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To be effective in relieving suffering, doctors must strike a balance between paucity and excess of empathy.
As a young doctor working in the E.R. my capacity for compassion, and that of my colleagues, was often stretched; this was particularly the case when my patients could be said to have brought misfortune on themselves. I saw drug addicts suffering overdose, teenagers retching after self-poisoning, thieves injured through being arrested, all treated more brusquely than other theoretically more blameless patients.
I tried hard to maintain empathy, reflecting that the overdosed, self-poisoned and criminal may no more have brought their problems on themselves than those with skiing or horse-riding injuries or heart palpitations through overwork.
But it’s complicated: I’ve stitched up many slashed wrists cut not through willfulness but as a release from intense anguish; I’ve attended alcoholics for whom alcohol was clearly a substitute for love.
I may not have always succeeded, but I always hoped that my humanity, or my professional duty to provide a high standard of care, would step in when my compassion was running low.
By GAVIN FRANCIS
Via Edwin Rutsch
There is no greater pursuit in life than that of making healthcare better for all. Ever since I can recall, I'd wanted to become a doctor. And that desire was driven by a need, a calling, to make a difference in the life of the patients we see. The spirit of that vulnerable, hopeful, yet determined patient-- embodied by a growing number of outstanding patient-advocates--now, that's inspiring!
My inspirations have come from many directions. Early imprints came from my mom, and her unwavering need to serve those around her and to leave things better than when you first found them. Her unapologetic dedication to anything she'd put her heart to, and her relentless energy and focus to do good by this world - - that's the sort of inspiration only the lucky few get to experience.
The great thinkers of the Age of Reason and the Enlightenment were scientists. Not only did many of them contribute to mathematics, physics, and physiology, but all of them were avid theorists in the sciences of human nature. They were cognitive neuroscientists, who tried to explain thought and emotion in terms of physical mechanisms of the nervous system. They were evolutionary psychologists, who speculated on life in a state of nature and on animal instincts that are “infused into our bosoms.” And they were social psychologists, who wrote of the moral sentiments that draw us together, the selfish passions that inflame us, and the foibles of shortsightedness that frustrate our best-laid plans.
Analysis of the second NEJM Catalyst Insights Council Survey on the Patient Engagement theme. Qualified executives, clinical leaders, and clinicians mayjoin the Insights Council and share their perspectives on health care delivery transformation.
The foundation has been laid for exciting advances in patient engagement, according to the second NEJM Catalyst Patient Engagement Survey. With fundamental patient engagement strategies such as patient portals and secure email firmly in place, health care organizations are now turning to Patient Engagement 2.0 — initiatives that will get patients even more involved in their care.
The survey was fielded to gauge participation in, and effectiveness of, patient engagement across health systems, hospitals, and physician organizations. More than 69% of respondents report that their organizations use patient engagement initiatives to increase patients’ meaningful participation in care.
Via Pharma Guy
According to Gavin McMahon from Make a Powerful Point, there is no one single type of presenter that would fit everyone. After a decade of working with presenters from all types of industries, he created the following categorization scheme for different presenter types:
Via Pharma Guy
Some people don't have a health care power of attorney or living will because they don't realize how important these documents are. Others worry that such documents mean they are signing their lives away. Not so.
These powerful documents make sure that you get the treatment you would want for yourself if you couldn't communicate your wishes. Here are a few myths that shouldn't get in the way of creating a health care power of attorney or living will:
Myth: More care is always better.
Truth: Not necessarily. Sometimes more care prolongs the dying process without respect for quality of life or comfort. It's important to know what interventions are truly important. It's often impossible to know that in advance. That's where the advice of a health care team is invaluable.
Obesity is a global public health threat. The transtheoretical stages of change (TTM SOC) model has long been considered a useful interventional approach in lifestyle modification programmes, but its effectiveness in producing sustainable weight loss in overweight and obese individuals has been found to vary considerably.Objectives
To assess the effectiveness of dietary intervention or physical activity interventions, or both, and other interventions based on the transtheoretical model (TTM) stages of change (SOC) to produce sustainable (one year and longer) weight loss in overweight and obese adults.Search methods
Studies were obtained from searches of multiple electronic bibliographic databases. We searchedThe Cochrane Library, MEDLINE, EMBASE and PsycINFO. The date of the last search, for all databases, was 17 December 2013.Selection criteria
Trials were included if they fulfilled the criteria of randomised controlled clinical trials (RCTs) using the TTM SOC as a model, that is a theoretical framework or guideline in designing lifestyle modification strategies, mainly dietary and physical activity interventions, versus a comparison intervention of usual care; one of the outcome measures of the study was weight loss, measured as change in weight or body mass index (BMI); participants were overweight or obese adults only; and the intervention was delivered by healthcare professionals or trained lay people at the hospital and community level, including at home.Data collection and analysis
Two review authors independently extracted the data, assessed studies for risk of bias and evaluated overall study quality according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). We resolved disagreements by discussion or consultation with a third party. A narrative, descriptive analysis was conducted for the systematic review.Main results
A total of three studies met the inclusion criteria, allocating 2971 participants to the intervention and control groups. The total number of participants randomised to the intervention groups was 1467, whilst 1504 were randomised to the control groups. The length of intervention was 9, 12 and 24 months in the different trials. The use of TTM SOC in combination with diet or physical activity, or both, and other interventions in the included studies produced inconclusive evidence that TTM SOC interventions led to sustained weight loss (the mean difference between intervention and control groups varied from 2.1 kg to 0.2 kg at 24 months; 2971 participants; 3 trials; low quality evidence). Following application of TTM SOC there were improvements in physical activity and dietary habits, such as increased exercise duration and frequency, reduced dietary fat intake and increased fruit and vegetable consumption (very low quality evidence). Weight gain was reported as an adverse event in one of the included trials. None of the trials reported health-related quality of life, morbidity, or economic costs as outcomes. The small number of studies and their variable methodological quality limit the applicability of the findings to clinical practice. The main limitations include inadequate reporting of outcomes and the methods for allocation, randomisation and blinding; extensive use of self-reported measures to estimate the effects of interventions on a number of outcomes, including weight loss, dietary consumption and physical activity levels; and insufficient assessment of sustainability due to lack of post-intervention assessments.Authors' conclusions
The evidence to support the use of TTM SOC in weight loss interventions is limited by risk of bias and imprecision, not allowing firm conclusions to be drawn. When combined with diet or physical activity, or both, and other interventions we found very low quality evidence that it might lead to better dietary and physical activity habits. This systematic review highlights the need for well-designed RCTs that apply the principles of the TTM SOC appropriately to produce conclusive evidence about the effect of TTM SOC lifestyle interventions on weight loss and other health outcomes.
Avec le numérique, ne peut-on pas générer ces « révolutions minuscules » ou ces « petits moments magiques », qui bousculent les certitudes et qui « boostent » la réflexion des élèves comme le disait si bien Jean Pierre Astolfi, et qui permettent aussi une réflexion des enseignants sur les différentes façons d’apprendre? Ces moments de manipulation via les interfaces numérique et en liaison avec l’apprenant directement concerné, ne sont-ils pas une façon de faire vivre concrètement dans l’action, l’expérience de ce qu’un savoir en construction produit comme surprise et inspiration ? Nous pouvons repenser ici à ce que Louis Legrand appelait une « pédagogie de l’étonnement » et Georges Snyders « la joie à l’école » !
Via Pierre Levy
Have you ever made a resolution to acquire a healthier lifestyle by changing your behaviour? Whether you wanted to be less stressed, cut out junk food, or stop smoking, you probably defined some simple rules and rewards to influence your behaviour and hopefully achieve that goal. When you applied those rules, you were in fact practicing “gamification”, the process of applying game mechanics to a real-life situation in order to generate a desired outcome. Unfortunately, you didn’t have the resources to turn those ideas into an exciting app.
A recent CDC survey showed that workplace efforts to prevent cardiovascular disease may get the most bang for their buck in the social services and transportation fields.
Using data from the 2013 Behavioral Risk Factor Surveillance System, the investigators analyzed responses from nearly 67 000 participants in 21 states who answered questions about their occupation and 7 “ideal” cardiovascular health habits established by the American Heart Association. Specifically, the investigators asked whether participants smoked; were physically active; had healthy blood pressure, blood glucose, and cholesterol levels; were overweight or obese; and ate a healthful diet.
When a patient’s illness escalates to an advanced disease or when a loved one suddenly dies, it is an emotional and stressful time for patients, family members and caregivers, who face many difficult decisions. Patients with an advanced condition need to determine what their care goals should be, and family members who have lost a loved one are burdened with a host of decisions during a time of grief.
And many physicians and healthcare leaders believe there continue to be care gaps with regard to end-of-life planning services and resources within the healthcare system.
Leading healthcare provider organizations and digital health companies are increasingly focusing their efforts on end-of-life planning and advance care planning in to order to deploy healthcare resources more appropriately to patients and families and promote a better patient experience. In many ways, digital health technology can play a crucial role in improving end-of-life planning and advance directives, and it’s an area that is long overdue for modernization and innovation.
Via Adrian Adewunmi Ph.D
E’ di grande interesse la riflessione di Eco su “la Repubblica” del 13 settembre, “Mezzo e messaggio quei cortocircuiti al tempo delle mail”, a proposito di quanto il mezzo condizioni il messaggio, soprattutto oggi in un contesto in cui cellulari e tablet dominano ogni minuto della nostra quotidianità. Il medium è il messaggio: si tratta della constatazione ormai più che nota che fece McLuhan nel suo famoso saggio degli anni Sessanta, quando la pervasività della televisione imponeva di fatto riflessioni nuove a proposito della teoria della comunicazione. Ricorda giustamente Eco come, fin dalle prime teorizzazioni sulla vicenda comunicativa (siamo nella prima metà del secolo scorso), il modello costituito da EMITTENTE, RICEVENTE, MEZZO e MESSAGGIO funzionasse ottimamente per comprendere quali fossero le condizioni materiali perché il campo della comunicazione fosse attivo e i messaggi trasmessi e ricevuti. Tuttavia, si ravvisò che era anche necessario che si considerassero altri due fattori, indispensabili ai fini della correttezza e della efficacia del messaggio trasmesso e ricevuto: il CODICE e il REFERENTE, per usare le espressioni di Jakobson. In effetti, ogni messaggio si costruisce in forza di un codice, di un linguaggio che deve essere condiviso dagli interlocutori. Posso parlare in perfetto italiano a un cinese che non conosce la mia lingua e il messaggio non viene compreso: quindi, di fatto, non esiste, perché il CODICE non è condiviso. Allo stesso modo, il referente – o, se si vuole, il “riferito”, l’oggetto della informazione lanciata – deve essere condiviso dal ricevente. Se faccio una dichiarazione d’amore, che costituisce il REFERENTE, cioè l’oggetto del mio messaggio, il ricevente potrà anche comprenderla in ordine al codice, ma non condividerla in ordine al contenuto. Respinge di fatto il messaggio al mittente, come si suol dire e si situa fuori dal campo della comunicazione. E bisogna sempre sperare che l’innamorato non torni alla carica fino a diventare uno stalker.
Via Luis Manuel
Social media are dynamic and interactive computer-mediated communication tools that have high penetration rates in the general population in high-income and middle-income countries. However, in medicine and health care, a large number of stakeholders (eg, clinicians, administrators, professional colleges, academic institutions, ministries of health, among others) are unaware of social media’s relevance, potential applications in their day-to-day activities, as well as the inherent risks and how these may be attenuated and mitigated.
We conducted a narrative review with the aim to present case studies that illustrate how, where, and why social media are being used in the medical and health care sectors.
Using a critical-interpretivist framework, we used qualitative methods to synthesize the impact and illustrate, explain, and provide contextual knowledge of the applications and potential implementations of social media in medicine and health care. Both traditional (eg, peer-reviewed) and nontraditional (eg, policies, case studies, and social media content) sources were used, in addition to an environmental scan (using Google and Bing Web searches) of resources.
We reviewed, evaluated, and synthesized 76 articles, 44 websites, and 11 policies/reports. Results and case studies are presented according to 10 different categories of social media: (1) blogs (eg, WordPress), (2) microblogs (eg, Twitter), (3) social networking sites (eg, Facebook), (4) professional networking sites (eg, LinkedIn, Sermo), (5) thematic networking sites (eg, 23andMe), (6) wikis (eg, Wikipedia), (7) mashups (eg, HealthMap), (8) collaborative filtering sites (eg, Digg), (9) media sharing sites (eg, YouTube, Slideshare), and others (eg, SecondLife). Four recommendations are provided and explained for stakeholders wishing to engage with social media while attenuating risk: (1) maintain professionalism at all times, (2) be authentic, have fun, and do not be afraid, (3) ask for help, and (4) focus, grab attention, and engage.
The role of social media in the medical and health care sectors is far reaching, and many questions in terms of governance, ethics, professionalism, privacy, confidentiality, and information quality remain unanswered. By following the guidelines presented, professionals have a starting point to engage with social media in a safe and ethical manner. Future research will be required to understand the synergies between social media and evidence-based practice, as well as develop institutional policies that benefit patients, clinicians, public health practitioners, and industry alike.
La farmacéutica francesa y Alphabet, matriz del gigante de Internet, desarrollarán dispositivos y servicios para el control de la diabetes. La farmacéutica francesa Sanofi y Verily Life Sciences (antes Google Life Sciences), filial de Alphabet, han creado la sociedad conjunta Onduo para el desarrollo de soluciones que combinen dispositivos, medicina, software y otros servicios dirigidos a mejorar la calidad de vida de las personas con diabetes. Esta nueva sociedad, un ejemplo más de los lazos que están surgiendo entre los sectores farmacéutico y tecnológico en el área de salud, tiene previsto invertir 500 millones de dólares. Entre los productos a la venta figurarán dispositivos conectados como plumas de insulina y servicios online.
Via Ignacio Fernández Alberti
Why doesn’t the government just get out of the way and let the private sector -- the “real revolutionaries” -- innovate? It’s rhetoric you hear everywhere, and Mariana Mazzucato wants to dispel it. In an energetic talk, she shows how the state -- which many see as a slow, hunkering behemoth -- is really one of our most exciting risk-takers and market-shapers.
Social marketing interventions have been shown to both promote and change many health-related behaviours and issues. As the HIV epidemic continues to disproportionately affect MSM and transgender women around the world, social marketing interventions have the potential to increase HIV/STI testing uptake among these populations.Objectives
To assess the impact of social marketing interventions on HIV/STI testing uptake among men who have sex with men and transgender women compared to pre-intervention or control group testing uptake in the same population.Search methods
We searched the following electronic databasesfor results from 01 January 1980 to the search date, 14 July 2010: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, LILACS (Latin America and Brazil), PsycINFO, PubMed, Web of Science/Web of Social Science, Chinese National Knowledge Infrastructure (CNKI), and CQ VIP (China). We also searched for conference abstracts in the Aegis archive of HIV/AIDS conference abstracts and the CROI and International AIDS Society websites. In addition to searching electronic databases, we searched the following sources of grey literature: Australasian Digital Theses Program, Canadian Evaluation Society, Eastview: China Conference Proceedings, ProQuest Dissertations and Theses, and World Health Organization Library Information System (WHOLIS). We contacted individual researchers, experts working in the field, and authors of major trials for suggestions of any relevant manuscripts that were in preparation or in press. References of published articles from the databases above were searched for additional, pertinent materials. All languages were included in this search.Selection criteria
Randomized controlled trials and controlled clinical trials that compared social marketing interventions with a control were included. Interrupted time series and pretest-posttest design studies (controlled or uncontrolled) that compared social marketing interventions with no intervention or a control were also included. Posttest-only studies and studies that combined pre-post data were excluded. Interventions that targeted at general public but did not include MSM or transgender women as a segment or did not have outcome data for an MSM or transgender segment were excluded.Data collection and analysis
Two authors independently extracted data from each included study and assessed study quality. Meta-analyses were conducted to compare pre- and post-intervention and intervention and control group outcomes of HIV and STI testing uptake. Quality of evidence was assessed using the GRADE approach.Main results
Three serial, cross-sectional pretest-posttest study designs (one with a control group and two without) were included in the final analysis. Statistical pooling was conducted for two studies and compared to pre-intervention level testing uptake, which showed that multi-media social marketing campaigns had a significant impact on HIV testing uptake (OR=1.58, 95%CI = 1.40 - 1.77). However, the campaigns were not found to be effective in increasing STI testing uptake (OR=0.94, 95%CI = 0.68 - 1.28). Overall, risk of bias was high and quality of evidence was low. None of the studies were conducted in developing countries or included male-to-female transgender women.Authors' conclusions
This review provided limited evidence that multi-media social marketing campaigns can promote HIV testing among MSM in developed countries. Future evaluations of social marketing interventions for MSM should employ more rigorous study designs. Long-term impact evaluations (changes in HIV or STI incidence over time) are also needed. Implementation research, including detailed process evaluation, is needed to identify elements of social marketing interventions that are most effective in reaching the target population and changing behaviours.
Plain language summary
Multi-media social marketing campaigns to increase HIV testing uptake among men who have sex with men and transgender women
Men who have sex with men and transgender women are disproportionately affected by HIV/AIDS worldwide. Unrecognized infections could be one of the driving forces of ongoing HIV transmission among these populations. Thus, it is important to promote HIV testing.
Limited evidence suggests that multi-media social marketing campaigns can significantly increase HIV testing uptake among men who have sex with men. Future research should employ more rigorous designs in evaluating social marketing interventions, measure their long-term impact, and identify intervention components that are most effective in reaching the target population and changing behaviours.
EVERY so often a management idea escapes from the pages of the Harvard Business Review and becomes part of the zeitgeist. In the 1990s it was “re-engineering”. Today it is “disruptive innovation”. TechCrunch, a technology-news website, holds an annual “festival of disruption”. CNBC, a cable-news channel, produces an annual “disruptor list” of the most disruptive companies. Mentioning “disruptive innovation” adds a veneer of sophistication to bread-and-butter speeches about education or health care. But just what is disruptive innovation?
The theory of disruptive innovation was invented by Clayton Christensen, of Harvard Business School, in his book “The Innovator’s Dilemma”. Mr Christensen used the term to describe innovations that create new markets by discovering new categories of customers. They do this partly by harnessing new technologies but also by developing new business models and exploiting old technologies in new ways. He contrasted disruptive innovation with sustaining innovation, which simply improves existing products. Personal computers, for example, were disruptive innovations because they created a new mass market for computers; previously, expensive mainframe computers had been sold only to big companies and research universities.
The “innovator’s dilemma” is the difficult choice an established company faces when it has to choose between holding onto an existing market by doing the same thing a bit better, or capturing new markets by embracing new technologies and adopting new business models. IBM dealt with this dilemma by launching a new business unit to make PCs, while continuing to make mainframe computers. Netflix took a more radical move, switching away from its old business model (sending out rental DVDs by post) to a new one (streaming on-demand video to its customers). Disruptive innovations usually find their first customers at the bottom of the market: as unproved, often unpolished, products, they cannot command a high price. Incumbents are often complacent, slow to recognise the threat that their inferior competitors pose. But as successive refinements improve them to the point that they start to steal customers, they may end up reshaping entire industries: classified ads (Craigslist), long distance calls (Skype), record stores (iTunes), research libraries (Google), local stores (eBay), taxis (Uber) and newspapers (Twitter).
Left to our own devices, most of us physicians try our best to provide high-quality care to our patients. But almost none of us provide perfect care to all of our patients all of the time. In fact, many of us get so caught up in our busy clinic schedules we occasionally forget to, say, order mammograms for women overdue for such tests, or we don’t get around to weaning our aging patients from unnecessary and potentially harmful medications.
Because the quality of American medical care is often uneven, third-party payers — insurance companies and government programs like Medicare — increasingly measure clinician performance and reward or punish physicians who provide a particularly high or low quality of care.
The result of all this quality measurement: gazillions of hours of clinic time spent documenting care rather than providing it.
Official Full-Text Publication: The Glymphatic System - A Beginner's Guide on ResearchGate, the professional network for scientists.
J Am Osteopath Assoc. 2016 Mar;116(3):170-7. doi: 10.7556/jaoa.2016.033.
The Glymphatic-Lymphatic Continuum: Opportunities for Osteopathic Manipulative Medicine.
AbstractThe brain has long been thought to lack a lymphatic drainage system. Recent studies, however, show the presence of a brain-wide paravascular system appropriately named the glymphatic system based on its similarity to the lymphatic system in function and its dependence on astroglial water flux. Besides the clearance of cerebrospinal fluid and interstitial fluid, the glymphatic system also facilitates the clearance of interstitial solutes such as amyloid-β and tau from the brain. As cerebrospinal fluid and interstitial fluid are cleared through the glymphatic system, eventually draining into the lymphatic vessels of the neck, this continuous fluid circuit offers a paradigm shift in osteopathic manipulative medicine. For instance, manipulation of the glymphatic-lymphatic continuum could be used to promote experimental initiatives for nonpharmacologic, noninvasive management of neurologic disorders. In the present review, the authors describe what is known about the glymphatic system and identify several osteopathic experimental strategies rooted in a mechanistic understanding of the glymphatic-lymphatic continuum.