Co-creation in health
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E-citizens, e-patients, communities in shaping e-health, health literacy.
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Why Physicians Need ‘Right Compassion’

Why Physicians Need ‘Right Compassion’ | Co-creation in health | Scoop.it
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
NY Time  Opinion Pages
 

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Pratique de la médecine en 2016 (1) : la surprescription – Hippocrate et Pindare sont dans un bateau …

Pratique de la médecine en 2016 (1) : la surprescription – Hippocrate et Pindare sont dans un bateau … | Co-creation in health | Scoop.it
J’ai quitté il y a peu la médecine de soin. Au bout de plus de 30 ans d’exercice, divers et varié, je n’ai plus envie de soigner ou du moins de soigner dans les conditions actuelles d’exercice.
Je voudrais dans les quelques billets qui vont suivre, vous livrer l’état de mes réflexions. Ce sont mes réflexions, mon analyse, mon ressenti, ce n’est en aucun cas, « la vérité », la « réalité » et donc ce que j’écris est critiquable

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Mediocrazia, Il filosofo Alain Deneault denuncia: “Un esercito di pecoroni nei posti decisionali. L’epoca del mediocre”

Mediocrazia, Il filosofo Alain Deneault denuncia: “Un esercito di pecoroni nei posti decisionali. L’epoca del mediocre” | Co-creation in health | Scoop.it

Gianna Fregonara per “Il Corriere della Sera” Curiosità, coraggio, talento? No, per essere cooptati, nelle imprese come nelle organizzazioni e nei posti decisionali, vince il conformismo,

denuncia in un saggio il filosofo canadese Alain Deneault.

Il primo allarme era venuto dagli Stati Uniti: le prestigiose università della Ivy League, quelle da cinquantamila dollari l’anno (retta più vitto e alloggio) sfornano «pecoroni di eccellenza», un gregge di conformisti, un’élite – ci mancherebbe – preparata e competente ma incapace di «curiosità, ribellione, coraggio morale, stravaganza appassionata», aveva tuonato poco più di un anno fa in un polemicissimo pamphlet William Deresiewicz, professore scartato sì da Yale, ma appassionatamente informato di quel che succede lì.

Il conformismo vincente

Adesso a puntare il dito contro il conformismo vincente è un altro autore sempre dal continente americano. Il filosofo canadese Alain Deneault ha da poco pubblicato un saggio (non ancora tradotto in Italia) dal titolo eloquente:La Médiocratie (La Mediocrazia, edizioni Lux). Dov’è finito il genio? Il talento e il pensiero critico e scomodo sono scomparsi? Le idee luminose ma per questo anche fastidiose non sono più apprezzate. L’audacia delle scoperte sgradita, schiacciata dall’«estremismo del centro», della normalità. Se Deneault ha ragione saremmo già sprofondati in un nuovo modello socio-economico fondato sul predominio sociale e culturale dei «mediocri». O, forse sarebbe meglio chiamarli, i «mediani», nel senso di persone che sono mediamente competenti, mediamente informate e mediamente esperte. In altre parole normali. Ma proprio per questo assimilate, pigre, sbiadite. Cooptate, nelle imprese come nelle organizzazioni e nei posti decisionali, non tanto per le loro doti ma perché leali e affidabili, certamente esperte ma noiose, che fanno funzionare gli ingranaggi meglio di colleghi magari talentuosi ma fuori dagli schemi e dunque inaccettabili.

Il principio di Peter

È una rivisitazione del principio di Peter (in una gerarchia ognuno arriva svolgere il lavoro per cui è incompetente) adattata al nuovo millennio quella contenuta nel Médiocratie di Deneault, un modello che porta secondo l’autore alla corruzione e alla disintegrazione della società. Una visione poco meno catastrofica di altra letteratura sull’argomento, che va da Flaubert a Marinetti fino al filone fantascientifico con il racconto «Null-P» di William Tenn, dell’inizio degli anni Cinquanta, che comincia con l’individuazione del modello dell’uomo medio e finisce con l’estinzione — nell’indifferenza dell’Universo — dell’umanità.

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Mediocrazia, così il «potere dei mediocri» ha ucciso il pensiero libero nelle università

Mediocrazia, così il «potere dei mediocri» ha ucciso il pensiero libero nelle università | Co-creation in health | Scoop.it

Le università sono il regno della mediocrazia? Prigioniere dei finanziamenti privati, hanno rinunciato a essere il laboratorio dello “spirito critico” a tal punto che il rapporto di subordinazione nei confronti di chi le sovvenziona ha corrotto alla base l’istituzione. È ciò che scrive nel libro “La Médiocratie” (Lux Editeur), il filosofo canadese Alain Deneault, che dedica un intero capitolo a un mondo che conosce da vicino perché ne fa parte: il mondo accademico. E il ritratto che ne emerge è del tutto desolante. Un quadro capace di provocare reazioni infuriate all’interno dell’ambiente universitario per le ragioni più diverse.

Certo, si potrebbe dire che in Italia siamo abituati a tutto questo. Si potrebbe aggiungere che i casi di nepotismo e di corruzione che hanno riempito le pagine di cronaca negli ultimi anni possono averci assuefatti a un realtà da cui spesso faticano a emergere gli esempi positivi, che tuttavia ci sono e sono molti. Si potrebbero precisare tante cose. Ma l’analisi di Deneault, per quanto possa apparire troppo crudele, ha il pregio di farci riflettere sulla strada lungo la quale ci siamo incamminati.

Che cosa sia la mediocrazia e perché i mediocri abbiano preso il potere nel corso della “rivoluzione anestetizzante” avvenuta negli ultimi anni sono i temi di due precedenti post basati sul libro di Deneault.

 

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Should patient groups be more transparent about their funding?

Patient groups often shout loudly for access to drugs but are quieter about their links to industry. Sophie Arie and Chris Mahony ask whether this is acceptable given increasing demands for transparency elsewhere in medicine

The recent decision that the multiple sclerosis drug nabiximols should be available on the NHS in Wales was met by MS charities as a small triumph for patients. Access to the drug, a cannabinoid spray that eases spasticity, had previously been denied because of its cost.

“As a charity we have campaigned over a long period for Sativex [nabiximols] to be widely available because of the significant impact that MS spasticity can have on daily activities,” Amy Bowen, director of service development at the Multiple Sclerosis Trust, told the BBC.1

She expressed hope that the recommendation would lead to the drug being more easily accessible in the rest of the UK.

The MS Trust failed, however, to mention either in media interviews or in lobbying documents, that it receives funding from the German drug giant Bayer, which markets the drug in the UK. The company donated £5000 (€6400; $8200) to the MS Trust in 2013 and 2012.2 3

On its website, the charity provides information about its corporate funding only in its annual review, and even this is not prominently displayed. Corporate funding is listed as a lump sum of £54 121 towards the back of the annual review, without naming individual companies or specifying how the funds were used. There is one reference within further tables of figures to a restricted grant from Sanofi.4

The Association of the British Pharmaceutical Industry requires drug companies to disclose all the details of their relations with patient groups and charities systematically and prominently on their websites. These show that, in addition to the £5000 …
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Cheating death

Cheating death | Co-creation in health | Scoop.it
Science is getting to grips with ways to slow ageing. Rejoice, as long as the side-effects can be managed

 

IMAGINE a world in which getting fitted with a new heart, liver or set of kidneys, all grown from your own body cells, was as commonplace as knee and hip replacements are now. Or one in which you celebrated your 94th birthday by running a marathon with your school friends. Imagine, in other words, a world in which ageing had been abolished.

That world is not yet on offer. But a semblance of it might be one day. Senescence, the general dwindling of prowess experienced by all as time takes its toll, is coming under scrutiny from doctors and biologists (see article). Suspending it is not yet on the cards. But slowing it probably is. Average lifespans have risen a lot over the past century, but that was thanks to better food, housing, public health and some medicines. The new increase would be brought about by specific anti-senescence drugs, some of which may already exist.

This, optimists claim, will extend life for many people to today’s ceiling of 120 or so. But it may be just the beginning. In the next phase not just average lifespans but maximum lifespans will rise. If a body part wears out, it will be repaired or replaced altogether. DNA will be optimised for long life. Add in anti-ageing drugs, and centenarians will become two a penny.

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Life expectancy vs. health expenditure over time, 1970-2014

Life expectancy vs. health expenditure over time, 1970-2014 | Co-creation in health | Scoop.it

The following graph visualizes the relationship between life expectancy and health expenditure, for a number of OECD countries across the period 1970-2014. Two points are worth mentioning. Firstly, all countries in this graph have followed an upward trajectory (life expectancy increased as health expenditure increased), but the U.S. stands out as an exception following a much flatter trajectory; gains in life expectancy from additional health spending in the U.S. were much smaller than in the other high-income countries, particularly since the mid-1980s. And secondly, the gains for all countries (except for the U.S.) were not diminishing, as in the previous graph. This suggests that there are many other factors affecting life expectancy, that are not determined by healthcare spending. Indeed, as we have pointed out before, healthcare is just one of many inputs to produce health.here to edit the content

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Jeff French's curator insight, August 11, 3:39 AM
Its not just how much you spend
Alex O. Awiti's curator insight, August 12, 12:27 AM
Public investments in healthcare matter!
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America’s health care prices are out of control. These 11 charts prove it.

America’s health care prices are out of control. These 11 charts prove it. | Co-creation in health | Scoop.it
Why does a drug in Switzerland cost three times less than the same one here?

 

Humira is an injectable medication used to treat multiple autoimmune diseases ranging from rheumatoid arthritis to psoriasis to ulcerative colitis — and it’s one of the best-selling drugs in American history. In 2014 alone, millions of Americans spent a combined $6.5 billion on Humira prescriptions.

But we probably didn’t have to. While Americans paid an average price of $2,669 for Humira, the Swiss were able to buy the exact same drug for $822 — and in the United Kingdom, patients got it for $1,362. If the United States paid what the Swiss paid for the arthritis drug, we would have spent $2 billion on Humira in 2014 rather than $6.5 billion.

There’s nothing different about the Humira that we bought in the United States and the drug the Swiss bought – except that in the United States, we’re terrible at negotiating a good deal on pretty much any medical service.

“It’s exactly the same product, but, in terms of the American patient, you’re just paying double or more the price for no more health gain,” says Tom Sackville, chief executive of the International Federation of Health Plans.

Every two years, his group publishes a report that compares health care prices in different countries. And it shows that Humira isn’t some weird anomaly; nearly every procedure or drug costs way more in the United States.

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I nemici della scienza - di Giovanni Bignami

I nemici della scienza - di Giovanni Bignami | Co-creation in health | Scoop.it

Giovanni Bignami - la Repubblica

PUGLIA, la ricreazione è finita. Lo ha detto la Ue al ministro delle Politiche agricole: entro trenta giorni si dia esecuzione all’ordinanza comunitaria, che ordina l’abbattimento di un numero limitato di ulivi, pena multe sempre più gravi. Science e Nature, le due riviste scientifiche più importanti del mondo, non hanno dubbi nell’imputare la colpevole inerzia italiana alla mancanza di fiducia del pubblico nella scienza, riflessa, ancor più colpevolmente, in inchieste giudiziarie per bloccare ogni azione degli scienziati competenti, anche contro il parere, stavolta chiaro e tempestivo, della Accademia dei Lincei.

A Modena, invece, incredibile battaglia tra genitori se fare vaccinare o no la figlia. L’incredibile non è che due genitori litighino, ma che il tribunale senta il bisogno di nominare dei periti (con grave perdita di tempo), dimostrando di prendere sul serio una posizione antiscientifica, andando anche contro le decisioni dell’Ordine dei Medici e della Regione. Sono due episodi che dimostrano un clima antiscientifico sempre più diffuso in Italia.
Negli Usa si chiama science denialism, il negazionismo della scienza. Nel Paese che venne pensato e fondato anche da scienziati, come Benjamin Franklin, e che è stato ed è un pilastro per la qualità, la quantità ed il peso politico della sua scienza, è uscito il libro drammatico: The War on Science. Racconta una realtà sempre più preoccupante.
Ricorderete la donna che ebbe quasi in mano i codici per scatenare la guerra nucleare, Sarah Palin. La bella Sarah, pur di mantenere la nascita del mondo a qualche migliaio di anni fa, si dice convinta, con prove fotografiche, che dinosauri e uomini coesistessero sulla Terra (i primi, come è noto, si sono invece estinti circa sessanta milioni di anni prima che comparissero i nostri antenati). E chissà se chiedessimo a Donald Trump… eppure il partito repubblicano non è sempre stato così. Negli anni 1920, un suo esponente di spicco fu Edwin Hubble, proprio l’uomo che fondò la moderna cosmologia osservativa.
Ma non è solo usando argomenti populisti o da setta religiosa, con un repertorio infinito e anche divertente di stupidaggini basate sulla paura, l’arroganza, la superstizione o semplice ignoranza, che si attacca la scienza. Anche grosse multinazionali, in evidente malafede, hanno cercato di propagare spettacolari falsità: “Allegria, non c’è pericolo di cancro al polmone se fumate, è tutto un complotto di medici comunisti...” ovvero: “Ma quale cambiamento climatico, l’uomo (e il petrolio che egli brucia) non fanno danni al pianeta...”. A ben altro livello, citiamo, con profondo rispetto, il Dalai Lama: «Se il Buddhismo è sbagliato e la scienza è giusta, deve essere il Buddhismo ad adeguarsi alla scienza ».
E nell’Italia di oggi, chi nega la scienza? Non solo chi crede negli oroscopi, cioè nel fatto che ogni mattina, complice la Rai, ci dividiamo in dodici squadre zodiacali, tutte destinate alla stessa giornata perché così dice l’oroscopo, comune a ciascun segno. È ridicolo, ma in fondo innocuo. C’è di molto peggio: anche da noi è in corso una deriva antiscientifica e gli esempi sono innumerevoli. Patetici, ma pericolosi, i casi Di Bella o Vannoni, alimentati dalla disperazione di chi soffre. Gravissimi anche altri casi di scellerate decisioni giudiziarie, come il condannare al “rimborso” chi ha vaccinato un bambino poi dimostratosi autistico ( perseverare diabolicum a Modena?), l’inquisire chi ricercava (bene, secondo l’Accademia dei Lincei e la Ue) sulla Xylella degli ulivi, o il trascinare per anni, per poi prosciogliere, Ilaria Capua dalla accusa di essere una “untrice”.
E via elencando nella galleria delle buffonate tragicomiche: si va dai complottisti che sanno tutto sul Dna come prova di giudizio, agli esperti (da bar/facebook) di Ogm, che non sanno di vivere già in un mondo geneticamente modificato da secoli, e per fortuna che lo è, se no saremmo tutti morti di fame. Dai social agli uffici giudiziari ai ministeri, ce n’è per tutti.
Certo, l’Italia ha scuse storiche per temere la scienza. La breccia di Porta Pia, la fine del potere temporale del Papa, è di solo un secolo e mezzo fa, e fu seguita da un occhiuto controllo della Chiesa su scuola e governi. Più grave il danno prodotto dagli epigoni di Benedetto Croce, che dava definizioni sprezzanti sulla matematica e chi la studia. A molte generazioni di italiani, me compreso, fu inculcato che non conoscere i classici è inaccettabile, ma non sapere di scienza è un vezzo da esibire.
Questa spaccatura nel Paese spiega, tra l’altro, il numero risibilmente basso di scienziati tra i 900 parlamentari, a parte i senatori a vita Cattaneo e Rubbia. Spiega anche la cronica disattenzione, governo dopo governo, nel costruire una popolazione di ricercatori italiani capaci di competere in Europa. A parte le brillanti eccezioni, sono i totali che contano: abbiamo la metà dei ricercatori necessari, e sono strangolati dalla dittatura della burocrazia ministeriale. Difficile rispondere ad una guerra senza le truppe e il loro rancio.
Per di più, oggi la scienza è confusa da molti con le sue applicazioni iperspecialistiche. Per fortuna c’è chi, come Piero Angela, sa attaccare a tutto campo il virus dell’antiscientismo, proponendo una visione della scienza dall’alto, forse senza troppi dettagli, ma unitaria e unificante, con attenzione alle ricadute sociali. Comunicare la scienza è imperativo quanto viverla, per poi invece fare, tutti insieme, la guerra all’ignoranza.
 
L’autore, presidente dell’Istituto nazionale di Astrofisica fino al 2015, è membro dell’Accademia dei Lincei
 
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How Not to Cut Health Care Costs

How Not to Cut Health Care Costs | Co-creation in health | Scoop.it

Health care providers in the United States and much of the rest of the world are trying to respond to the tremendous pressure to reduce costs. Many of their attempts, however, are counterproductive, ultimately leading to higher costs and sometimes lower-quality care.

What’s going on? Our findings show that to identify cost-cutting opportunities, hospital administrators typically work from the information that is most readily available to and trusted by them—namely, the line-item expense categories on their P&L statements. Those categories, such as personnel, space, equipment, and supplies, are attractive targets: Reducing spending on them appears to generate immediate results. But the reductions are usually made without considering the best mix of resources needed to deliver excellent patient outcomes in an efficient manner.

  • Mistake #1: Cutting Back on Support Staff
  • Mistake #2: Underinvesting in Space and Equipment
  • Mistake #3: Focusing Narrowly on Procurement Prices
  • Mistake #4: Maximizing Patient Throughput
  • Mistake #5: Failing to Benchmark and Standardize
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Les ePatientes, ces héroïnes

Les ePatientes, ces héroïnes | Co-creation in health | Scoop.it
Les ePatientes ? Courageuses. Audacieuses. Déterminées. Les ePatientes sont des patientes actives, émancipées, qui s’investissent dans la prise en charge de leur santé et font bénéficier d’autres patients de leurs connaissances.
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Enhancing compassion in general practice: it’s not all about the doctor

Enhancing compassion in general practice: it’s not all about the doctor | Co-creation in health | Scoop.it
‘ Patients were left lying in soiled sheets or sitting on commodes for hours. Some patients needing pain relief got it late or not at all. ’1 Such were the findings from the Mid Staffordshire Inquiry with recommendations for recruiting compassionate staff and having clinician compassion training.2 However, this call for compassion is not new. Medical codes of practice require us to practise with compassion. Compassionate care should be routine, a daily motivation and practice not unlike antisepsis and hand washing.

The crisis of compassion in medicine is multifaceted in origin and no universal panacea is likely to be found. Many of us cannot define compassion or articulate the differences between compassion and empathy. Others might argue that compassion training is redundant as doctors are either compassionate or not. We remain remarkably ignorant about compassion, unsure of what it is, where it comes from, or what might influence compassion in our practices.

Compassion comes from the Latin roots com , which means ‘together with’, and pati , ‘to bear or suffer’.3 Compassion is built on the capacity to empathise — a form of cognitive and emotional perspective taking — but involves the additional step of wanting to alleviate suffering.4 The distinction is important. An after-hours GP may recognise and feel the distress of a crying child having an asthma attack but, because he is now 30 minutes late in picking up his wife at the airport, rushes to the car park and lets colleagues manage the child. The family concerned might feel fobbed off and is unlikely to have experienced compassion as part of the clinical interchange. The doctor was empathetic but, technically, was not compassionate. Empathy without compassion is not only out of step with professional requirements but also is differentially likely to sustain negative …
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Pharmacist to Pharma: 7 Reasons I Thank You for Free Lunch!

Pharmacist to Pharma: 7 Reasons I Thank You for Free Lunch! | Co-creation in health | Scoop.it

I stand up for the rights of pharmaceutical companies to buy lunches or host dinners that are educational in nature. Academics, reporters, and politicians who fear this practice is driving up the costs of health care need to calm down and think differently.

 

As a pharmacist, I’ve gotten to know many pharmaceutical representatives over a sandwich. We talk about health care, drugs, side effects, and how to help patients. Those conversations are valuable to me, and I don’t mind the sandwich. 


Here are 7 reasons to relax about the free pharma lunch:

1. Most health care providers work long hours and don’t have much availability in their day-to-day schedules. Many are on call nights, holidays, and weekends. In spite of this, they have to remain on the cutting edge of medical science, including knowledge about new drugs. Therefore, it’s simply efficient to combine learning opportunities with meals. 

2. A health care provider’s time is extremely valuable. Every provider is needed at virtually all times. It’s all hands on deck every day to care for patients and save or improve lives.  As such, every minute spent “working” is important and valuable. A relatively inexpensive meal in exchange for 15 to 20 minutes of time is a bargain. 

3. The fact that prescribing frequency increases after engaging in lunch-and-learn sessions doesn’t mean that physicians wrote prescriptions out of guilt because they were given a free tuna fish sandwich, as they could afford their own lunch quite easily. The prescribing frequency could just as easily be tied to the education.

4. Providing a meal is a socially acceptable means for showing kindness and respect. If I want to thank you for your time, I might bake you a cake or cook you a casserole. You came over and fixed my computer? You’re getting a pizza. Sales representatives are responsible for educating prescribers in their territory through face-to-face meetings. A meal represents a tangible token of appreciation for their time.

5. Patients benefit when health care providers develop relationships with pharmaceutical companies. Many of these companies offer educational resources to patients and financial assistance to the uninsured or underinsured. But, getting these benefits to patients typically requires building relationships with providers. As a pharmacist, I can say I’m very grateful for some of the outstanding sales representatives I’ve gotten to know, because the services their companies offer are useful to my patients. Sometimes, these relationships have been built over a burger. Is that a crime?

6. Yes, it’s possible for incentives to go too far, but we’re talking about $18 to $20 meals, not lavish trips to the Swiss Alps.

7. Health care providers aren’t computers or machines. Learning takes time, and reminders about how a drug fits into the current recommended treatment regimen is appreciated. A drug representative gets to be an expert on a particular molecule, but we have to know all the molecules. So, spending a few moments with an expert on 1 specific drug helps reinforce best practices and treatment standards. 



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Pharma Guy's curator insight, July 2, 7:36 AM

It seems some physicians value the sandwich more than the education. Read, for example, “When Big Pharma Paid for Lunch & Learn Sessions, Academic Physicians Showed Up on Time - Now, Not So Much!”; http://sco.lt/6jFdVB

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How is social media helping to inform patient choice?

Social media is fundamentally changing the PR and marketing industry, and the healthcare sector is no exception. From Facebook and Twitter pages to blogs, YouTube videos and Snapchats, these channels give healthcare organisations the opportunity to influence patients in their pursuit of healthcare. There’s even a social network dedicated to health that allows patients to seek support and advice from hundreds of health communities. Healthcare has got social. 

With easy access to vast amounts of healthcare information, the patient-doctor dynamic is changing and patients are now much more informed about conditions and treatment options. With hashtags categorising conversations within social media, be it #Diabetes or#BreastCancer, patients can discuss specific conditions, in real time, accessing information from other patients and any engaged clinicians. The information patients find does have a significant impact: a survey by Adweek found that for more than 40% of consumers’ information found via social media affects the way they deal with their health.

Listen to what patients are saying

Social media allows clinician and practices the opportunity to ‘listen in’ on these conversations and many of these online communities will provide the perfect targets for information from private practices. What’s more, group members will also be more likely to take recommendations from other group members and online friends, particularly younger people. In one recent survey by Search Engine Watch, 90% of respondents from 18 to 24 years of age said they would trust medical information shared by others on their social media networks. If someone in a group or forum says good things about a private practice, other potential patients may hear about it and follow up on the recommendation.

 

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Theater Reviews. Long held to supporting roles, women surgeons are now leading and shaping the field

Theater Reviews. Long held to supporting roles, women surgeons are now leading and shaping the field | Co-creation in health | Scoop.it
According to Preeti John, a Baltimore-based surgeon who gathered essays, poems, and interviews from sixty women surgeons for her book, Being a Woman Surgeon, a surgeon’s life is challenging, requiring not only physical stamina but also “strength of character, balance, careful planning, and a firm commitment to what is important.” These adapted essays from four of the surgeons featured in the book calmly and proudly attest to the truth of her statement.
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10 Things your Audience Hates About your Presentation

See it with animations! https://vimeo.com/179236019 It’s impossible to win over an audience with a bad presentation. You might have the next big thing, but if …

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Why Digital Transformation Fails: Ignoring Staff and Stakeholders

Why Digital Transformation Fails: Ignoring Staff and Stakeholders | Co-creation in health | Scoop.it

Based upon my own experience and many discussions over the past few years, there's one key reason why digital transformation efforts fail: a lack of communication and involvement of people who matter far more than assumed, and those who are all too often overlooked.

It happens in transformations on the level of a business function, processes, an overall business model and most certainly societal evolutions.

Overlooking internal customers

We could also call it a lack of leadership, but then, in a non-traditional sense: the ability to ‘lead’ or, better, create a common purpose with a clear buy-in and involvement of all stakeholders, not just buy-in of leadership itself.

Most companies realize that there's often a link between customer-centricity and customer experience on one hand, and digital transformation on the other. However, when you start looking from the top-down, there's a distinct lack of involving, let alone informing and guiding ‘internal customers’.

We've mentioned before how many customer-facing employees feel that leadership doesn’t really care about them. In transformative projects, employees and other critical stakeholders are often left out far too much as well, amidst uncertainties, leadership changes, a lack of basic involvement and uni-directional “internal” communication and management patterns.

You've probably heard about the so-called 'Iceberg of Ignorance' concept, depicted below. Never mind the percentages but we do know there's a cost in not being close enough to those front-line employees who, in the end, need to make transformations and your customer-centric initiatives happen. And it’s exactly there – and thus close to the customer – that we need to be in digital transformation.

 

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The Community Cure for Health Care (SSIR)

The Community Cure for Health Care (SSIR) | Co-creation in health | Scoop.it
Large health care systems are beginning to invest core operating dollars in connecting their patients to community resources, in service of the ultimate solution to better costs and outcomes: keeping patients healthy.

Twelve-year old Anna has asthma. She lives in a low-income neighborhood and gets her care at a clinic affiliated with a major teaching hospital. Despite high-quality medical care, Anna’s asthma is not well controlled. Last year she missed almost two weeks of school, had two urgent care visits, and a brief but scary (and expensive) hospital stay. Her pediatrician believes that the old, rent-subsidized apartment where Anna’s family lives may be part of the problem: The presence of mold, moisture, rodents, and dust mites, for example, may trigger her asthma attacks but lie beyond the scope of a clinical intervention.

Situations like Anna’s (a composite illustration) are a major factor in worsening health and rising health care costs in the United States. Unhealthy living conditions, nutrition, and a host of social and environmental factors turn potentially manageable health issues into costly ones for both patient and provider. Indeed, the Robert Wood Johnson Foundation, the largest private US grantmaker focused on health, estimates that just 20 percent of a person’s health is related to health care. The rest stems from behavioral, environmental, and social factors. As highlighted by The Commonwealth Fund, asthma symptoms can be linked to where families live; frequent emergency-department visits and hospitalizations can be linked to homelessness; and diabetes-related hospital admissions and other health problems can be linked to food insecurity. In health systems like Kaiser Permanente—one of the largest managed care organizations in the United States—just one percent of the patient population accounts for approximately 25 percent of the total cost of medical services provided annually, often due to non-medical factors.

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JAMA Forum: Will Episode Payment Models Show How to Better Pay for Hospital Care?

JAMA Forum: Will Episode Payment Models Show How to Better Pay for Hospital Care? | Co-creation in health | Scoop.it

What’s the right way to pay for hospital care? Believe it or not, even in 2016, we don’t really know. In many advanced economies, hospital care is paid with a yearly budget for a given population. In other countries with advanced health care systems, hospital care is paid piecemeal; every inpatient day generates new bills for the room, the nursing staff, and the procedures.

Piecemeal was how Medicare paid for hospital care until the mid-1980s when it switched, for a large majority of hospitals, to what is known as prospective payment. Paying prospectively was simple: identify why someone was admitted and provide a lump sum for that hospitalization based on our best understanding of what it costs to care for that condition. Although the formula for payments is complex, the idea underlying it is straightforward. We pay more for more complicated conditions and for patients with more complex issues, and then let hospitals figure out how best to spend the chunk of money from an “inpatient bundle.”

Most policy makers believe prospective payment has worked well. Seen in one light, we know that bundling payments for inpatient care has reduced hospital spending growth. For example, inpatient spending on acute myocardial infarction (AMI) grew just 0.9% annually from 1997 through 2010, far below the overall growth in health care spending. However, the number and types of hospitalizations have changed, such that per capita hospital spending has grown at nearly 5% between 2000 and 2010.

But the news is worse. Much of the spending growth around inpatient care, which has grown slowly, has shifted to postacute care—long-term hospital care, rehabilitation care, and skilled nursing facility care—where spending hasskyrocketed. Inpatient bundles may appear to have successfully curtailed spending growth, but like pushing on a balloon, the spending growth bulges elsewhere.

Given these challenges, the Centers for Medicare & Medicaid Services (CMS) has experimented with 30-day bundles for the last several years, allowing hospitals to voluntarily choose which conditions they want to bundle. The hospital receives a single payment for the expected costs of a patient’s hospitalization for the condition and first 30 days after discharge. If the hospital uses fewer services, it gets to keep some of the savings; if it spends extra, it typically has to pay Medicare back. The effect of this program, which has had only modest participation, is largely unknown.

To move toward bundles that extend beyond hospital care, CMS introduced 2 new programs over the past year. TheComprehensive Care for Joint Replacement, introduced in April 2016, focuses on hip and knee replacement surgery for all acute-care hospitals in 67 metropolitan areas. On July 25th, CMS announced a substantial expansion, the Episode Payment Model (EPM) program, for 3 conditions: AMI, coronary artery bypass graft (CABG) surgery, and hip and femur fracture surgery. All health care services for these conditions that occur within 90 days of discharge, rather than within 30 days, are included in a single bundled payment that a hospital must manage. The rationale is that most of the health care services that occur soon after discharge are related to the condition for which the patient was hospitalized, and holding hospitals accountable for that care makes sense.

 

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Quali sono le responsabilità penali quando si utilizza un defibrillatore?

Quali sono le responsabilità penali quando si utilizza un defibrillatore? | Co-creation in health | Scoop.it
Ma allora, quali sono i rischi quando si utilizza un defibrillatore?

Nessuno! A ben vedere non esiste nessun rischio pratico nell’utilizzare il defibrillatore senza aver frequentato un corso BLSD, poiché le istruzioni di questo strumento sono talmente chiare e precise che nessuno potrebbe sbagliare. Ovviamente, si consiglia sempre di frequentarlo per imparare le tecniche di massaggio cardiaco, di messa in sicurezza della scena e di utilizzo del defibrillatore.
Come abbiamo visto, anche sotto il profilo penale l’operatore non rischia nulla, in quanto è un soccorritore occasionale che sta prestando soccorso ed assistenza ad una persona in pericolo di vita. Non si deve temere di creare danni derivati da manovre salvavita, come il massaggio cardiaco e l’uso del defibrillatore, poiché si è tutelati dalla legge.

 

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The Difference Between Being A Man In 1914 Compared To 2014

The Difference Between Being A Man In 1914 Compared To 2014 | Co-creation in health | Scoop.it

Life has definitely changed a lot in the last one hundred years.

Back in 1914, a man could follow a set life path and not have to worry too much about the slowly changing world around him. It was clear that he needed to grow up, get a job, get married, have a family and then prepare for retirement and death. Yet, for a man in 2014, life isn’t so simple and straightforward anymore.

Here are just a few of the many differences between being a man in 1914 vs. 2014

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Hybrid Pedagogy, Digital Humanities, and the Future of Academic Publishing 

Hybrid Pedagogy, Digital Humanities, and the Future of Academic Publishing  | Co-creation in health | Scoop.it

It is not enough to write monographs. It is not enough to publish. Today, scholars must understand what happens when our research is distributed, and we must write, not for rarified audiences, but for unexpected ones. New-form scholarly publishing requires new-form scholarly (digital) writing. Digital academic publishing may on the surface appear as a lateral move from print to screen, but in fact it brings with it new questions about copyright, data analysis, multimodality, curation, archiving, and how scholarly work finds an audience. The promise of digital publishing is one that begins with the entrance of the written, and one that concludes with distribution, reuse, revision, remixing — and finally, redistribution.

Digital publishing is a field worthy of rigorous research and deep discourse. In a post-print environment, for example, social media — Twitter, Facebook, Pinterest, WordPress, or Tumblr — have supplanted the static page as the primary metaphors for how we talk about the dissemination of information. Digitized words have code and algorithms behind them, and are not arrested upon the page; rather they are restive there.

 


Via Pierre Levy
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What to Do When You Get a New Boss Every Few Months

What to Do When You Get a New Boss Every Few Months | Co-creation in health | Scoop.it

In some workplaces, reorgs and personnel changes are constant, which means that you might be getting a new boss every few months. How do you develop an effective relationship with your manager when the person filling that role keeps shifting? How much of an investment should you make? How can you get what you need to succeed and grow in your role? And is maintaining continuity your responsibility?

What the Experts Say
Managing your relationship with your boss is challenging enough as it is. When that person changes every six months, the task becomes a lot more difficult—and time-consuming. “There’s a big part of work that is relational,” says Reb Rebele, an instructor in the Master of Applied Positive Psychology (MAPP) program at the University of Pennsylvania and co-author of “Collaborative Overload”. “You’re dealing with people on a regular basis, getting to know them, establishing norms, and establishing patterns. If your manager is constantly changing, you’re doing a lot of extra relational work and it’s a much bigger investment of your time and energy.” Priscilla Claman, the president of Career Strategies, a Boston-based consulting firm and a contributor to the HBR Guide to Getting the Right Job, agrees that having to cycle through new managers is “one of the world’s most frustrating things.” Your “impulse may be to duck and hide,” she says, but you must instead be proactive. It’s never easy to have several bosses in as many years, but there are ways to make this challenging situation more tolerable. Here are some tips.

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How to Pay for Health Care

How to Pay for Health Care | Co-creation in health | Scoop.it

The United States stands at a crossroads as it struggles with how to pay for health care. The fee-for-service system, the dominant payment model in the U.S. and many other countries, is now widely recognized as perhaps the single biggest obstacle to improving health care delivery.

 

Fee for service rewards the quantity but not the quality or efficiency of medical care. The most common alternative payment system today—fixed annual budgets for providers—is not much better, since the budgets are disconnected from the actual patient needs that arise during the year. Fixed budgets inevitably lead to long waits for nonemergency care and create pressure to increase budgets each year.

We need a better way to pay for health care, one that rewards providers for delivering superior value to patients: that is, for achieving better health outcomes at lower cost. The move toward “value-based reimbursement” is accelerating, which is an encouraging trend. And the Centers for Medicare & Medicaid Services (CMS), to its credit, is leading the charge in the United States.

That doesn’t mean, however, that health care is converging on a solution. The broad phrase “value-based reimbursement” encompasses two radically different payment approaches: capitation and bundled payments. In capitation, the health care organization receives a fixed payment per year per covered life and must meet all the needs of a broad patient population. In a bundled payment system, by contrast, providers are paid for the care of a patient’s medical condition across the entire care cycle—that is, all the services, procedures, tests, drugs, and devices used to treat a patient with, say, heart failure, an arthritic hip that needs replacement, or diabetes. If this sounds familiar, it’s because it is the way we usually pay for other products and services we purchase.

We need a way to pay for health care that fosters the delivery of superior value to patients.

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For patients, social media is much more than selfies and cat videos

For patients, social media is much more than selfies and cat videos | Co-creation in health | Scoop.it
Emerging social media sites targeting patients are increasingly playing a vital role in societal “information sharing” research announced today by the University of Warwick, Coventry, U.K.Sites such as HealthUnlocked in the U.K. allow patients to tap into a community with the same health challenges for moral support, shared information about health care providers and practical advice to manage their medical condition.

“People receive care from each other — moral support, encouragement, hope. A formal health system is not set up to offer this at a community level,” Eivor Oborn, professor of health care management at Warwick Business School and lead study author, told HCB News. “Chronic illness management is part of everyday life for an increasing number of people. Learning how to support each other … especially for behavior changes, such as weight loss … rather than relying only on professional advice, is important.”
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Should Your Driverless Car Hit a Pedestrian to Save Your Life?

Should Your Driverless Car Hit a Pedestrian to Save Your Life? | Co-creation in health | Scoop.it

People say that one day, perhaps in the not-so-distant future, they’d like to be passengers in self-driving cars that are mindful machines doing their best for the common good. Merge politely. Watch for pedestrians in the crosswalk. Keep a safe space.

A new research study, however, indicates that what people really want to ride in is an autonomous vehicle that puts its passengers first. If its machine brain has to choose between slamming into a wall or running someone over, well, sorry, pedestrian.

In this week’s Science magazine, a group of computer scientists and psychologists explain how they conducted six online surveys of United States residents last year between June and November that asked people how they believed autonomous vehicles should behave. The researchers found that respondents generally thought self-driving cars should be programmed to make decisions for the greatest good.

 

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