How algorithm driven medicine can affect patient care

How algorithm driven medicine can affect patient care

From the KevinMD article of  Mon Jan 30, 2012

 

Whenever someone is scheduled for an operation, the assigned nurse is required to fill out a “pre-op checklist” to ensure that all safety and quality metrics are being adhered to. Before the patient is allowed to be wheeled into the OR we make sure the surgical site is marked, the consents are signed, all necessary equipment is available, etc. One of the most important metrics involves the peri-operative administration of IV antibiotics. SCIP guidelines mandate that the prophylactic antibiotic is given within an hour of incision time to optimize outcomes. This has been drilled into the heads of physicians, health care providers, and ancillary staff to such an extent that it occasionally causes total brain shutdown.

Let me explain. For most elective surgeries I give a single dose of antibiotics just before I cut. For elective colon surgery, the antibiotics are continued for 24 hours post-op. This is accepted standard of care. You don’t want to give antibiotics inappropriately or continue them indefinitely.

But what about a patient with gangrenous cholecystitis or acute appendicitis? What if, in my clinical judgment, I want to start the patient on antibiotics right away (i.e. several hours before anticipated incision time) and then continue them for greater than 24 hours post-op, depending on what the clinical status warrants? I should be able to do that right?

Well, you’d be surprised. You see, at two different, unaffiliated hospitals I cover, the surgeons have seen that decision-making capability removed from their power….

How A Parent’s Education Can Affect The Mental Health Of Their Offspring

How A Parent’s Education Can Affect The Mental Health Of Their Offspring

From the 29 January 2012 article at ScienceNews Today

New research sheds light on cycle of low socioeconomic status and depression Could depression in adulthood be tied to a parent’s level of education? A new study led by Amélie Quesnel-Vallée, a medical sociologist from McGill University, suggests this is the case…

 

…

The team found that higher levels of parental education meant fewer mental health issues for their adult children. “However, we also found much of that association may be due to the fact that parents with more education tend to have children with more education and better paying jobs themselves,” explained Quesnel-Vallée. “What this means is that the whole process of climbing up the social ladder that is rooted in a parent’s education is a crucial pathway for the mental health of adult children.”

These findings suggest that policies aimed at increasing educational opportunities for all, regardless of social background, may help break the intergenerational cycle of low socioeconomic status and poor mental health. “Children don’t get to choose where they come from. I think we have a responsibility to address health inequalities borne out of the conditions of early childhood,” said Quesnel-Vallée.

Related articles

• How A Parent’s Education Can Affect The Mental Health Of Their Offspring (medicalnewstoday.com)
• Exploring how a parent’s education can affect the mental health of their offspring (eurekalert.org)
• DSM-IV: Depression Defined (everydayhealth.com)

The Rights Of People With Disabilities Are Not Being Promoted, Study Finds

The Rights Of People With Disabilities Are Not Being Promoted, Study Finds

From the press release of Queen’s University (January 25, 2012

Historic legal rulings did not protect the rights of persons with disabilities, while legal rulings concerned with race or gender provided much more protection of individual rights and freedoms according to the Canadian Charter of Rights and Freedoms Queen’s University PhD student Christopher A. Riddle has determined in a recent study. “The motivation for this examination came from the very simple observation that the rights of persons with disabilities were not being promoted through the very mechanisms designed to ensure justice for everyone,” says the study’s author…

Related articles

• The Rights Of People With Disabilities Are Not Being Promoted, Study Finds (medicalnewstoday.com)
• Study shows the rights of people with disabilities are not being promoted (medicalxpress.com)
• US Hospitality Industry Often Reluctant To Hire People With Disabilities (medicalnewstoday.com)

Study Finds Religion Helps Us Gain Self-Control

 

Although I am not sure if there really is a cause/effect here, it is an interesting study. Perhaps self control is related to a cluster of factors, and religion is one?

Study Finds Religion Helps Us Gain Self-Control

From the Medical News Today article of Wed Jan 25, 2012

Excerpt

Thinking about religion gives people more self-control on later, unrelated tasks; according to results from a series of recent Queen’s University study.

“After unscrambling sentences containing religiously oriented words, participants in our studies exercised significantly more self-control,” says psychology graduate student and lead researcher on the study, Kevin Rounding.
Study participants were given a sentence containing five words to unscramble. Some contained religious themes and others did not. After unscrambling the sentences, participants were asked to complete a number of tasks that required self-control – enduring discomfort, delaying gratification, exerting patience, and refraining from impulsive responses.

Participants who had unscrambled the sentences containing religious themes had more self-control in completing their tasks.

“Our most interesting finding was that religious concepts were able to refuel self-control after it had been depleted by another unrelated task,” says Mr. Rounding. “In other words, even when we would predict people to be unable to exert self-control, after completing the religiously themed task they defied logic and were able to muster self-control.”

“Until now, I believed religion was a matter of faith; people had little ‘practical’ use for religion,” Mr. Rounding explains. “This research actually suggests that religion can serve a very useful function in society. People can turn to religion not just for transcendence and fears regarding death and an after-life but also for practical purposes.”

Thinking about religion gives people more self-control on later, unrelated tasks; according to results from a series of recent Queen’s University study. “After unscrambling sentences containing religiously oriented words, participants in our studies exercised significantly more self-control,” says psychology graduate student and lead researcher on the study, Kevin Rounding. Study participants were given a sentence containing five words to unscramble. Some contained religious themes and others did not

Related articles

• Queen’s study finds religion helps us gain self-control (esciencenews.com)
• Queen’s study finds religion helps us gain self-control (eurekalert.org)
• Courting rules: how men use self-control to make relationships count for God (winteryknight.wordpress.com)

Complementary and alternative medicine need more randomized trials

From the KeviMD column of Wed Feb 1, 2012 11:00 

 Since I dedicated an entire issue of JAMA on Nov. 11, 1998 to the theme of Complementary and Alternative Medicine in an effort to move CAM into the mainstream, I keep hoping that some of the numerous CAM offerings will make it out of the realm of anecdotal and placebo-healer-effect, and successfully through randomized controlled clinical trials.

So I got excited when I saw the BMJ Evidence Centre via McMaster feature the article, entitled “Evidence for the efficacy of complementary and alternative medicines in the management of rheumatoid arthritis: a systematic review,” published in Rheumatology in September 2011.

What’s Wrong With a Welfare Nation?

Posted on January 31, 2012 by mikethemadbiologist

At The Atlantic, a post by Alex Tabarrok, “The Innovation Nation vs. the Warfare-Welfare State“, has been making its way around the bloggysphere, in part due to the big shout out to science, as embodied by this figure:

Tabarrok:

We like to think of ourselves as an innovation nation, but our government is a warfare/welfare state. To build an economy for the 21st century we need to increase the rate of innovation and to do that we need to put innovation at the center of our national vision.

Innovation, however, is not a priority of our massive federal government. Nearly two-thirds of the U.S. federal budget, $2.2 trillion annually, is spent on the four biggest warfare and welfare programs, Medicaid, Medicare, Defense and Social Security. In contrast, the National Institutes of Health, which funds medical research, spends $31 billion annually, and the National Science Foundation spends just $7 billion.

I’m all for cutting back on the warfare state–that senitment is as old as the biblical prophets. And spending more money on non-military research is a good thing (and while we’re on the subject, go sign this petition). Regular readers will know I agree with that. But I’m not sure what’s wrong with the so-called welfare programs.

I’m all for controlling healthcare costs and figuring out ways of delivering care more effectively (who could possibly be against these things?).

MSN Careers – Tense times: Overcoming workplace incivility – Career Advice Article

Tense times: Overcoming workplace incivility

via MSN Careers – Tense times: Overcoming workplace incivility – Career Advice Article

Excerpt

some tips:

Take rudeness for what it’s worth.
Being on the receiving end of an unnecessarily sharp barb or inconsiderate brush-off can ruin your day. Why let it? Constructive criticism merits reflection; rudeness does not. So, don’t overthink the situation. While you can’t control how someone else treats you, you can limit how much it affects you. A person’s poor manners or behavior says less about you than it does about him or her.

Don’t go it alone.
What do you say at the end of a hard day when you’re asked about work? “I don’t want to talk about it” is a common response. But in many cases, bottling your feelings only exacerbates the problem.

Opening up to supportive friends or family can be cathartic. Likewise, seeking the wisdom of a mentor or sharing work-related war stories with a trusted member of your network often yields valuable insights and new coping strategies.

Rise above the fray.
Pessimism is contagious, and it’s all too easy for chronic complainers to bring others down. Don’t get caught up in the negativity. It’s possible to keep tabs on office undercurrents without feeding the grapevine with additional gripes, groans or gossip. Displaying a toxic attitude doesn’t solve anything, but it will likely make you look bad — and feel worse.

Give yourself a break.
You might believe you can’t afford to take time off. But can you afford not to? Whether you jet off to a tropical island or do a “staycation,” stepping away to recharge your batteries is healthy. Getting some distance and decompressing has a way of putting even your biggest workplace woes in perspective.

Similarly, it’s smart to take mini-breaks during the day. When tensions are running high, go for a quick stroll to collect your thoughts and cool off.

Finally, take an honest look at yourself. It’s very easy to point fingers and identify others’ annoying personality flaws. But what about your own? Try to be more mindful of how your bad habits, moods and behaviors might negatively impact co-workers….

Workstation – Building a Bridge to a Lonely Colleague – NYTimes.com and Related Article about Lonliness in General

Workstation – Building a Bridge to a Lonely Colleague – NYTimes.com

From the 28 January article

IT’S lonely at the top, or so it is said. But in fact it doesn’t matter where a person is in the office hierarchy — employees at all levels become lonely, even when other workers are all around them….

…

Because it is part of the human condition, loneliness is often regarded as a personal problem. But managers may need to view it as an organizational issue as well, according to research by Professor Barsade and Hakan Ozcelik, an associate business professor at California State University, Sacramento.

In a recent study of more than 650 workers, the two researchers found that loneliness — as reported both by the sufferer and his or her co-workers — reduces an employee’s productivity. This was true on both individual and team-oriented tasks.

Just look at what loneliness can do to a person, and you’ll see why. “Loneliness tends to distort social cognition and influences an individual’s interpersonal behavior, resulting in increased hostility, negativity, depressed mood, increased anxiety, lack of perceived control and decreased cooperativeness,” Dr. Wright says.

Professor Barsade is investigating whether loneliness may also be “contagious,” the way she has found emotions like anger and happiness to be in the workplace…

Read the entire NY Times article 

 

Feeling Left Out? Being Ignored Hurts, Even By A Stranger

From the Fri Jan 27, 2012 Medical News Today article

Feeling like you’re part of the gang is crucial to the human experience. All people get stressed out when we’re left out. A new study published in Psychological Science, a journal of the Association for Psychological Science, finds that a feeling of inclusion can come from something as simple as eye contact from a stranger. Psychologists already know that humans have to feel connected to each other to be happy. A knitting circle, a church choir, or a friendly neighbor can all feed that need for connection. Eric D…

Related articles

• How to Handle Loneliness (everydayhealth.com)
• Why Loneliness Matters (webmd.com)
• Loneliness May Cause Fitful Sleep (nlm.nih.gov)

Breaking Bad Habits – NIH News in Health, January 2012

Breaking Bad Habits – NIH News in Health, January 2012

From the article

If you know something’s bad for you, why can’t you just stop? About 70% of smokers say they would like to quit. Drug and alcohol abusers struggle to give up addictions that hurt their bodies and tear apart families and friendships. And many of us have unhealthy excess weight that we could lose if only we would eat right and exercise more. So why don’t we do it?

NIH-funded scientists have been searching for answers. They’ve studied what happens in our brains as habits form. They’ve found clues to why bad habits, once established, are so difficult to kick. And they’re developing strategies to help us make the changes we’d like to make.

“Habits play an important role in our health,” says Dr. Nora Volkow, director of NIH’s National Institute on Drug Abuse. “Understanding the biology of how we develop routines that may be harmful to us, and how to break those routines and embrace new ones, could help us change our lifestyles and adopt healthier behaviors.”

Habits can arise through repetition. They are a normal part of life, and are often helpful. “We wake up every morning, shower, comb our hair or brush our teeth without being aware of it,” Volkow says. We can drive along familiar routes on mental auto-pilot without really thinking about the directions. “When behaviors become automatic, it gives us an advantage, because the brain does not have to use conscious thought to perform the activity,” Volkow says. This frees up our brains to focus on different things.

Habits can also develop when good or enjoyable events trigger the brain’s “reward” centers. This can set up potentially harmful routines, such as overeating, smoking, drug or alcohol abuse, gambling and even compulsive use of computers and social media.

“The general machinery by which we build both kinds of habits are the same, whether it’s a habit for overeating or a habit for getting to work without really thinking about the details,” says Dr. Russell Poldrack, a neurobiologist at the University of Texas at Austin. Both types of habits are based on the same types of brain mechanisms.

“But there’s one important difference,” Poldrack says. And this difference makes the pleasure-based habits so much harder to break. …

Read the entire article here

 

 

Related articles

• Breaking Bad Habits (mayorshealthline.wordpress.com)

Elsevier’s Publishing Model Might be About to Go Up in Smoke – Forbes

Elsevier’s Publishing Model Might be About to Go Up in Smoke – Forbes 

From the 28 January 2012 article

Academic publishing is a very good game indeed if you can manage to get into it. As the publisher the work is created at the expense of others, for free to you. There are no advances, no royalties, to pay. The editing, the checking, the decisions about whether to publish, these are all also done for free to you. And the market, that’s every college libarary in the world and they’re very price insensitive indeed….

…

There’s not much new about this analysis and investors in Reed Elsevier, the owners of Elsevier, either do or should know all of this.

However, there’s something happening that might change this, for Reed Elsevier shareholders, quite delightful position. That is, a revolt of the academics who provide both the papers and the readership.

A start was made by British mathematician Tim Gowers, in a blog post here. That wasn’t the very start, but it looks like one of those pebbles that starts the avalanche rather than the one that just tumbles down the hillside. And there’s a great deal to be said for a scientific post which references Spike Milligan‘s superb book, Adolf Hitler, My Part in his Downfall.

As he says:

“I am not only going to refuse to have anything to do with Elsevier journals from now on, but I am saying so publicly. I am by no means the first person to do this, but the more of us there are, the more socially acceptable it becomes, and that is my main reason for writing this post,”

There is now a petition running for academics to sign up to this, here….

Read the entire article here

Related articles

• Could LexisNexis and Thomson Reuter legal publishing model go up in smoke? (kevin.lexblog.com)
• Elsevier Publishing Boycott Gathers Steam Among Academics (chronicle.com)
• Death to Elsevier! (freethoughtblogs.com)
• Death to Elsevier! (scienceblogs.com)
• Boycott Elsevier (whyevolutionistrue.wordpress.com)
• The cost of knowledge (terrytao.wordpress.com)
• On Elsevier (michaelnielsen.org)
• Scientists Organize Elsevier Boycott (science.slashdot.org)
• Boycott Elsevier (blogs.discovermagazine.com)
• Elsevier Snapped by Price Elasticity (arnoldit.com)
• The boycott Elsevier movement (marginalrevolution.com)
• Lists of Elsevier journals to boycott (rrresearch.fieldofscience.com)