I was struck by a number of dichotomies, or dualities, as I reflected on my reactions and the reactions of those around me.
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Background: Although there are compelling moral arguments for patient participation in medical decisions, the link to health outcomes has not been systematically explored.Objective: Assess the extent to which patient participation in decision making within medical encounters is associated with measured patient outcomes. Methods: We conducted a primary search in PubMed—excluding non-English and animal studies—for articles on decision making in the context of the physician–patient relationship published through the end of February 2015, using the MeSH headings (Physician-Patient Relations [MeSH] OR Patient Participation [MeSH]) and the terms (decision OR decisions OR option OR options OR choice OR choices OR alternative OR alternatives) in the title or abstract. We also conducted a secondary search of references in all articles that met the inclusion criteria. Results: A thorough search process yielded 116 articles for final analysis. There was wide variation in study design, as well as measurement of patient participation and outcomes, among the studies. Eleven of the 116 studies were randomized controlled trials (RCTs). Interventions increased patient involvement in 10 (91%) of the 11 RCTs. At least one positive outcome was detected in 5 (50%) of the 10 RCTs reporting increased participation; the ratio of positive results among all outcome variables measured in these studies was much smaller. Although proportions differed, similar patterns were found across the 105 nonrandomized studies. Conclusions: Very few RCTs in the field have measures of participation in decision making and at least one health outcome. Moreover, extant studies exhibit little consistency in measurement of these variables, and results are mixed. There is a great need for well-designed, reproducible research on clinically relevant outcomes of patient participation in medical decisions.
To determine the effect of statin use on progression of vascular calcification in type 2 diabetes (T2DM).RESEARCH DESIGN AND METHODS:Progression of coronary artery calcification (CAC) and abdominal aortic artery calcification (AAC) was assessed according to the frequency of statin use in 197 participants with T2DM.RESULTS:
After adjustment for baseline CAC and other confounders, progression of CAC was significantly higher in more frequent statin users than in less frequent users (mean ± SE, 8.2 ± 0.5 mm(3) vs. 4.2 ± 1.1 mm(3); P < 0.01). AAC progression was in general not significantly increased with more frequent statin use; in a subgroup of participants initially not receiving statins, however, progression of both CAC and AAC was significantly increased in frequent statin users.CONCLUSIONS:
More frequent statin use is associated with accelerated CAC in T2DM patients with advanced atherosclerosis.
The impact of inequality on health is gaining more attention as public and political concern grows over increasing inequality. The income inequality hypothesis, which holds that inequality is detrimental to overall population health, is especially pertinent. However the emphasis on inequality can be challenged on both empirical and theoretical grounds. Empirically, the evidence is contradictory and contested; theoretically, it is inconsistent with our understanding of human societies as complex systems. Research and discussion, both scientific and political, need to reflect better this complexity, and give greater recognition to other social determinants of health.
Seeking a second opinion is often exercised in many areas of life. It is often quoted that:
Your treating physicians should not mind, and in most cases, a good physician may even recommend that a second opinion be obtained. This recommendation is NOTa bad thing! As physicians, we are often very comfortable with our recommendations, but understand that there may be other ways of accomplishing what is best for you, the patient.
***Cancer is often a scary and frightening diagnosis! It is my recommendation to NEVER go to an appointment alone, if at all possible.*
This is how many languages some of the world's biggest websites recognise.
In terms of social media websites, Facebook recognises the most languages – some 120 in 2015. These include Afrikaans, Albanian and Azerbaijani through to Turkish and Vietnamese. Next is Twitter, with 48 languages in 2015, while LinkedIn only supports 24 languages – just 0.3% of the world’s total.
his is a version of the talk delivered at PACSA 2015 by Andrew Weatherall and Mike Blackburn on Social Media and Anaesthesia. As a bit of an experiment in demonstrating the scope for engagement different ways, Mike arranged a Twitter feed to run in real time on one screen while the presentation went ahead on the second screen. At the same time, the session was live streamed (well, until the connection broke).
You can imagine when we got this topic it was pretty exciting. Try to talk on the entirety of social media with someone you’d never met in real life. And the talk pretty much requires you rely on the IT. What could go wrong?
Well what we thought was more worthwhile was to demonstrate what social media can offer, rather than just talk about it. So let’s start with a question,
“How do you stay great as an anaesthetist?”
The Old School
On the day, Mike pitched in with the old expectations of how you’d stay up to date and make sure you were providing the best possible care. A mix of journals and reading and chatting to people (along with clinical practice), with the occasional conference thrown in.
Things have changed though. As mentioned by AW, one of the old challenges was getting access to some literature. Now the challenge is filtering an overwhelming amount of literature. Social media might just be a way to find the stuff that’s most relevant while also finding more colleagues to have that chat with.
We got into social media through different paths but both ended up realising it could be a powerful tool in being better anaesthetists. Mike probably got there first, while AW first used social media to find contacts to provide an education in the area of research, and actively try to broaden his world view. The medical bit came later.
Tackling inequality and poverty aren’t mutually exclusive; rather, efforts devoted to fighting the former contribute to solving the latter.
1. A Fact: Inequality has increased
There is a common storyline about income inequality that goes something like this. Inequality has not increased; even if it has, there is little that can be done about it; and even if public policy has punch, the effort directed to fighting inequality diverts attention from more pressing problems, like poverty.
There is a strand of truth to this. The inequality our society faces challenges us not to use the policies of yesteryear, but to rethink social policy for a new reality. Fortunately, we already have a set of precedents in our toolkit that can be built upon to address both inequality and poverty in a smart way.
At least one aspect of this storyline has become a caricature. We seem to have gone past the denial stage. It is pretty well accepted that income inequalities have risen significantly during the last three decades in many countries, Canada included.
The growing prevalence of mHealth technology promises a new dynamic between patients and caregivers, as well as better health outcomes and cost-effificiency. Yet challenges remain in the effort to get both patients and providers on board.
Millions of asymptomatic women undergo breast screening annually because their doctors tell them to do so. Not only are these women's presumably healthy breasts being exposed to highly carcinogenic x-rays, but thousands have received a diagnosis of 'breast cancer' for entirely benign lesions that when left untreated would have caused no harm to them whatsoever.
Flux, territoires, figures : à la fin du xxe siècle, les bribes d’une rhétorique deleuzienne envahissent la sphère de certains chorégraphes situés à la marge de leur art. Sans induire pour autant un discours de vérité, ces emprunts ont cristallisé une éthique minimisant le plus souvent la prégnance des universaux et des idéaux édictés par les récits modernistes.
Aujourd’hui, « l’air du temps » aime s’inspirer de Gilles Deleuze, de ses écrits, de sa pensée, de ses concepts. Dans le domaine des arts, les idées du maître prennent chair pour devenir couleur, odeur, mouvements. Pour autant, comme le rappelle Anne Cauquelin, il ne s’agit pas pour ces artistes de faire de ces concepts les dérivés de sensations, ni, à l’inverse, de traduire les œuvres en terme de raison. Mais de s’inspirer de cette philosophie de l’art et de la vie pour appréhender le monde de la création. De l’accompagner pour parfois l’accommoder ou s’en détourner : « Ainsi, le concept quitte son ancrage, emprunte l’allure de la couleur et du son, se met en mouvement et produit du mouvement »...
Via Vincent DUBOIS, Luis Manuel
Pharmacists, physicians and researchers have tried for decades to understand why the same medication, at the same dose, can work well for some people but not for others, or why some people need higher or lower doses of the same drug, or why some people have side effects, while others do not.
After a distinguished panel of social scientists spoke about the role of race in health disparities, an audience Q&A session followed
A recent OBSSR panel discussion focused on how race contributes to health disparities in America. With the recent advent of the genomic era, many basic biological concepts, including race and how we study disease, have undergone radical change.
Dr. Jo Phelan focuses her research on how socioeconomic status and gender contribute to inequalities in health. During the panel discussion, she reviewed her research showing that, when presented with objective articles about specific genetic health differences among particular populations, many people tend to extrapolate those findings to conclude erroneously that there must be fundamental racial differences among people in general.
The final panelist, Dorothy Robert, JD, examined the idea that race is a political category, not a biological classification. She emphasized the role of race in creating health disparities through social inequalities and suggested that research should be aimed at eliminating these societal factors that create gaps in health.
Following the presentations, the panelists fielded audience questions, focusing on how to enact changes that could ultimately eliminate health disparities.
If the world were mapped according to how many scientific research papers each country produced, it would take on a rather bizarre, uneven appearance. The Northern hemisphere would balloon beyond recognition. The global south, including Africa, would effectively melt off the map.
This image makes a dramatic point about the complexities of global inequalities in knowledge production and exchange. So what is driving this inequality and how can it be corrected?
Wouldn’t it be interesting if 5,000 years on from ancient Egypt, the scribe profession came to the rescue of frontline health care?
Statistics suggest that physicians are now spending a minimal amount of time in direct patient care, shockingly as little as 10 percent of their day. This proportion of time that physicians (and nurses) actually spend interacting with patients has been shrinking year by year.
There’s the need to communicate with other members of the expanding health care team, increased bureaucratic requirements, and over the last several years — the need to navigate and use the electronic medical record to enter notes and place orders. Of course, it’s not realistic to suggest that it’s possible for any doctor to spend 100 percent of the day in direct patient care, but 10 percent is quite frankly, a little sick.
Mientras que los servicios de telesalud ofrecen importantes beneficios para el cuidado del paciente, existen varias barreras regulatorias de pie en el camino.
Mientras que los servicios de telesalud ofrecen estos beneficios significativos, hay varias barreras que obstaculizan. Estos obstáculos hacen que sea más difícil para la industria de la salud aprovechar verdaderamente el potencial de la tecnología de la telemedicina
En particular, algunas regulaciones estatales hacen que sea mucho más difícil ofrecer servicios de telesalud médico debido a las restricciones en su práctica y las políticas de reembolso complejas, de acuerdo con The Pew Charitable Trusts
Hay estados en que los pacientes que participan en una visita telemedicina tienen que estar acompañados por una enfermera u otro profesional médico a su lado. Esto restringe claramente los servicios de telesalud para ser practicada de forma remota o en casa.
Algunos estados como Hawai, Ohio, e Indiana no ofrecen cobertura de Medicaid para visitas de telesalud si los pacientes viven una distancia menor de sus proveedores de atención médica.
Otro de los principales obstáculos de pie en el camino de la utilización generalizada de telesalud es el hecho de que los médicos a menudo tienen que tener licencia en todos los estados que practican la medicina independientemente de si se practica virtualmente o en persona.
Otra restricción exige a los médicos cumplir y llevar a cabo un examen físico de sus pacientes antes de participar en una consulta de atención virtual.
Via Ignacio Fernández Alberti
The U.S. Food and Drug Administration is looking to include patients and caregivers every step of the way when it comes to development of new medical tools.
Consumers are becoming more involved in their health than ever before thanks to the increasing number of technologies available to them, and new approaches by the federal agency "will help to ensure that patient perspectives also have an effect on which medical products are developed and cleared or approved for the market," according to an article in the Journal of the American Medical Association.
FDA members Nina L. Hunter, Ph.D, Kathryn M. O'Callaghan and Robert Califf--the latter of whom has been nominated for FDA Commissioner--use the viewpoint to address efforts the agency is making in this area.
Like Charon, Joyce both practices and teaches the multidisciplinary study of empathy. Recently in class, Joyce employed a series of exercises intended to help students build empathy with one another.
One exercise involves building a conceptual map based on what one class member perceives of another. In a different exercise, students take turns holding each other’s styloid bone on the wrist, while students write in the air.
Via Edwin Rutsch
Some population groups continue to experiencecancer health disparities and a diminished quality of life. These groups include the poor, racially and ethnically diverse groups, and those with limited or no access to healthcare. Cancer is a terrifying disease for whomever it touches. Unfortunately, it also generates some myths and false ideas out of fear and having inaccurate information.
To better understand cancer and cancer health disparities, some common misconceptions are addressed below.
Myth 1: Everyone experiences the same burden of cancer, regardless of racial/ethnic background and socioeconomic factors.
Truth: It is true that cancer affects people of all races and ethnicities in the U.S.; however, some population groups experience a greater burden than others. People from low socioeconomic households, who lack or have inadequate health insurance, and members of select racially and ethnically diverse communities frequently have a higher incidence and/or mortality rate for specific types of cancers. There are many examples of cancer health disparities.
On a cold winter's night in 1968, a phone rang in an apartment on Spadina Road. The man who answered it was Lowell Cross, an American student at the University of Toronto. He'd come north to write his thesis on the history of electronic music, studying under Marshall McLuhan among others. Soon, he would become known as "the inventor of the laser light show," but he was already experimenting with new technologies — combining electronic music with electronic visuals. One of his multimedia projects had just been featured at Expo '67 in Montreal. He was gaining quite a reputation. That's why his phone was ringing. John Cage was calling.Cage was the world's most notoriously experimental composer. Cross was a big fan — in fact, Cage featured prominently in his thesis. Now, the composer was calling to ask Cross for help: he needed someone to build a musical chessboard.
At first, Cross said no. He was just too busy; he had a thesis to write. But then Cage said two words that changed his mind: