Medicine's Dangerous Guessing Game (Keith Winstein in WSJ)
Different Methods of Weighing the Risks and Benefits of Medical Treatments Lead to Varying Conclusions About Their Safety
extract
"Simply put, the issue is a matter of whether to adjust for time. In other words, should the chances of contracting a harmful side effect be calculated by figuring out the simple percentage of all those taking the drug who have come down with the side effect? Or should those calculations be adjusted for the duration that patients have been treated?"
Thursday, September 10, 2009
Interactive Medical Cases — A New NEJM Feature
Interactive Medical Cases
"Educators have long recognized that learning is enhanced and retention improves when the educational material is relevant and engaging and includes interaction. Building on the increasing capacity of the online environment, we are pleased to launch this week a new series of Interactive Medical Cases at NEJM.org.
The interactive cases are an extension of the Clinical Problem-Solving cases that we publish each month. These articles present clinical cases that are diagnostic puzzles. In the articles published in print, an expert clinician discussant responds to sequential clinical information as a case unfolds, eventually reaching a diagnosis. The interactive cases are designed to let the reader determine the diagnostic and treatment plans. The format recapitulates a clinical encounter by presenting the patient's history with results of the physical examination and laboratory and radiographic tests. EXAMPLE
Multiple-choice questions, interspersed throughout each interactive case, address both differential diagnosis and management. After a choice is made, immediate feedback is provided to indicate why the selected response is optimal or is likely to be unhelpful. At the conclusion of each case, users are able to gauge their performance relative to that of their peers."
"Educators have long recognized that learning is enhanced and retention improves when the educational material is relevant and engaging and includes interaction. Building on the increasing capacity of the online environment, we are pleased to launch this week a new series of Interactive Medical Cases at NEJM.org.
The interactive cases are an extension of the Clinical Problem-Solving cases that we publish each month. These articles present clinical cases that are diagnostic puzzles. In the articles published in print, an expert clinician discussant responds to sequential clinical information as a case unfolds, eventually reaching a diagnosis. The interactive cases are designed to let the reader determine the diagnostic and treatment plans. The format recapitulates a clinical encounter by presenting the patient's history with results of the physical examination and laboratory and radiographic tests. EXAMPLE
Multiple-choice questions, interspersed throughout each interactive case, address both differential diagnosis and management. After a choice is made, immediate feedback is provided to indicate why the selected response is optimal or is likely to be unhelpful. At the conclusion of each case, users are able to gauge their performance relative to that of their peers."
Tuesday, September 8, 2009
Monday, September 7, 2009
The Good Enough Revolution (Must Read!)
The Good Enough Revolution: When Cheap and Simple Is Just Fine
extract
"In 2007, Flanagin and her colleagues wondered what would happen if, instead of building a hospital in a new area, Kaiser just leased space in a strip mall, set up a high tech office, and hired two doctors to staff it. Thanks to the digitization of records, patients could go to this "microclinic" for most of their needs and seamlessly transition to a hospital farther away when necessary. So Flanagin and her team began a series of trials to see what such an office could do. They cut everything they could out of the clinics: no pharmacy, no radiology. They even explored cutting the receptionist in favor of an ATM-like kiosk where patients would check in with their Kaiser card.
Posted using ShareThis
extract
"In 2007, Flanagin and her colleagues wondered what would happen if, instead of building a hospital in a new area, Kaiser just leased space in a strip mall, set up a high tech office, and hired two doctors to staff it. Thanks to the digitization of records, patients could go to this "microclinic" for most of their needs and seamlessly transition to a hospital farther away when necessary. So Flanagin and her team began a series of trials to see what such an office could do. They cut everything they could out of the clinics: no pharmacy, no radiology. They even explored cutting the receptionist in favor of an ATM-like kiosk where patients would check in with their Kaiser card.
What they found is that the system performed very well. Two doctors working out of a microclinic could meet 80 percent of a typical patient's needs. With a hi-def video conferencing add-on, members could even link to a nearby hospital for a quick consult with a specialist. Patients would still need to travel to a full-size facility for major trauma, surgery, or access to expensive diagnostic equipment, but those are situations that arise infrequently.
If that 80 percent number rings a bell, it's because of the famous Pareto principle, also known as the 80/20 rule. And it happens to be a recurring theme in Good Enough products. You can think of it this way: 20 percent of the effort, features, or investment often delivers 80 percent of the value to consumers. That means you can drastically simplify a product or service in order to make it more accessible and still keep 80 percent of what users want—making it Good Enough—which is exactly what Kaiser did"Posted using ShareThis
Wireless technologies to help nurses deliver patient care safely and efficiently
by Kate Huvane Gamble in HealthInformatics September 2009
".... one of the most significant barriers to care delivery is communication. Nurses", says Fran Turisco, research principal in the Waltham, Mass.-based Emerging Practices Healthcare Group of CSC (Falls Church, Va.), "are often placed in the middle of the communication loop, where they constantly receive and place calls to physicians, pharmacy and lab, all while trying to tend to patients.
".... one of the most significant barriers to care delivery is communication. Nurses", says Fran Turisco, research principal in the Waltham, Mass.-based Emerging Practices Healthcare Group of CSC (Falls Church, Va.), "are often placed in the middle of the communication loop, where they constantly receive and place calls to physicians, pharmacy and lab, all while trying to tend to patients.
“So the issue is how you cut out some of the middle men in these communication loops,” she says. “And how do you shorten the timeframe between when a nurse needs to talk to someone and when she actually gets to talk to that person, then either make a care decision or figure out what needs to get done next.”
Sunday, September 6, 2009
Academic Publishing 2.0 (or 3.0) Must Reads!
Brian Whitworth (see previous post) is also one of the many who are campaigning for an end to the 'feudal' system which operates within academic publishing - a system which is fortunately showing signs of the upheaval that socio-technical change is bringing in all areas of life - in favour of a more democratic 'Knowledge Exchange System' (see pic)
Whitworth, B. & Friedman, R., 2009, Reinventing academic publishing online Part I: Rigor, Relevance and Practice, First Monday, Volume 14, Number 8, 3 August 2009
Whitworth, B. & Friedman, R., 2009, Reinventing academic publishing online Part II: A Socio-technical Vision First Monday, Volume 14, Number 9, September 2009
Web of System Performance
Brian Whitworth (Institute of Information and Mathematical Sciences, Massey University, Auckland, New Zealand) has some very interesting papers on evaluating 'Socio-Technical Systems' on a multi-criteria basis. Here are three (some written with others):Expanding the Criteria for Evaluating Socio-Technical Software, IEEE Transactions on Systems, Man and Cybernetics, Part A, Volume 38, Issue 4, July p777 - 790
The Social Requirements of Technical Systems, Chapter 1 of Whitworth, B., and Moor, A.d. (eds.) Handbook of Research on Socio-Technical Design and Social Networking Systems. IGI, Hershey, PA, 2009
The Web of System Performance: A multi-goal model of information system performance, Communications of the ACM, May, Vol 49, No 5, p93-99.
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