U of Minnesota Medical Center’s nurses ditch their pagers
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Google URL Tricks Made Easy
5 weeks ago
Friday, September 25, 2009
Thursday, September 24, 2009
Monday, September 21, 2009
Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why.
Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why.
Extract:
From 2001 to 2006, the percentage of new products cut from development after Phase II clinical trials, when drugs are first tested against placebo, rose by 20 percent. The failure rate in more extensive Phase III trials increased by 11 percent, mainly due to surprisingly poor showings against placebo. Despite historic levels of industry investment in R&D, the US Food and Drug Administration approved only 19 first-of-their-kind remedies in 2007—the fewest since 1983—and just 24 in 2008. Half of all drugs that fail in late-stage trials drop out of the pipeline due to their inability to beat sugar pills.
Extract:
From 2001 to 2006, the percentage of new products cut from development after Phase II clinical trials, when drugs are first tested against placebo, rose by 20 percent. The failure rate in more extensive Phase III trials increased by 11 percent, mainly due to surprisingly poor showings against placebo. Despite historic levels of industry investment in R&D, the US Food and Drug Administration approved only 19 first-of-their-kind remedies in 2007—the fewest since 1983—and just 24 in 2008. Half of all drugs that fail in late-stage trials drop out of the pipeline due to their inability to beat sugar pills.
The upshot is fewer new medicines available to ailing patients and more financial woes for the beleaguered pharmaceutical industry. Last November, a new type of gene therapy for Parkinson's disease, championed by the Michael J. Fox Foundation, was abruptly withdrawn from Phase II trials after unexpectedly tanking against placebo. A stem-cell startup called Osiris Therapeutics got a drubbing on Wall Street in March, when it suspended trials of its pill for Crohn's disease, an intestinal ailment, citing an "unusually high" response to placebo. Two days later, Eli Lilly broke off testing of a much-touted new drug for schizophrenia when volunteers showed double the expected level of placebo response.
It's not only trials of new drugs that are crossing the futility boundary. Some products that have been on the market for decades, like Prozac, are faltering in more recent follow-up tests. In many cases, these are the compounds that, in the late '90s, made Big Pharma more profitable than Big Oil. But if these same drugs were vetted now, the FDA might not approve some of them. Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time.
It's not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger.
Brainshark Takes on Slideshare
Brainshark Launches Free Service: Takes on Slideshare: "
Sunday, September 20, 2009
Mobile Devices for Nursing: a Comparative Human Factors Evaluation
Tara McCurdie at Med 2.0
Nothing about use with patients for education
Nothing about use with patients for education
Paul Grundy, MD, Patient-Centered Medical Home champion
Saturday, September 19, 2009
My sort of unconference
The BIL:PIL 2009 Healthcare Innovation Conference will bring together over 200 entrepreneurs, health professionals, technologists, and laypeople to describe the future of healthcare
BIL = Benevolence. Inspiration. Levity
BIL = Benevolence. Inspiration. Levity
Thursday, September 17, 2009
Monday, September 14, 2009
Pilots Use Checklists. Doctors Don't. Why Not? Must read!
by Maggie Mahar
summarising Atul Gawande's New Yorker piece The Checklist
"If a new drug were as effective at saving lives as Peter Pronovost’s checklist, there would be a nationwide marketing campaign urging doctors to use it."
summarising Atul Gawande's New Yorker piece The Checklist
"If a new drug were as effective at saving lives as Peter Pronovost’s checklist, there would be a nationwide marketing campaign urging doctors to use it."
The Melding of Man, Machine, and Media
by Dan Boscov-Ellen
"augmented reality... has the potential to revolutionize the way we consume media and information, particularly on mobile devices."
"augmented reality... has the potential to revolutionize the way we consume media and information, particularly on mobile devices."
Health care consumers views on Health IT
Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services
Consumer Engagement in Developing Electronic Health Information Systems
Final report. Based on 20 focus groups regionally and socially mixed with 4 in Spanish
extract:
"Results of the focus groups suggest that participants were optimistic that health IT would benefit health care quality. They thought that computers may add efficiency to health care and reduce medical errors, such as those associated with illegible handwriting. However, some participants were concerned that health IT might make providers more impersonal, devoting more attention to the computer screen and less to the patient.
A large proportion of the participants initially thought that health care consumers should not help in determining how health IT was designed and used. They stated that health IT was the domain of experts in medicine and computers. They felt that health care consumers like themselves lacked the knowledge needed to have a role in health IT matters. However, upon further discussion, the participants tended to feel that they needed to have a say about health IT in order to protect the privacy and security of their medical information."
Consumer Engagement in Developing Electronic Health Information Systems
Final report. Based on 20 focus groups regionally and socially mixed with 4 in Spanish
extract:
"Results of the focus groups suggest that participants were optimistic that health IT would benefit health care quality. They thought that computers may add efficiency to health care and reduce medical errors, such as those associated with illegible handwriting. However, some participants were concerned that health IT might make providers more impersonal, devoting more attention to the computer screen and less to the patient.
A large proportion of the participants initially thought that health care consumers should not help in determining how health IT was designed and used. They stated that health IT was the domain of experts in medicine and computers. They felt that health care consumers like themselves lacked the knowledge needed to have a role in health IT matters. However, upon further discussion, the participants tended to feel that they needed to have a say about health IT in order to protect the privacy and security of their medical information."
Thursday, September 10, 2009
The risks in communicating 'risks'
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?"
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?"
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.
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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
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