Notes & Links: July 31, 2013

User Evaluation of the Effects of Text Simplification Algorithm Using Term Familarityon Preception, Understanding, Learning and Information Retention

That title is a mouthful but as with most mouthfuls once you digest it you are filled with wholesome goodness. Leroy, et. al out of Claremont Graduate University publishing in Journal of Medical Internet Research have completed a study whose objective is:

To develop an evidence-based writer support tool to improve perceived and actual text difficulty. To this end, we are developing and testing algorithms that automatically identify difficult sections in text and provide appropriate, easier alternatives; algorithms that effectively reduce text difficulty will be included in the support tool. This work describes the user evaluation with an independent writer of an automated simplification algorithm using term familiarity.

Term familiarity is a new term for me. The authors describe it how easy words are for readers and is measured using Google Web Corpus. The authors identified unfamiliar word and tagged for replacement with easier words. They measured both perceived and actual text difficulty. 

 …our conclusion that lexical simplification is beneficial and has an immediate impact on understanding and learning. However, we did not find an effect of simplification on retention of information. This may be due to a lack of sustained learning or it may be due to the study design.

I would offer that part of retention and improved understanding and learning is to test participants with an HCP to help them or within a social media with others who have read the same article. Small group dynamics and learning will drive results some much better.

Hive Marketing In Healthcare: Creating and Maintaing Communities of Shared Interest

The Healthcare Marketer defines Hive but it strikes me that what he is describing is community of practice. Etienne Wenger on his Web site defines community of practice as:

Communities of practice are formed by people who engage in a process of collective learning in a shared domain of human endeavor: a tribe learning to survive, a band of artists seeking new forms of expression, a group of engineers working on similar problems, a clique of pupils defining their identity in the school, a network of surgeons exploring novel techniques, a gathering of first-time managers helping each other cope.

The Healthcare Marketer makes the following point:

By creating these online environments, something health insurance companies, pharmaceutical companies and patient advocacy groups have already pioneered, the provider organization changes its relationship with its constituents. 

These groups may have ‘pioneered’ this but the reality Jean Lave and Etienne Wenger coined the phrase in 1991 in a book titles ‘Situated Learning’. And further I am not sure how active learning is within the framework of insurance companies etc. We have a fairly sophisticated and savy group of healthcare learners who are cynical. 

That Awkward Moment When The Woman You Try Robbing Know Systema

This has nothing to do with healthcare but everything to do with “You Go Girl” How can you not fall in love with that woman? Hehehe Thank you Daring Fireball for the tip.

The Harmony of Loss Found in the Caregiver Community

There have been many comments to my essay for the Mayo Clinic Patient Caregiver Scholarship contest. I am struck by them all. Struck by the resonate chord and the harmony we share as caregivers. They fill me with hope and understanding. 

What touches me the most is that we share a similar sense of loss while at the same time we have a strength of knowledge and understanding. This comes from our collective sharing of experiences and using that knowledge to move forward to find some peace. Peace that does not come easily while the pain is mitigated by knowing we are not alone.

If you can read the essay and the comments leave one if can but most of all feel the sense of place we share.

Notes & Links: July 29, 2013

10 Reasons Why ObamaCare is Good for US

HealthPopuli has listed reasons she believes ObamaCare is good for us and the US. You’ve seen most of these enumerated else where but her list is more. It explains why each point will make a difference to us as consumer and the US as a nation. If you are looking to arm yourself for arguments with those who want to strike the ACA down the language and support here will serve you well. 

Github: How an Open Source Programming Tool With a Funny Name Could Help Revolutionize Medical Research. 

Joyce Lee, MD writing on The Health Care Blog brings a great idea from the tech world of programers and code writers to healthcare. Use open source GitHub to share medical research. Her thoughts on this really clarify how to make this idea work. But more important she has seeded the idea with her her own project. 

Why Healthcare Facilities Belong on Pinterest

I have made fun of Pinterest calling it Twitter for people who can’t read. Well Michael Sherman posting on HealthWorks Collective makes the case why Pinterest works and changes my mind. Guess I will have to stop laughing at my own jokes. 

Moms, Are Your Autoantibodies Causing Autism?

Provocative headline from and equally provocative study out of University of California, Davis. Emily Willingham contributing to Forbes does an excellent job of clarifying the data and putting into understandable writing for all of us.

Second, and probably more significant, is a question nags at me when I read these fetal-exposure-to-autoantibody studies. Once mothers make these autoantibodies, they don’t stop. Thus, if the autoantibodies are causative or play a big role in autism risk, I’d expect to see a higher rate of younger autistic siblings of autistic children whose mothers test positive for these autoantibodies or fall in the 99% specificity category. The evidence equation adds up like this: Researchers can show (1) the presence of autoantibodies around birth + (2) having an autistic child + (3) a greater autism risk or rate among younger siblings of that child than already exists for siblings of autistic children. Such results would, I think, help solidify these indicators that for a subset of cases of autism, maternal autoantibodies during fetal development play a role.

Notes & Links: July 26, 2013

Chromecast vs. AirPlay: How do They Compare?

The Verge has a comparison of Google’s new Chromecast to Apple’s established AirPlay.Great review well balanced with a handy dandy chart to compare features.

What’s So Wrong About Sexting, Anyway?

Glenn Cohen on The Health Care Blog Op-Ed takes a serious look at sexting and Mr. Weiner. I have deliberately stayed away from reading much about this except for the passing headlines including those in the NY Post.But I read this entire op-ed piece and found it thoughtful and well measured. 

Reaching Rare Disease Communities

Pam Todd writing on HealthWorks Collective addresses the need for patients with rare diseases to find useful, clear, concise, and practical information. I agree.

Pam opens with the following quote “If you can’t outspend, outreach”. Sorry but money buys reach plan and simple. Though I will say those with rare disease are likely avid, relentless, and over the top aggressive searchers and knowledge consumers. They may make reach beat spend. May is the operative word.

What’s The Role of A Hospital In 10 Years?

Dave Chase writing in Forbes takes a look at the changes facing the hospital of today and does a great job of comparing it to the previous and current plight of print newspapers. 

While no analogy is perfect, health system boards would be well advised to study what newspaper industry leaders did (or perhaps more appropriately, didn’t do) when faced with a dramatic industry change. Turn back the clock 15 years and the following dynamics were present:

Notes & Links: July 25, 2013

I’m a Patient and I Read Like a Seventh Grader: This is Your Problem

Chen Sirkis writing on HealthWorks Collective makes the case for a collective need for content focused on the below average reader. Use videos, pictures, and collateral material aimed at a 15 year old. JAMA Internal Medicine published a study on readability. 

The research determined that such materials often are too complex for their intended audience. The main reason is that the average American adult reads at approximately a seventh- to- eighth-grade level.

We can do better with this audience since they are the key to driving durable improvements in outcomes. Currently we are collectively speaking in an echo chamber to ourselves. Additionally I wonder if this audience is more at risk when visiting sites that do not speak to evidence based medicine or proven science. Will they make decisions based on bad information? 

Social Media Gets Strep Throat Epidemic Under Control

Michael Sherman writing on HealthWorks Collective share an article from Clinical Infectious Diseases how 18 of 63 party goers came down with strep throat. 

After seeing a large number of posts on Facebook related to strep throat, one parent alerted the Minnesota health department that this wasn’t just a coincidence. The department then conducted phone interviews with attendees and their family members and analyzed DNA from strep bacteria samples.

I hope we see more studies show social media being part of improved identification of disease and its effect on specific populations. 

Identifying “good” and “bad” hospitals

The Incidental Economist takes a look at a new paper from JAMA Internal Medicine “Mortality for Publicly Reported Conditions Overall Hospital Mortality Rates“. The study looks at reportable data for hospital mortality rates indicate overall hospital performance. IE does a great job at reviewing this study. 

A hospital’s 30-day mortality rates for Medicare’s 3 publicly reported conditions—acute myocardial infarction, congestive heart failure, and pneumonia—were correlated with overall hospital mortality rates, even in clinically dissimilar fields. Hospitals in the top quartile of performance on the publicly reported mortality rates had greater than 5-fold higher odds of being top performers for a combined metric across 19 common medical and surgical conditions, translating into absolute overall mortality rates that were 3.6% lower for the top performers than for the poor performers. Finally, performance on the publicly reported conditions far outperformed 2 other widely used markers of quality: size and teaching status. […]

Perhaps the crap load of data we are collecting and sharing will help patients make better healthcare decisions that improves overall outcomes. The real issue will be how well we teach patients to find and appraise this data and what it means especially in light of the article on patient reading skills. We got our work cut out for us.

Mayo Patient/Caregiver Scholarship

I have to pay more attention to the rules. I didn’t notice that the essay I submitted to Mayo Clinic Patient/Caregiver Scholarship had the following:

All entries will be reviewed for compliance with contest rules, and beginning July 15 those that qualify will be published on this page for public comments and voting.

 So if you would take a look HERE and comment and vote. Only if you feel my essay works. And as they say in Chicago vote early vote often. 



Notes & Links: July 24, 2013

ScienceBlogs has an article titled “A Board Certification in “Integrating” Quackery and Pseuudoscience with Real Medicine” 

The article examines new board certifications in integrative medicine. 

ACIM, founded by Andrew Weil, MD and directed by Victoria Maizes, MD, was in dialogue with the American Board of Physician Specialties (ABPS) toward establishing an American Board of Integrative Medicine in collaboration with the American Board of Integrative and Holistic Medicine (ABIHM). In that time, the plan has gone forward and over the last few months has come to fruition. Now there is indeed a board certification process for “integrative medicine,” and I can’t help but take a look at it.

The board examination includes the following:

  • Nutrition
  • Dietary supplements, botanicals and other natural products
  • Mind-body medicine and spirituality
  • Complementary and alternative therapies
  • Whole medical systems
  • Lifestyle, prevention, and health promotion
  • Integrative approaches (including conventional medicine)
  • Foundations of integrative medicine
  • Professional practice of integrative medicine

To be honest here I am struggling to find a visceral response. I am scratching my head in wonder if this is forward thinking or quackery? 

Return On Community in Healthcare

The Healthcare Marketer’s title got me right off the bat. Now to read the post. 

But ROI does not help communications professionals and hospital administrator understand the significant changes that need to take place in healthcare marketing for us to establish relevance with the connected consumer. The world has changed and healthcare marketing has not kept pace. We are currently facing a crisis of relevance.

His primary point and one I agree with is that when we invest in a community in healthcare we will see a return on investment in both dollars saved and outcomes. Better patient care is driven today by communities. Those of us following #hcsm etc know how important social media is and what it is doing. Patient engagement with the HCP is key. It is smallest most important unit of learning in healthcare from there it moves to communities. Adult learning theory is the driver of this since adults will only learn and change behavior based on reflection in action when they are seeking solutions to problems. A community shares knowledge and learning and drives change. Read the post and you will be rewarded. 

Marketing to Physicians? Think Education and Email

Here is the graphic on this topic. The n=124 rather small. But take a read if you have the time. Let me know what you think

Notes & Links: July 22, 2013

The Price Of The Autism-Measles Panic, 15 Years Later

We should send a thank you note to Jenny McCarthy for helping thin the herd. The final paragraph captures it well.

“As the Wales outbreak demonstrates, though, it takes more than parents. It also takes people–scientists and journalists–willing to use sensationalism to drum up readership and attention and money and to sideline public health in the process. And unfortunately, we have yet to develop a vaccine against simple human venality.”

The Affordable Care Act Will Fail Without Patient Engagement”

This is a thoughtful and well measured analysis of the ACA, Patient Engagement, and cost. Adrian Gropper, MD makes the following point which I see as yet another reason to engage patients in their care. It is time to  put patient centric first. 

The path to health reform in the age of unlimited connectivity and mobility cannot continue to bypass the patient. EHRs are an institutional tool and they are unlikely to be either the doctor’s or the patient’s lightsaber regardless how many federal regulations, certifications and billions of dollars we throw at them. 

The Office Visit Revisited

This is timely, important, and so spot on regarding the fact the office visit is not a drive by but part of a continuum of care. Dr. Lamberts says it well when he writes:

My care is no longer episodic, so why should my records be?  I no longer need “visits” as units of commerce, and no longer need “problems” as the goods for which I am paid.  This took me quite a while to figure out, and has me making some radical (crazy?) changes to how I think about care.

Read this if you want to where healthcare should be moving and why. It takes the EMR and makes it the narrative in the care. So well written and on point. 

Notes & Links July 17, 2013

Don’t Trust Online Tests For Alzheimer’s Disease 

Color me surprised the Internet may not be the best place to find trustworthy evidence based knowledge you can take to your HCP. 

Gary Drevitch article in Forbes reminds us that reader beware is the mantra for Web based medical/healthcare knowledge. 

But a new report released today at the Alzheimer’s Association’s International Conference in Boston finds such claims to be scientifically invalid and characterizes their hosts as unethical and often predatory in their pursuit of profits through sales of sketchy prevention tools to a beleaguered, vulnerable older population.

We need to create projects where we are teaching people how to critical appraise healthcare information. Even a well written article in a fairly mass media outlet will not reach everyone. And who is letting HCPs know that this is an issue? 

Ya Gotta Love Marco Arment

There’s a new app he created while sitting around which looks like a must have. It quickly draws arrows and boxes on screen shots so you can email them and the reader can quickly find what you are referencing. 

It’s called Bugshot. Love it

Clipboard: 4 of 5 MA Groups in Medicare Experiment Save Money in the blog White Coat Notes 

Four of the five — Partners HealthCare, Steward Health Care, the Beth Israel Deaconess Physician Organization, and the Mount Auburn Cambridge Independent Practice Association — said Tuesday that they spent less on patient care than the Medicare target for 2012, in part by reducing expensive hospital stays. The groups split the savings with Medicare.

 This is not clearly a huge win since it is early but it shows we can make a difference within a system of so many moving parts and people and goals. 

Notes & Links July 16, 2013

Jenny, Jenny, oh Jenny

David Kroll has a wonderful piece in Forbes titled “Jenny McCarthy Is A Dangerous Medical Celebrity” As you can guess from the title is shakes the reality of allowing someone with “Mommy instincts” to present medical and scientific advice as if it was evidence based medicine. Clearly stating opinion vs. evidence is critical to helping learner acquire knowledge and make life critical decisions.

Giving McCarthy an unrestricted and highly-visible platform to continue her record of pseudoscience views on issues critical to child health is both irresponsible and dangerous.

We Know Cost Kills People

Cost Prevents People from Seeking Preventive Healthcare” is posted on HealthPopuli It reviews a TeleVox survey of over 1,015 US adults titled “A Call for Change: How Adopting a Preventive Lifestyle Can Ensure a Healthy Future for More Americans” 

Some of the data HealthPopuli pulls  

  • Only 1 in 3 people in he US have spoken with their personal doctors about their medical history and risk factors for diseases 
  • Only 33% have had cholesterol checks
  • In the past two years, only 26% of people have been screened for diabetes
  • She ends with:

Making prevention cool, beautiful, smart – whatever motivates the prevention-poor patient – is the must-do for health plans, providers, payors (employers, unions and government health insurance sponsors). And to do that requires asking people the very question: what will lead you to actually seek prevention.