Nudges—and the technologies to deliver them—are becoming an increasingly important part of American healthcare. They are being used to keep patients safe, steer doctors and consumers to make more cost-effective decisions, and improve the quality of care.
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8-Week Evidence-Based LIGHT Self-Efficacy Course (Saturday afternoons) Registration, Sa... - 0 views
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About LIGHT After eight years of research and development, UC San Diego will debut a novel program this September, called LIGHT (Light Induced Guided Healing Therapy) through its Centers for Integrative Health. Developed by Paula Marie Jackson and Tom Thudiyanplackal, LIGHT is an evidence-based protocol that empowers the individual with a self-care approach to enhancing self-efficacy, which is an individual's belief in his or her innate ability to achieve goals. This protocol has been shown to improve mood, decrease fatigue, and positively affect quality of life.
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Evidence Based Medicine Explained - YouTube - 1 views
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"In this Sketchy EBM video, we explore the definition of Evidence-Based Medicine and a few of the risks."
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No Pushing, no Shoving. Instead, Nudges in the Right Direction - 1 views
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behavioral economics, a field that combines economics with the psychology of making decisions.
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help guide a stakeholder to a preferred option
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Nudging
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(EHR) makes it relatively easy to use defaults and reminders to guide healthcare decisions.
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behavioral “design team” embedded in health system
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“There are opportunities to work through all of these mediums to align nudges with improved medical decision-making,” Patel says.
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Because nudges can be very powerful, they need to be implemented carefully. “We focus on driving outcomes using national guidelines and evidence-based criteria,”
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“Well-designed nudges based on clinical evidence make it easier for clinicians to effectively treat patients based on the latest evidence,”
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In the realm of patient safety, “alarm fatigue” can set in so that safety alerts end up having the opposite of their intended effect
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Recommended by Gina Soloperto: "Applying lessons from behavioral economics, health systems are using "nudges" to influence the choices clinicians make."
Levels of Evidence - Evidence-Based Medicine - Research & Subject Guides at Stony Brook... - 0 views
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Safety concerns with consumer-facing mobile health applications and their consequences:... - 0 views
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Results Of the 74 studies identified, the majority were reviews of a single or a group of similar apps (n = 66, 89%), nearly half related to disease management (n = 34, 46%). A total of 80 safety concerns were identified, 67 related to the quality of information presented including incorrect or incomplete information, variation in content, and incorrect or inappropriate response to consumer needs. The remaining 13 related to app functionality including gaps in features, lack of validation for user input, delayed processing, failure to respond to health dangers, and faulty alarms. Of the 52 reports of actual or potential consequences, 5 had potential for patient harm. We also identified 66 reports about gaps in app development, including the lack of expert involvement, poor evidence base, and poor validation.
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Lancet: Effectiveness of wearable activity trackers to increase physical activity and i... - 0 views
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"Summary Wearable activity trackers offer an appealing, low-cost tool to address physical inactivity. This systematic review of systematic reviews and meta-analyses (umbrella review) aimed to examine the effectiveness of activity trackers for improving physical activity and related physiological and psychosocial outcomes in clinical and non-clinical populations. Seven databases (Embase, MEDLINE, Ovid Emcare, Scopus, SPORTDiscus, the Cochrane Library, and Web of Science) were searched from database inception to April 8, 2021. Systematic reviews of primary studies using activity trackers as interventions and reporting physical activity, physiological, or psychosocial outcomes were eligible for inclusion. In total, 39 systematic reviews and meta-analyses were identified, reporting results from 163 992 participants spanning all age groups, from both healthy and clinical populations. Taken together, the meta-analyses suggested activity trackers improved physical activity (standardised mean difference [SMD] 0·3-0·6), body composition (SMD 0·7-2·0), and fitness (SMD 0·3), equating to approximately 1800 extra steps per day, 40 min per day more walking, and reductions of approximately 1 kg in bodyweight. Effects for other physiological (blood pressure, cholesterol, and glycosylated haemoglobin) and psychosocial (quality of life and pain) outcomes were typically small and often non-significant. Activity trackers appear to be effective at increasing physical activity in a variety of age groups and clinical and non-clinical populations. The benefit is clinically important and is sustained over time. Based on the studies evaluated, there is sufficient evidence to recommend the use of activity trackers."
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The Quantification of Placebo Effects Within a General Model of Health Care Outcomes - 1 views
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It is proposed that the integration of a scientific model of placebo effects within a general model of health care outcomes could finally end the placebo debate and help to integrate these powerful effects into the health care system.
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Positive expectancy is recognized as a central component of placebo phenomena by all placebo theorists
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The proposed model emphasizes that the search for a placebo personality factor must be combined with the measurement of situational expectancy.
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an individual who has negative expectations regarding treatment effectiveness would likely produce a stronger than average “nocebo” effec
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placebo-prone personality
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Absorption
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receptivity to sensory experiences and a propensity for sustained, focused attention.
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Absorption has a genetic basis and is higher in women compared to men
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Absorption can go in either a positive or negative direction, depending on the situation,
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Subjects were randomly
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outcome measures
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based on three scales
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includes scales measuring fatigue, pain, and spasticity
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Judgment that the placebo was the active device resulted in a positive score with a magnitude of the confidence rating.
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if judgment was that the placebo was the placebo device, the confidence rating of the placebo was a negative score, with the magnitude of the rating.
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scored in the upper quintile on improved quality of life, as measured by the 3 QLI (an average of three symptom scales measuring pain, fatigue, and spasticity) after receiving treatment with a sham device.
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placebo responders
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Placebo responders scored higher on Absorptio
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Placebo responders gave higher confidence ratings that the placebo was the active device
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This study provides support for a two-factor model of placebo responding.
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importance of positive expectancy
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both cognitive and emotional factors mediate these effects
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Positive beliefs or confidence in the treatment coupled with a desire to feel better activate processes that result in positive outcomes.
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positive expectancy is an essential factor
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disease-specific pathways that are activated by positive expectancies have helped to transform this “soft” psychologic factor into a “hard” physiologic factor with physically measurable effects.
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While the shift from negative to positive affect may be the hallmark of placebo responding, negative affect alone is not sufficient and can play a role in people who worsen as well (nocebo effects).
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Numerous research studies have reliably shown that Absorption is modestly (yet very consistently) correlated with hypnotizability.
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Hypnotizability is often associated with “suggestibility,” with perhaps the sense of a weak-willed character or unbridled fantasy-proneness, the “unreality factor” that has plagued placebo theory for decades.
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enlightening to view these individual differences as a natural endowment in self-regulation skills: a potential innate strength rather than a simple weakness with a natural ability for self-directed healing in response to health challenges.
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Decades of research have reliably demonstrated that individuals scoring high in Absorption can skillfully modulate an impressive array of physiologic processes in laboratory settings.
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The literature suggests that the mind–body control of high Absorption scorers is similar to the self-regulation skills that many are seeking to develop with meditation, mindfulness, yoga, and qigong.
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The regular practice of mind–body control and the cultivation of positive attitudes may enhance regulation at higher levels, improving the regularity of circadian and other rhythms,
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points to the role of both expectation and conditioning, with conditioning playing a greater role in certain pathways such as immune modulation.
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somatic vulnerability of high Absorption individuals who suffer from negative biases in perception.
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nocebo phenomena described by these researchers are important for our model as they directly illustrate the power of a negative interaction of the two factors.
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Many physicians admit to prescribing placebos to contribute to patient wellness, even though this “dark secret” is not condoned and is considered to be ethically questionable.
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High Absorption individuals may benefit from encouragement to utilize their innate self-regulation skills toward maximum therapeutic effect.
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ersons with average Absorption scores can be encouraged to become more skilled at self-regulation through mind–body therapies
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The model does not specifically address the many factors that contribute to confidence in the treatment, such as cost, pill color, pill size, or confidence-enhancing paraphernalia.
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The role of provider and patient interaction are also not specifically addressed.
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he model also does not directly address the role of stress reduction
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The strength of placebo responding in domains such as pain and depression clearly indicate the importance of the shift from a negative to a positive state.
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the unresolved issue of why some people respond to placebos whereas others do not
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asic two-factor model can be further tested with the basic measurement tools of expectancy and Absorption,
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Conclusions
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the recognition that positive expectancy and expert self-regulation skills significantly contribute to health outcomes can help to integrate these powerful effects into the health care system
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The “positive psychology” movement is shifting attention to the power of positive expectation
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undermining nature of negative expectancy and pessimistic language, especially in vulnerable populations such as those with pain and depression
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Practitioners of the art of health care have always recognized the importance of motivated and empowered patients and the power of a kind word and a ray of hope.
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This is the time to quantify these factors, integrating art and science, and finally solving (and forgiving Descartes for) the mind–body problem.
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"The topic of placebo effects is distinguished by decades of keen scientific interest1-4 coupled with a general skepticism regarding the ultimate significance of these phenomena. The importance of psychologic factors in mediating these effects may contribute to the attitude that placebo effects are not as substantial as a therapeutic effect produced by a drug. Complementary and alternative therapies have sometimes been dismissed as "mere placebos." However, recent studies have provided compelling evidence that placebo effects are physiologically measurable with condition-specific pathways.5"
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Dr. Jake Fleming recently suggested these potent keywords: quantifiable placebo The keywords led to this article. I find it affirming and empowering.
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Coronavirus Will Change the World Permanently. Here's How. - POLITICO - 0 views
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Instead of asking, “Is there a reason to do this online?” we’ll be asking, “Is there any good reason to do this in person?”
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saluting our doctors and nurses, genuflecting and saying, “Thank you for your service,”
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give them guaranteed health benefits and corporate discounts
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it will force us to reconsider who we are and what we value, and, in the long run, it could help us rediscover the better version of ourselves.
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has the potential to break America out of the 50-plus year pattern of escalating political and cultural polarization
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the “common enemy” scenario, in which people begin to look past their differences when faced with a shared external threat
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second reason is the “political shock wave” scenario
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enduring relational patterns often become more susceptible to change after some type of major shock destabilizes them
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now is the time to begin to promote more constructive patterns in our cultural and political discourse. The time for change is clearly ripening.
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The COVID-19 crisis
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has already forced people back to accepting that expertise matters.
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move them back toward the idea that government is a matter for serious people.
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the end of our romance with market society and hyper-individualism.
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We could turn toward authoritarianism
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reorient our politics and make substantial new investments in public goods—for health, especially—and public services.
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to allowing partial homeschooling or online learning for K-12 kids has been swept away by necessity.
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the social order it helps support—will collapse if the government doesn’t guarantee income for the millions of workers who will lose their jobs in a major recession or depression
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de-militarization of American patriotism and love of community will be one of the benefits to come out of this whole awful mess.
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But how do an Easter people observe their holiest day if they cannot rejoice together on Easter morning?
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How do Jews celebrate their deliverance from bondage when Passover Seders must take place on Zoom
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Can Muslim families celebrate Ramadan if they cannot visit local mosques for Tarawih prayers
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All faiths have dealt with the challenge of keeping faith alive under the adverse conditions of war or diaspora or persecution—but never all faiths at the same time.
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Contemplative practices may gain popularity
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One group of Americans has lived through a transformational epidemic in recent memory: gay men. Of course, HIV/AIDS
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Plagues drive change.
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awakened us to the need for the protection of marriage
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People are finding new ways to connect and support each other in adversity
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demand major changes in the health-care system
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COVID-19 will sweep away many of the artificial barriers to moving more of our lives online
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uptake on genuinely useful online tools has been slowed by powerful legacy players,
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collaboration with overcautious bureaucrats
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Medicare allowing billing for telemedicine was a long-overdue change
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s was revisiting HIPAA to permit more medical providers to use the same tools the rest of us use every day to communicate, such as Skype, Facetime and email.
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The resistance
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we will be better able to see how our fates are linked.
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near-impossible to put that genie back in the bottle in the fall
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college
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forcing massive changes in a sector that has been ripe for innovation for a long time.
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Once companies sort out their remote work dance steps, it will be harder—and more expensive—to deny employees those options.
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Yo-Yo Ma
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Perhaps we can use our time with our devices to rethink the kinds of community we can create through them
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This is a different life on the screen from disappearing into a video game or polishing one’s avatar.
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breaking open a medium with human generosity and empathy
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Not only alone together, but together alone.
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The rise of telemedicine
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Out of necessity, remote office visits could skyrocket in popularity as traditional-care settings are overwhelmed by the pandemic
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they’ve been forced to make impossible choices among their families, their health and financial ruin.
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This crisis should unleash widespread political support for Universal Family Care
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single public federal fund that we all contribute to, that we all benefit from, that helps us take care of our families while we work, from child care and elder care to support for people with disabilities and paid family leave.
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potlight on unmet needs of the growing older population
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The reality of fragile supply chains for active pharmaceutical ingredients coupled with public outrage over patent abuses that limit the availability of new treatments has led to an emerging, bipartisan consensus that the public sector must take far more active and direct responsibility for the development and manufacture of medicines.
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resilient government approach will replace our failed, 40-year experiment with market-based incentives
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Science reigns again.
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Truth and its most popular emissary, science, have been declining in credibility for more than a generation
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Quickly, however, Americans are being reacquainted with scientific concepts like germ theory and exponential growth
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Unlike with tobacco use or climate change, science doubters will be able to see the impacts of the coronavirus immediately
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for the next 35 years, I think we can expect that public respect for expertise in public health and epidemics to be at least partially restored
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Congress can finally go virtual.
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We need Congress to continue working through this crisis, but given advice to limit gatherings to 10 people or fewer, meeting on the floor of the House of Representatives is not an especially wise option right now
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nstead, this is a great time for congresspeople to return to their districts and start the process of virtual legislating—permanently
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Lawmakers will be closer to the voters they represent
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sensitive to local perspectives and issues
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A virtual Congress is harder to lobby
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Party conformity also might loosen with representatives remembering local loyalties over party ties.
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Big government makes a comeback.
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Not only will America need a massive dose of big government
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we will need big, and wise, government more than ever in its aftermath.
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The widely accepted idea that government is inherently bad won’t persist after coronavirus.
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functioning government is crucial for a healthy society
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most people are desperately hoping
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a rebirth of the patriotic honor of working for the government.
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the coronavirus crisis might sow the seeds of a new civic federalism, in which states and localities become centers of justice, solidarity and far-sighted democratic problem-solving.
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we will see that some communities handled the crisis much better than others.
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success came in states where government, civic and private-sector leaders joined their strengths together in a spirit of self-sacrifice for the common good.
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The coronavirus is this century’s most urgent challenge to humanity.
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a new sense of solidarity, citizens of states
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The rules we’ve lived by won’t all apply
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pandemic has revealed a simple truth:
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many policies that our elected officials have long told us were impossible and impractical were eminently possible and practical all along.
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student loans and medical debt
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evictions were avoidable; the homeless could’ve been housed
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Trump has already put a freeze on interest for federal student loans
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Governor Andrew Cuomo has paused all medical and student debt owed to New York State
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Democrats and Republicans are discussing suspending collection on—or outright canceling—student loans as part of a larger economic stimulus package
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It’s clear that in a crisis, the rules don’t apply
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an unprecedented opportunity to not just hit the pause button and temporarily ease the pain, but to permanently change the rules so that untold millions of people aren’t so vulnerable to begin with.
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Revived trust in institutions.
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oronavirus pandemic, one hopes, will jolt Americans into a realization that the institutions and values Donald Trump has spent his presidency assailing are essential to the functioning of a democracy—and to its ability to grapple effectively with a national crisis.
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government institutions
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need to be staffed with experts (not political loyalists),
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decisions need to be made through a reasoned policy process and predicated on evidence-based science and historical and geopolitical knowledge
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we need to return to multilateral diplomacy,
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to the understanding that co-operation with allies—and adversaries, too—is especially necessary when it comes to dealing with global problems like climate change and viral pandemics.
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t public trust is crucial to governance
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1918 flu pandemic
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the main lesson from that catastrophe is that “those in authority must retain the public’s trust” and “the way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one.”
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Expect a political uprising.
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Occupy Wall Street 2.0, but this time much more massive and angrier.
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Electronic voting goes mainstream.
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how to allow for safe voting in the midst of a pandemic, the adoption of more advanced technology
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To be clear, proven technologies now exist that offer mobile, at-home voting while still generating paper ballots.
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This system is not an idea; it is a reality that has been used in more than 1,000 elections for nearly a decade by our overseas military and disabled voters.
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hould be the new normal.
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Election Day will become Election Month.
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The change will come through expanded early voting and no-excuse mail-in balloting, effectively turning Election Day into Election Month
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Once citizens experience the convenience of early voting and/or voting by mail, they won’t want to give it up.
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. Some states, such as Washington, Oregon and Utah, already let everyone vote at home.
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Voters already receive registration cards and elections guides by mail. Why not ballots?
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First, every eligible voter should be mailed a ballot and a self-sealing return envelope with prepaid postage.
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Elections administrators should receive extra resources to recruit younger poll workers, to ensure their and in-person voters’ health and safety, and to expand capacity to quickly and accurately process what will likely be an unprecedented volume of mail-in votes.
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In the best-case scenario, the trauma of the pandemic will force society to accept restraints on mass consumer culture as a reasonable price to pay to defend ourselves against future contagions and climate disasters alike.
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In the years ahead, however, expect to see more support from Democrats, Republicans, academics and diplomats for the notion that government has a much bigger role to play in creating adequate redundancy in supply chains—resilient even to trade shocks from allies. This will be a substantial reorientation from even the very recent past.
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pressure on corporations to weigh the efficiency and costs/benefits of a globalized supply chain system against the robustness of a domestic-based supply chain.
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other gap that has grown is between the top fifth and all the rest—and that gap will be exacerbated by this crisis.
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In this crisis, most will earn steady incomes while having necessities delivered to their front doors.
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other 80 percent of Americans lack that financial cushion.
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will struggle
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A hunger for diversion.
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After the disastrous 1918-19 Spanish flu and the end of World War I, many Americans sought carefree entertainment, which the introduction of cars and the radio facilitated.
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The economy quickly rebounded and flourished for about 10 years, until irrational investment tilted the United States and the world into the Great Depression.
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human beings will respond with the same sense of relief and a search for community, relief from stress and pleasure.
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Less communal dining—but maybe more cooking
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many people will learn or relearn how to cook over the next weeks.
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ikely there will be many fewer sit-down restaurants in Europe and the United States. We will be less communal at least for a while.
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A revival of parks.
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Urban parks—in which most major cities have made significant investments over the past decade—are big enough to accommodate both crowds and social distancing.
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Society might come out of the pandemic valuing these big spaces even more,
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A change in our understanding of ‘change.’
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Americans have said goodbye to a society of frivolity and ceaseless activity in a flash
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Our collective notions of the possible have changed already
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The tyranny of habit no more.
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Maybe, as in Camus’ time, it will take the dual specters of autocracy and disease to get us to listen to our common sense, our imaginations, our eccentricities—and not our programming.
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and environmentally and physiologically devastating behaviors (including our favorites: driving cars, eating meat, burning electricity)
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echarged commitment to a closer-to-the-bone worldview that recognizes we have a short time on earth
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In the coronavirus pandemic, we're making decisions without reliable data - 4 views
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A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data
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This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19.
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As most health systems have limited testing capacity, selection bias may even worsen in the near future.
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The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher.
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Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%).
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Although successful surveillance systems have long existed for influenza, the disease is confirmed by a laboratory in a tiny minority of cases.
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Some worry that the 68 deaths from Covid-19 in the U.S. as of March 1610 will increase exponentially to 680, 6,800, 68,000, 680,000 … along with similar catastrophic patterns around the globe. Is that a realistic scenario, or bad science fiction? How can we tell at what point such a curve might stop?
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In the absence of data, prepare-for-the-worst reasoning leads to extreme measures of social distancing and lockdowns.
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This has been the perspective behind the different stance of the United Kingdom keeping schools open12, at least until as I write this. In the absence of data on the real course of the epidemic, we don’t know whether this perspective was brilliant or catastrophic.
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One of the bottom lines is that we don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society, and mental health.
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At a minimum, we need unbiased prevalence and incidence data for the evolving infectious load to guide decision-making.
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Dr. Michael Kurisu D.O. "My take is this article is written by a very credible source. John P.A. Ioannidis is from Stanford and great resource. Makes argument that we are basing a LOT of our decisions on faulty or NO data ! Its fascinating to me that there has been less than 10,000 deaths globally and we have had SO MUCH DISRUPTION in the economy. I definitely feel we should be tracking the amount of deaths that are going to occur from people that will be pushed into poverty as well as the number of people being denied access to medical care right now. Yes… with COVID19, it CAN get much worse…. But maybe not… we don't know yet. This article actually increased my morale and put me on track to help GET MORE DATA. Then we can make informed decisions. And then TRACK ALL THE DATA moving forward.
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DeAunne Denmark, MD, PhD, "Excellent piece spelling out the pervasive and critical issues due to abysmal lack/tardiness in US testing, especially of large populations where initial outbreaks occurred, for those both visibly sick and not. And most importantly, healthcare workers. We cannot even begin to estimate CFR, much less develop reliable projection models, without valid data on everybody who is carrying. "The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate the incidence of new infections."
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Association of the Functional Medicine Model of Care With Patient-Reported Health-Relat... - 0 views
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Importance The incidence of chronic disease is increasing along with health care-related costs. The functional medicine model of care provides a unique operating system to reverse illness, promote health, and optimize function. The association between this model of care and patient's health-related quality of life (HRQoL) is unknown.
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Qualifying and quantifying the precision medicine rhetoric - 0 views
bmcgenomics.biomedcentral.com/...s12864-019-6242-8
Evidence-based P4 Precision Personalized Camille-Nebeker genomics
shared by Dennis OConnor on 19 Nov 19
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Background With the rise of precision medicine efforts worldwide, our study objective was to describe and map the emerging precision medicine landscape. A Google search was conducted between June 19, 2017 to July 20, 2017 to examine how "precision medicine" and its analogous terminology were used to describe precision medicine efforts. Resulting web-pages were reviewed for geographic location, data type(s), program aim(s), sample size, duration, and the key search terms used and recorded in a database. Descriptive statistics were applied to quantify terminology used to describe specific precision medicine efforts. Qualitative data were analyzed for content and patterns.
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About - The Human Project - 1 views
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"The Human Project is a groundbreaking research platform being developed as a public resource to solve some of the toughest challenges we face. By discovering critical connections between our biology, behavior, and environment, it aims to enable major advancements in medicine, yield new therapeutics, advance our understanding of human behavior, and foster evidence-based public policies that improve lives. "