Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] How Many Patients Did We Hurt Last Month? Learning (But Not Too Much) From The Best Hospitals

From the 6 November 2013 HealthCare Blog post by ASHISH JHA, MD

A few years ago, I was working on a strategy for improving the quality and safety of VA healthcare.  As part of this effort, I called up senior quality leaders of major healthcare organizations across the nation.  One call is particularly memorable.  Because I promised anonymity, I will not name names but this clinical leader was very clear about his responsibility: every month, he met with his CEO, who began the meetings with three simple questions: “How many patients did we hurt last month? How many patients did we fail to help? And did we do better than the month before?

The CEO and the entire hospital took responsibility for every preventable injury and death that occurred and the culture of the place was focused on one thing: getting better.  When I looked them up on Hospital Compare, they too had excellent outcomes and they regularly get “A” ratings for patient safety from the Leapfrog Group.

 

How do the BIDMCs and these other super-high performers pull it off?  How do they build a culture of quality when so many organizations seem to struggle?  High performance is complex, of course, and I won’t try to be overly simplistic.  But a few things seem common among many high performing institutions. They seem to be focused on three things:  timely, clinically relevant outcomes data; transparency within (and usually outside) the organization; and a constant focus on getting better.

You can see the kinds of data that BIDMC posts on its website – it’s not just the standard Hospital Compare stuff (which everyone has to do) but other data on a series of outcomes which are not required.   When I hear Kevin Tabb, their current CEO talk about quality – it’s obvious that quality is not a platitude.  He is genuinely focused on getting better.

So what’s the lesson from BIDMC, Mayo and other high performing institutions? There is no substitute for great leadership.  Each of them seems to have been blessed with leaders who, despite all the wrong incentives in the healthcare system, prioritize patient care and drive their organizations to great performance.  They are internally motivated and do all the things I describe above, despite the fact that our primary payment systems incentivize them to do more, not better.  They are extraordinary leaders- with not only great vision but also the ability to execute that vision.

But here’s the risk:  too many policymakers believe that all we need to do is figure out what BIDMC or Mayo or Kaiser does and just get everyone else to do it. Such an approach, while seemingly perfectly good on paper, fails to account for the human element.  The strategies that they have used have been executed by individuals unusually focused on improving care.  Barring substantial improvements in cloning technology, we can’t expect that each hospital will have a great leader.

We don’t expect that every technology company will have a Steve Jobs.  In every industry, there are a few visionary leaders, but the rest of the organizations?  They are run by mortals – and mortals respond to incentives.  And here lies the problem:  the incentives in the system are not motivating the typical CEO to improve care.  Whatever strategy we employ around timely data, transparency, etc. won’t work until the leadership is properly motivated and focused on quality.  And while that happens in pockets, it’s not happening across the entire healthcare system.  And this is where we will pick up in my next blog: how to get the rest of the organizations to make quality a real priority.

 

Read the entire article here

 

November 8, 2013 Posted by | health care | , , | 1 Comment

[Journal Article] Novel Genetic Patterns May Make Us Rethink Biology and Individuality

From the 7 November 2013 ScienceDaily article

Professor of Genetics Scott Williams, PhD, of the Institute for Quantitative Biomedical Sciences (iQBS) at Dartmouth’s Geisel School of Medicine, has made two novel discoveries: first, a person can have several DNA mutations in parts of their body, with their original DNA in the rest — resulting in several different genotypes in one individual — and second, some of the same genetic mutations occur in unrelated people. We think of each person’s DNA as unique, so if an individual can have more than one genotype, this may alter our very concept of what it means to be a human, and impact how we think about using forensic or criminal DNA analysis, paternity testing, prenatal testing, or genetic screening for breast cancer risk, for example. Williams’ surprising results indicate that genetic mutations do not always happen purely at random, as scientists have previously thought.

His work, done in collaboration with Professor of Genetics Jason Moore, PhD, and colleagues at Vanderbilt University, was published in PLOS Genetics journal on November 7, 2013.

Genetic mutations can occur in the cells that are passed on from parent to child and may cause birth defects. Other genetic mutations occur after an egg is fertilized, throughout childhood or adult life, after people are exposed to sunlight, radiation, carcinogenic chemicals, viruses, or other items that can damage DNA. These later or “somatic” mutations do not affect sperm or egg cells, so they are not inherited from parents or passed down to children. Somatic mutations can cause cancer or other diseases, but do not always do so. However, if the mutated cell continues to divide, the person can develop tissue, or a part thereof, with a different DNA sequence from the rest of his or her body.

….

f our human DNA changes, or mutates, in patterns, rather than randomly; if such mutations “match” among unrelated people; or if genetic changes happen only in part of the body of one individual, what does this mean for our understanding of what it means to be human? How may it impact our medical care, cancer screening, or treatment of disease? We don’t yet know, but ongoing research may help reveal the answers.

Christopher Amos, PhD, Director of the Center for Genomic Medicine and Associate Director for Population Sciences at the Cancer Center, says, “This paper identifies mutations that develop in multiple tissues, and provides novel insights that are relevant to aging. Mutations are noticed in several tissues in common across individuals, and the aging process is the most likely contributor. The theory would be that selected mutations confer a selective advantage to mitochondria, and these accumulate as we age.” Amos, who is also a Professor of Community and Family Medicine at Geisel, says, “To confirm whether aging is to blame, we would need to study tissues from multiple individuals at different ages.” Williams concurs, saying, “Clearly these do accumulate with age, but how and why is unknown — and needs to be determined.”

Just as our bodies’ immune systems have evolved to fight disease, interestingly, they can also stave off the effects of some genetic mutations. Williams states that, “Most genetic changes don’t cause disease, and if they did, we’d be in big trouble. Fortunately, it appears our systems filter a lot of that out.”

Mark Israel, MD, Director of Norris Cotton Cancer Center and Professor of Pediatrics and Genetics at Geisel, says, “The fact that somatic mutation occurs in mitochondrial DNA apparently non-randomly provides a new working hypothesis for the rest of the genome. If this non-randomness is general, it may affect cancer risks in ways we could not have previously predicted. This can have real impact in understanding and changing disease susceptibility.”

 

 

November 8, 2013 Posted by | Medical and Health Research News | , , , , , , , , | Leave a comment

[Report] Fast Food Facts 2013 Measuring Progress in the Nutritional Quality and Marketing of Fast Food to Children and Teens

Thinking my reaction to advertising was formed during weekly grocery trips when I was in grade school (back in the 60’s)
When we checked out the groceries I remember the candy, gum, and other goodies in the check out area.
While I did look at the items longingly, I knew not to ask for any of them. So, this carried over to advertising on television, especially Saturday morning cartoons.
McDonald’s? Thinking maybe, and just maybe we went there once during my grade school years.

 

From the November 2013 Robert Wood Johnson Report

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The nutritional quality of fast-food meals, and how those meals are marketed to children and teens, has improved, but more work is needed.

The Issue:
Fast Food FACTS 2013, issued by the Yale Rudd Center for Food Policy & Obesity, examines the nutritional quality of fast food, and how restaurants market their foods and beverages to children and teens. The report examines 18 of the top restaurant chains in the United states, and updates a similar report released in 2010.

 Key Findings

  • A total of $4.6 billion was spent on all advertising by fast food restaurants in 2012. This was an 8 percent increase over 2009. McDonald’s spent 2.7 times as much to advertise its products as all fruit, vegetable, bottled water, and milk advertisers combined.
  • Less than 1 percent of all kids’ meal combinations met recommended nutrition standards.
  • On average, U.S. preschoolers viewed 2.8 fast food ads on TV every day in 2012; children aged 6-11 years viewed 3.2 ads per day; and teens viewed 4.8 ads per day.
  • Fast food restaurants continued to target black and Hispanic youth, populations at high risk for obesity and related diseases.
Conclusion:
Researchers conclude that while improvements have been made, there is more work to be done to improve the overall nutritional quality of fast food. Additionally, the researchers call for fast food restaurants to stop targeting children and teens with marketing that encourages frequent visits to these restaurants.

About the Study:
The Yale Rudd Center for Food Policy & Obesity used the same methods as it did for the original Fast Food FACTS in 2010. Nutritional data were collected in February 2013, and most marketing data examine practices through 2012. The report was funded by the Robert Wood Johnson Foundation.

November 8, 2013 Posted by | Nutrition | , , , , , , , , | Leave a comment

How’s life? 2013 Measuring well-being [in OECD countries]

From the OECD (Organization for Economic Co-operation and Development]**

Every person aspires to a good life. But what does “a good or a better life” mean? The second edition of How’s Life? paints a comprehensive picture of well-being in OECD countries and other major economies, by looking at people’s material living conditions and quality of life across the population. In addition, the report contains in-depth studies of four key cross-cutting issues in well-being that are particularly relevant: how has well-being evolved during the global economic and financial crisis?; how big are gender differences in well-being?; how can we assess well-being in the workplace?; and how to define and measure the sustainability of well-being over time?

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Read the book by chapter

1. The OECD Better Life Initiative: Concepts and indicators

What drives people’s and nations’ well-being and where do countries need to improve to achieve greater progress for all? The OECD Better Life Initiative launched in 2011 addresses these questions by measuring well-being outcomesin 11 dimensions.

2. How’s Life? at a glance

This chapter shows that OECD countries have made considerable progress in many well-being areas over the past 20 years or so, although progress has been uneven across the 11 dimensions included in the OECD well-being framework. Similarly, there is great diversity in patterns amongst different countries as well as disparity in well-being achievements of different groups of the population within a country.

3. Well-being and the global financial crisis

This chapter analyses how well-being has changed during the global economic and financial crisis. Even though some effects of the crisis may become visible only in the long-term, the report finds that the crisis has had large implications for some economic and non-economic aspects of people’s well-being. Clear negative trends have emerged in subjective well-being and civic engagement, with increasing levels of stress, lower life satisfaction and decreasing trust in national governments.

4. Gender differences in well-being: Can women and men have it all?

The chapter looks at gender differences in well-being, showing that the traditional gender gap in favour of men has narrowed but has not disappeared. It also finds that women and men do well in different areas of well-being and that they are increasingly sharing tasks and roles.

5. Well-being in the workplace: Measuring job quality

This chapter looks at the quality of employment and well-being in the workplace. The report presents evidence on the main factors that drive people’s commitment at work and are key to strengthening their capacity to cope with demanding jobs.

6. Measuring the sustainability of well-being over time

The last chapter of the report studies the links between current and future well-being. It looks at ways to define and measure sustainability of well-being over time. This chapter focuses on four types of resources (or “capital”) that can be measured today, and that matter for future well-being: economic, natural, human, and social capital.

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** From the About Page

Our origins date back to 1960, when 18 European countries plus the United States and Canada joined forces to create an organisation dedicated to global development. Today, our 34 member countries span the globe, from North and South America to Europe and the Asia-Pacific region. They include many of the world’s most advanced countries but also emerging countries like Mexico, Chile and Turkey. We also work closely with emerging giants like China, India and Brazil and developing economies in Africa, Asia, Latin America and the Caribbean. Together, our goal continues to be to build a stronger, cleaner, fairer world.

November 8, 2013 Posted by | Public Health | , , , | Leave a comment

[NCHS Data Brief] Emergency Department Visits by Persons Aged 65 and Over: United States, 2009–2010

The emergency department entrance at Mayo Clin...

The emergency department entrance at Mayo Clinic’s Saint Marys Hospital. The red-and-white emergency sign is clearly visible. (Photo credit: Wikipedia)

 

From the November 2013 [US] National Center for Health Statistics

 

Key findings

Data from the National Hospital Ambulatory Medical Care Survey, 2009–2010

  • In 2009–2010, a total of 19.6 million emergency department (ED) visits in the United States were made by persons aged 65 and over. The visit rate for this age group was 511 per 1,000 persons and increased with age.
  • The percentage of ED visits made by nursing home residents, patients arriving by ambulance, and patients admitted to the hospital increased with age.
  • Twenty-nine percent of ED visits by persons aged 65 and over were related to injury, and the percentage was higher among those aged 85 and over than among those aged 65–74 or 75–84.
  • The percentage of ED visits caused by falls increased with age.

From 2000–2010, the number of persons in the United States aged 65 and over rose 15%, from 35.0 million to 40.3 million, and in 2010 this age group represented 13% of the population (1). It is estimated that by 2030, nearly one in five persons will be aged 65 and over (2). Given their growing proportion of the population, older individuals will comprise an increasing share of emergency department (ED) patients in the coming years. This is important because of the ED’s role in treating acute illness and injury in older adults and providing a pathway to these patients for hospital admission (3,4). This report describes ED visits made by individuals aged 65 and over and compares age groups 65–74, 75–84, and 85 and over.

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Read the entire summary here & link to the full text of the article

 

 

 

November 8, 2013 Posted by | Consumer Health, Consumer Safety, health care, Health Statistics | , | Leave a comment

[New Scientist Article] Data trackers monitor your life so they can nudge you

From the 7 November 2013 New Scientist article by Hal Hodson

Once you know everything about a person, you can influence their behaviour. A thousand students with tattletale phones are going to find out how easy that is

THERE’S something strange about this year’s undergraduate class at the Technical University of Denmark – they all have exactly the same kind of phone.

The phones are tracking everywhere the students go, who they meet and when, and every text they send. Around 1000 students are volunteers in the largest-ever experiment of its kind, one that could change our understanding of how we interact in groups.

Sune Lehmann and Arek Stopczynski of DTU are using the data to build a model of the social network the students live in – who talks to who, where groups gather. They plan to test whether the results can be used for purposes like boosting student achievement, or even improving mental health. “We hope to be able to figure out how to make this work in terms of academic performance,” says Lehmann.

This is sociology on a different scale, gathering detailed data about an entire group and then using that information to “nudge” them into changing their behaviour. Used ethically, the results could improve the way society works, transforming everything from healthcare and public transport to education and governance. Used for the wrong reasons, it could be extremely dangerous.

Used ethically, the results could improve the way society works, transforming everything from healthcare and public transport to education and governance. Used for the wrong reasons, it could be extremely dangerous.

Used ethically, the results could improve the way society works, transforming everything from healthcare and public transport to education and governance. Used for the wrong reasons, it could be extremely dangerous. a 2010 study, participants were encouraged to boost their activity levels either through personal rewards, or rewards given to a buddy who was supposed to keep tabs on them. Being motivated by an incentivised buddy resulted in twice the activity increase of the direct reward.

..nudges related to public health could be as simple as allowing doctors to ring up their patients when their activity levels start to follow patterns that correlate with, say, diabetes or depression, and asking them if they are feeling OK.

But we shouldn’t lose sight of the potential dark side, says Evan Selinger, a technology ethicist at the Rochester Institute of Technology in New York. “There is extraordinary power in the access to data at a personal level – even predicting future behaviour,” he says. “There’s a lot to be gained, but there’s a lot of problems that scare the living ******** out of me.”

 

 

 

November 8, 2013 Posted by | Psychology, Public Health | , , , , , , , , , | Leave a comment

   

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