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Archive for the ‘Health Sciences & Medicine’ Category

As friends of mine know, I have changed my diet to “near” vegan for about 6 months now, based on reading and review of data that I had not seen before (but actually has been around for a while).  Since so many people have asked me, and then want some place to go, I’m creating this post so I can refer people later.

Documentary:
“Forks over Knives”
This is available as a Netflix stream and plenty of places.  Kinda low budget but interviews and involves the real stalwarts/academics in this field Carl Esselstyn and Colin Campbell.
– there is also a book, which has recipes and a very rough summary of the documentary.  Personally I didn’t find it too worthwhile.  Does have a good set of recipes, though.
Books:
Engine 2 Diet –
– A good place to get started, with recipes, shopping lists, and strategies in restaurants.  Particularly good place to start for people who are younger, reasonably healthy and do not have any major medical problems (yet).
Esselstyn’s book:
Has clinical experience of decades of controlling many of the heart attack and stroke risks in patient after their first heart attack.
Colin Campbell’s Book:
– A real review of the science of nutrition, and talks extensively about the association of Meat based proteins (particularly milk) and cancer.  This is probably the “bible” of nutrition, with some 400+ reference from peer reviewed journal articles.  I have heard that it is still very readable, but I can’t vouch for it since I have a background in epidemiology.  That said, I will say that the material is very well grounded.
What I do:
Based on data outlined in a number of the above books, I am, “mostly vegan,” which means I eat meat/dairy/fish in my meals once a week.  I also make a reasonable effort to avoid, but don’t sweat the small amount of non-vegan products found in most breads and baked goods.  (cakes and such are not healthy, whether vegan or not!).  This meets my goal of staying “less than 5%” animal protein.  I also take B12 vitamins on occasion (generally about once or twice a week when I remember), which I think should be more than enough since I am not strictly vegan anyway.
Hope this helps someone out in the interwebs!

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So… restless leg syndrome does affect the quality of life of many people, and it is really troubling… now a solution.

My only question is… nobody figured this out before?

… and where did these guys get the idea in the first place?  Right.

Sexual intercourse and masturbation: Potential relief factors for restless legs syndrome?

Luis F. Marin, a, , André C. Felicioa and Gilmar F. Pradoa

a Neuro-Sono Sleep Center, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Sao Paulo, Brazil

Received 2 January 2011;  accepted 18 January 2011.  Available online 4 March 2011.

via ScienceDirect – Sleep Medicine : Sexual intercourse and masturbation: Potential relief factors for restless legs syndrome?.

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Atul Gawande is at it again.  This article really needs to be read by everyone in Health Care or who is interested in the Health Care debate.  And particularly anyone who dose Health Care and Statistics.  Courtesy of The New Yorker

Brenner wasn’t all that interested in costs; he was more interested in helping people who received bad health care. But in his experience the people with the highest medical costs—the people cycling in and out of the hospital—were usually the people receiving the worst care. “Emergency-room visits and hospital admissions should be considered failures of the health-care system until proven otherwise,” he told me—failures of prevention and of timely, effective care.

If he could find the people whose use of medical care was highest, he figured, he could do something to help them. If he helped them, he would also be lowering their health-care costs. And, if the stats approach to crime was right, targeting those with the highest health-care costs would help lower the entire city’s health-care costs. His calculations revealed that just one per cent of the hundred thousand people who made use of Camden’s medical facilities accounted for thirty per cent of its costs. That’s only a thousand people—about half the size of a typical family physician’s panel of patients.

Things, of course, got complicated. It would have taken months to get the approvals needed to pull names out of the data and approach people, and he was impatient to get started. So, in the spring of 2007, he held a meeting with a few social workers and emergency-room doctors from hospitals around the city. He showed them the cost statistics and use patterns of the most expensive one per cent. “These are the people I want to help you with,” he said. He asked for assistance reaching them. “Introduce me to your worst-of-the-worst patients,” he said.

They did. Then he got permission to look up the patients’ data to confirm where they were on his cost map. “For all the stupid, expensive, predictive-modelling software that the big venders sell,” he says, “you just ask the doctors, ‘Who are your most difficult patients?,’ and they can identify them.”

via Lower Costs and Better Care for Neediest Patients : The New Yorker.

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A quick hat-tip from ACEP weekend review:

Medication reconciliation rule on hold

Based on comments from ACEP and others, the Joint Commission is taking another look at its National Patient Safety Goal requiring medication reconciliation by emergency physicians. This goal will not be scored during reviews until at least July 2011, when revised language should be in place.

LINK

Some sanity exists in this world.

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I found this article interesting, particularly from the eye of a statistician.  Particularly since some of the same problems that results for “meta-analysis” studies are actually reflected in this articles, which deals with the aggregation of Video Game reviews.  In many ways, we see that the problems are similar to the weakness in a meta-analysis study.  Namely, different studies (or in this case, reviewers) have different purposes and designs to how they evaluate something, and trying to put them all together in a nice simple number is just, well, too simplifying.

Linked below for reference.

The world of game reviews is often difficult to navigate. Everyone uses different scores, and a large emphasis is placed on the single score given to games by Metacritic, a review-aggregation site. Metacritic uses a scale of 1 to 100 for reviews, a figure calculated by averaging multiple scores. What comes out after that averaging is seen as something akin to a gold standard for judging the quality of a game. Weve been asked numerous times why were not included in the game rankings given by Metacritic: our reviews arent linked from the site, and were not included in the final uber-score. Thats by design.

via Game reviews on Metacritic: why we avoid inclusion.

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I’m honestly finding television harder and harder to watch.  Still, even on CNN nobody bothers to argue over the claim that Americans have “overwhelmingly rejected” the bill.  It seems that unsubstantiated claims are just the norm.

In the later phase of the health care debate, the argument most often heard from Republicans has been this: The American people have rejected this bill; we are only their messengers.The verb “rejected” is often amplified with words such as “overwhelmingly” or “resoundingly” or “again and again.”How can President Obama and his Democratic Congress possibly move a piece of social change legislation comparable to Social Security or Medicare without the support of the American people?

via Just How Unpopular Is The Health Care Bill? – Watching Washington Blog : NPR.

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Sometimes you get an article that is simply refreshing.  The problem with most political economic debate is that it is being done by amateurs to an audience that has no idea what is being discussed.  It is far easier to simply give the mantra “private competition is better!” without actually looking to see if that’s true.

Newsweek published an article by Clayton Christensen, Professor at HBS, which actually lays out some of these misconceptions.  (BTW, Newsweek website actually stinks at finding articles, I found it much easier to find the article, after getting an excerpt forwarded to me by email, by using Google News.  kinda sad).

Those who debate insurance reform in Washington and pit public against privately funded care are framing the problem incorrectly. Here’s a better way to think about it: Economists are wrong in asserting that competition controls costs. Most often innovation and competition drive prices up, not down, because bringing better, higher-priced products to market is more profitable. Hospital-vs.-hospital competition causes providers to expand their scope and offer more premium-priced services. Equipment suppliers boost the capability and cost of their machines and devices. Drugmakers develop products that bring the highest prices. It’s because we have such competition, not because we lack it, that health costs are rising by 10% a year.

The type of competition that brings prices down is disruptive innovation. Disruption in health care entails moving the simplest procedures now performed in expensive hospitals to outpatient clinics, retail clinics, and patients’ homes. Costs will drop as more of the tasks performed only by doctors shift to nurses and physicians’ assistants. Hoping that our hospitals and doctors will become cheap won’t make health care more affordable and accessible, but a move toward lower-cost venues and lower-cost caregivers will.

via Health Care: The Simple Solution – BusinessWeek.

Complete article copied, in link below, in case it gets deleted or paywalled:

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I honestly don’t understand what took them so long.  Ars Technica reviews the issue the best for the layperson:

This week, after receiving the conclusions of a multiyear ethics investigation of UK doctor Andrew Wakefield performed by the General Medical Counsel GMC, the editors of British medical journal The Lancet formally retracted a study which purported to find a link between the childhood MMR vaccine, gastrointestinal disease, and autism. It was published in 1998 and has been a source of controversy ever since.

via The Lancet retracts paper linking MMR vaccines and autism.

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Often, the most effective techniques are simple, so simple that they make medicine look bad.  Handwashing effectiveness was one thing, but how about the idea of cleaning the patient before surgery?  NY Times summary to the recently published New England Journal articles linked below.

The studies, published Thursday in The New England Journal of Medicine, examined infections that develop at the site of surgery, often around the incision, and afflict more than 300,000 patients a year in the United States.

While experts are increasingly trying to stop hospital-acquired infections by approaches including stepped-up hand-washing by doctors and nurses, the new studies looked at the bacteria patients may be carrying before entering the hospital, especially a common bacteria, staphylococcus aureus.

“About one-third of people at any one time carry this bacterium in their nose or on their skin,” said a co-author of one study, Dr. Henri Verbrugh, a professor of medical microbiology at Erasmus University Medical Center in the Netherlands. “It does not give them any problem, but if they go to a hospital and the skin is somehow breached, they are really prone to invasion or infection by their own bacteria.”

Dr. Verbrugh and colleagues tested patients for the bacteria using nasal swabs. They treated about 500 who carried the bacteria for five days with an antibiotic ointment on their noses and showers with soap treated with chlorhexidine, an antiseptic. After surgery, which sometimes occurred during the five-day treatment, those patients were 60 percent less likely to develop infections than patients receiving a placebo of ointment and soap.

via Hospitals Could Stop Infections by Tackling Bacteria Patients Bring In, Studies Find – NYTimes.com.

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So, I received an unsolicited mailing from a prestigious sounding “Consumers’ Research Council of America.”

“Congratulations on your prestigious recognition in the ‘Guide to America’s Top Emergency Medicine Physicians’ “

Too bad it looks like a sham.  It is pretty suspicious when they immediately want to sell me a $200 plaque.  It seems that they do this for various medical fields, but relatively recently they made the mistake of also trying to bilk financial planners… resulting in the following article from Forbes.com.

“Consumers’ Research appears to be trying to create the image of a quality, beholden-to-no-one research organization like, say, Consumers Union, the similarly sounding nonprofit publisher of highly reputable Consumer Reports. But Consumers’ Research looks more like a stalking horse for S L D Industries, which also sells a wide range of traditional trophies and corporate awards.”

In that respect, I have to admit the plaques look pretty nice, and it isn’t a bad way to make a practice look respectable.  I’m sure they get a decent amount of business from medical professionals.  Honestly, how is a patient supposed to be able to tell?

Scanned letters below the break:

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