN mask so you dont cause CO2 retention. Look it up. So how is it not possible with a tight fitting mask? How about hypoxia? I think so. We need studies on these are practice what you guys all preach and what we learn in school EBM, prior to putting everyone on tight fitting mask without knowing the risk for all ages.

Just answer this: do you think the potential risk of wearing a mask outweighs the potential benefits?

  • Like 2
  • Upvote 2
Link to post
Share on other sites

Evidence-Based Medicine is a wonderful tool. Thanks to its application over time, medicine has made many advances. For example, we can now treat many (but unfortunately not all) cancer patients using proven protocols.

EBM marches forward, but it takes time. While we wait, we can only live in the era in which we live, have access to knowledge that is known, and -- unfortunately -- remain ignorant of what one day will become clear.  And so, for ourselves and our patients, we often have to make some decisions today without the benefit of EBM results. In such cases, it's risk vs benefit.

So "no" -- unless you're on death's doorstep -- to a risky drug; but "yes" to wearing a simple mask when you can't socially distance.

Edited by UGoLong
  • Upvote 3
Link to post
Share on other sites
  • Moderator
22 minutes ago, UGoLong said:

Evidence-Based Medicine is a wonderful tool. Thanks to its application over time, medicine has made many advances. For example, we can now treat many (but unfortunately not all) cancer patients using proven protocols.

EBM marches forward, but it takes time. While we wait, we can only live in the era in which we live, have access to knowledge that is known, and -- unfortunately -- remain ignorant of what one day will become clear.  And so, for ourselves and our patients, we have to make some decisions today without the benefit of EBM results. In such cases, it's risk vs benefit.

So "no" -- unless you're on death's doorstep -- to a risky drug; but "yes" to wearing a simple mask when you can't socially distance.

Many also believe EBM means only following double blinded RCTs, but it just means following the best available evidence. Sometimes that is just anecdotal reports and expert opinion, and there is no expert opinion that masks are harmful, no anecdotal evidence of harm from thousands of man power years of wearing masks (cloth, N95, or p100 [of which there are several types some with one valve]or even NBC masks), and we have contrary evidence that reverse precautions DO work, low level evidence masks DO prevent disease spread, evidence that vaccines DO minimize transmission.

I wasn’t going to get into it because I felt my simple risk benefit question should be sufficient to end the argument, but let’s circle back to the OPs point of Venturi mask. The point is not to prevent CO2 rebreathing from retention, but a minimum flow rate is needed to use the Venturi principle. if the flow isn’t the same, the entrainment of room air is not the same. Here’s some basics for you on that:


now let’s talk simple face mask. You can’t have CO2 narcosis with these because they have holes for this very reason. We deliver high flows because they are VERY imprecise in their oxygen deliver due to entrainment though said holes.

next we have the non-rebreather. It’s true, you could have CO2 narcosis with this, though unlikely because they rarely have a tight seal, but it happens you have a big bag on the end and it’s not supposed to entrain room air, whereas ALL other masks bring in room air, including cloth masks, N95, p100s, and NBC masks. It was common practice to break one of the exhalation valves to prevent this from happening if there was some problem with oxygen flow, thus eliminating the problem. 

Further, the purpose of nonrebreathers isn’t so much to remove CO2, but to denitrogenate the air (making up a much larger portion of room air) and provide higher FiO2. Only with the non-rebreather is CO2 retention a possibility because it’s designed not to entrain room air.

Now we could talk about COPDers, but you and the majority of people upset about masks don’t have COPD. If you do want to go down that path, I can point to an equal number of marathon athletes that wear masks during competition due to asthma. https://www.rxwiki.com/feature-article/olympian-galen-rupp-suffers-asthma-and-allergies So you shouldn’t have a problem walking up and down the hall wearing a mask.

So none of the mask arguments holds water, because it’s not possible with room air entrainment. 
 

Let’s look at the physics of breathing in a n95. When you exhale, you have about 18% oxygen with a tidal volume of (not exertional) of 500mL. I think we can all assume there is less than 500mL of volume in a n95. So a lot air exchange. 
 

Finally, no one is saying wear a mask 24 hours a day! Why is it so hard to wear a mask for an hour for going to the store? N95 or cloth mask, it’s not hard to tolerate it while you pick out your steak at the butcher. As far as health care workers, you should be getting breaks! If you don’t get a 15 minute break to go take off you mask twice a day and 30 minutes for lunch, you’re being abused! Not by the mask but being overworked by admins that don’t care. In those instances, you have bigger fish to fry. Don’t argue for looser mask restrictions, argue for a better work environment.

anyways, I think that’s about all I can stand on this subject. Still no response to the vaccine evidence requested. No evidence, just timeline associations. If the science hasn’t won yet, it’s not going to.

  • Like 1
Link to post
Share on other sites
18 hours ago, LT_Oneal_PAC said:

Just answer this: do you think the potential risk of wearing a mask outweighs the potential benefits?

Dont know the risk. Need EBM like we are trained to think about. Also the deaths rates are declining since May and there is not enough evidence yet to prove which mask are helpful and which mask are safe to wear long term. 

  • Downvote 4
Link to post
Share on other sites
11 hours ago, LT_Oneal_PAC said:

Many also believe EBM means only following double blinded RCTs, but it just means following the best available evidence. Sometimes that is just anecdotal reports and expert opinion, and there is no expert opinion that masks are harmful, no anecdotal evidence of harm from thousands of man power years of wearing masks (cloth, N95, or p100 [of which there are several types some with one valve]or even NBC masks), and we have contrary evidence that reverse precautions DO work, low level evidence masks DO prevent disease spread, evidence that vaccines DO minimize transmission.

I wasn’t going to get into it because I felt my simple risk benefit question should be sufficient to end the argument, but let’s circle back to the OPs point of Venturi mask. The point is not to prevent CO2 rebreathing from retention, but a minimum flow rate is needed to use the Venturi principle. if the flow isn’t the same, the entrainment of room air is not the same. Here’s some basics for you on that:


now let’s talk simple face mask. You can’t have CO2 narcosis with these because they have holes for this very reason. We deliver high flows because they are VERY imprecise in their oxygen deliver due to entrainment though said holes.

next we have the non-rebreather. It’s true, you could have CO2 narcosis with this, though unlikely because they rarely have a tight seal, but it happens you have a big bag on the end and it’s not supposed to entrain room air, whereas ALL other masks bring in room air, including cloth masks, N95, p100s, and NBC masks. It was common practice to break one of the exhalation valves to prevent this from happening if there was some problem with oxygen flow, thus eliminating the problem. 

Further, the purpose of nonrebreathers isn’t so much to remove CO2, but to denitrogenate the air (making up a much larger portion of room air) and provide higher FiO2. Only with the non-rebreather is CO2 retention a possibility because it’s designed not to entrain room air.

Now we could talk about COPDers, but you and the majority of people upset about masks don’t have COPD. If you do want to go down that path, I can point to an equal number of marathon athletes that wear masks during competition due to asthma. https://www.rxwiki.com/feature-article/olympian-galen-rupp-suffers-asthma-and-allergies So you shouldn’t have a problem walking up and down the hall wearing a mask.

So none of the mask arguments holds water, because it’s not possible with room air entrainment. 
 

Let’s look at the physics of breathing in a n95. When you exhale, you have about 18% oxygen with a tidal volume of (not exertional) of 500mL. I think we can all assume there is less than 500mL of volume in a n95. So a lot air exchange. 
 

Finally, no one is saying wear a mask 24 hours a day! Why is it so hard to wear a mask for an hour for going to the store? N95 or cloth mask, it’s not hard to tolerate it while you pick out your steak at the butcher. As far as health care workers, you should be getting breaks! If you don’t get a 15 minute break to go take off you mask twice a day and 30 minutes for lunch, you’re being abused! Not by the mask but being overworked by admins that don’t care. In those instances, you have bigger fish to fry. Don’t argue for looser mask restrictions, argue for a better work environment.

anyways, I think that’s about all I can stand on this subject. Still no response to the vaccine evidence requested. No evidence, just timeline associations. If the science hasn’t won yet, it’s not going to.

But the medical community throws fits when we have low level evidence on nontraditional treatments or experts that are not MDs or DOs or PhDs. But it's ok now? I dont have time to tell you I understand  venturi and other gas laws. Do you have proof that there is not CO2 retention? I get symptoms of forgetfulness, headaches, dizzy when wearing a mask too long. How about evidence that there is 20.9% O2 in the mask at all times? No we don't have evidence on the mask as you were saying, how about the elderly or children wearing mask? Your evidence is based off a few people that you wear a mask around. Have you took a poll around all the hospitals in your town? Also your tidal volume is too high. Most adults are around 300 ml resting. Vents are set higher but do not reflect actual volume in a non intubated patient. Good try.

Link to post
Share on other sites
  • Moderator
1 hour ago, camoman1234 said:

But the medical community throws fits when we have low level evidence on nontraditional treatments or experts that are not MDs or DOs or PhDs. But it's ok now? I dont have time to tell you I understand  venturi and other gas laws. Do you have proof that there is not CO2 retention? I get symptoms of forgetfulness, headaches, dizzy when wearing a mask too long. How about evidence that there is 20.9% O2 in the mask at all times? No we don't have evidence on the mask as you were saying, how about the elderly or children wearing mask? Your evidence is based off a few people that you wear a mask around. Have you took a poll around all the hospitals in your town? Also your tidal volume is too high. Most adults are around 300 ml resting. Vents are set higher but do not reflect actual volume in a non intubated patient. Good try.


We have lots of PhD and MD/DO expert opinion on masks. 

so I need to poll everyone, but you get to base this off your experience?

300mL. Please, I've cited evidence at every juncture, and you haven’t. You have a lot to learn about respiratory physiology.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1019420/pdf/thorax00036-0073.pdf


While you may understand some physics, just like the data, you are twisting it into something it’s not.

2 hours ago, camoman1234 said:

Dont know the risk. Need EBM like we are trained to think about. Also the deaths rates are declining since May and there is not enough evidence yet to prove which mask are helpful and which mask are safe to wear long term. 

This is it. You don’t understand EBM, correlation, causation, association, confounding variables. I’m fine if you want to do a double blind RCT on mask. No one is stopping you, but the best available evidence say benefits outweigh risks. You haven’t convinced me or anyone else here otherwise. But by all means, let them speak if I’m wrong.

if you want to be a champion of EBM, you could pick a lot better topics than this. Go look at tPA. I suspect the only reason you care is it affects you directly and it’s been highly politicized.
 

Done with you. Talk into the void if you like. Thanks for playing, Tim.

 

 

7DCFB6DC-6509-4B30-8BB9-DD541AF5D5ED.gif

  • Like 3
  • Upvote 3
Link to post
Share on other sites
  • Administrator

No masks don't hurt. At all.

That doesn't mean there's no costs; every countermeasure has costs.  Masks...
- Make it easier for criminals to avoid identification
- Obscure non-verbal communication and lip reading.
- require time and effort to make, maintain, and use.
- May be uncomfortable and/or cause glasses fogging.

Am I leaving anything out?  Pretty short list.

Now, what is the break-even point?  At what percentage chance to reduce R0, reduce your own chance of catching Covid-19, etc. is this a good deal?  Considering the morbidity and mortality, that's a pretty low bar for me.  But hey, I wear wraparound safety glasses essentially any time I'm not sleeping or showering, so I already have a predisposition to PPE.

It's relatively easy math to do, even with all the uncertainties involved, and pretty much any nonzero value for harm reduction from mask use makes the use case straightforward.  Risk assessment is all about working with incomplete data and doing the best you can with regards to appropriate countermeasures.

But remember, boys and girls, Americans, on the whole, like to buy Powerball tickets and worry about commercial air travel safety: Math doesn't drive action, perception of math does, and humans are terrible at appropriately estimating the impact of low-frequency, high-impact events.

  • Like 1
  • Upvote 3
Link to post
Share on other sites
On 7/10/2020 at 1:06 PM, LT_Oneal_PAC said:


We have lots of PhD and MD/DO expert opinion on masks. 

so I need to poll everyone, but you get to base this off your experience?

300mL. Please, I've cited evidence at every juncture, and you haven’t. You have a lot to learn about respiratory physiology.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1019420/pdf/thorax00036-0073.pdf


While you may understand some physics, just like the data, you are twisting it into something it’s not.

This is it. You don’t understand EBM, correlation, causation, association, confounding variables. I’m fine if you want to do a double blind RCT on mask. No one is stopping you, but the best available evidence say benefits outweigh risks. You haven’t convinced me or anyone else here otherwise. But by all means, let them speak if I’m wrong.

if you want to be a champion of EBM, you could pick a lot better topics than this. Go look at tPA. I suspect the only reason you care is it affects you directly and it’s been highly politicized.
 

Done with you. Talk into the void if you like. Thanks for playing, Tim.

 

 

7DCFB6DC-6509-4B30-8BB9-DD541AF5D5ED.gif

I get on here for 5 to 10 mins and then I'm off for a day or so. I dont have time nor have anything to impress you with by writing a thesis. 

I learned 5cc/kg for tidal volume back in the day so let's correct everything so you are happy. 300 cc to 500 cc resting tidal volume.

I brought up the point deaths from covid have been declining since May but cases are increasing so questioning making. There's more to making that medicine and sound science. Keep on keeping on with whatever you want to believe. The news will inform you of accurate death counts....

Link to post
Share on other sites
10 hours ago, camoman1234 said:

I get on here for 5 to 10 mins and then I'm off for a day or so. I dont have time nor have anything to impress you with by writing a thesis

Stop getting your “sources” from breitbart or q-anon. 

Edited by JoeM
  • Like 2
  • Upvote 1
  • Downvote 1
Link to post
Share on other sites
12 hours ago, camoman1234 said:

I get on here for 5 to 10 mins and then I'm off for a day or so. I dont have time nor have anything to impress you with by writing a thesis. 

I learned 5cc/kg for tidal volume back in the day so let's correct everything so you are happy. 300 cc to 500 cc resting tidal volume.

I brought up the point deaths from covid have been declining since May but cases are increasing so questioning making. There's more to making that medicine and sound science. Keep on keeping on with whatever you want to believe. The news will inform you of accurate death counts....

This is just pure laziness and you’re proving everyone’s point. You know your hypothesis disintegrates with evidence so you refuse to provide it. Your cognitive bias therefore lives on. When confronted with evidence, you resort childish excuses. You have enough time to come on here and make extraordinary claims but don’t have time to provide extraordinary evidence? The last sentence sounds like your mantra. 
 

“What can be asserted without evidence, can be dismissed without evidence.“

-Christopher Hitchens

  • Upvote 2
Link to post
Share on other sites
On 7/12/2020 at 10:30 AM, ANESMCR said:

This is just pure laziness and you’re proving everyone’s point. You know your hypothesis disintegrates with evidence so you refuse to provide it. Your cognitive bias therefore lives on. When confronted with evidence, you resort childish excuses. You have enough time to come on here and make extraordinary claims but don’t have time to provide extraordinary evidence? The last sentence sounds like your mantra. 
 

“What can be asserted without evidence, can be dismissed without evidence.“

-Christopher Hitchens

I have to post EBM on known topics such as respiratory masks or surgical mask not stopping Covid or other airborne diseases? Are you even a PA? I should not have to post these points....

Link to post
Share on other sites

It's my observation that issues of political, social, public health  have become jumbled together in addressing COVID-19, creating dissention amplified by inconsistency from many agencies and quarters. Basic common sense & EBM have  been overshadowed by various agendas.

 

Edited by CAdamsPAC
  • Like 1
  • Upvote 2
Link to post
Share on other sites
3 hours ago, camoman1234 said:

I have to post EBM on known topics such as respiratory masks or surgical mask not stopping Covid or other airborne diseases? Are you even a PA? I should not have to post these points....

Once again, if you expect to be taken seriously, yes. Otherwise you’re just a political shill.

Link to post
Share on other sites
22 hours ago, ANESMCR said:

Once again, if you expect to be taken seriously, yes. Otherwise you’re just a political shill.

I shouldn't have to post RCT trials and articles on basic knowledge that a PA should know from school. Are you a PA or just a troll?

Link to post
Share on other sites
6 hours ago, camoman1234 said:

I shouldn't have to post RCT trials and articles on basic knowledge that a PA should know from school. Are you a PA or just a troll?

You were researching RCT on mask efficacy in PA school? Did your capstone/thesis poster presentation section under methods and results read “I shouldn’t have to post anything here”. Because it sure sounds like you don’t know how this process works at all beyond using the abbreviations.

So what happens to the ad hominem when you find out that I’m obviously a PA? Based on your logic, and that every response you’ve had on this thread opposes your alternative facts, does that mean all of us aren’t PAs? Also, it would appear that I’m the only one being trolled here. Everyone else has given up on you. 

With the amount of effort you’ve put into refusing to respond intelligently to anyone, you could’ve easily produced something...I never even said I necessarily disagreed with you. I just think your presentation is a skunk. 

Edited by ANESMCR
Link to post
Share on other sites
Guest
This topic is now closed to further replies.
×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More