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)