Will the mobile become a health folder?

By Josep M. Picas

Recently converted to the world of Apple, I was surprised that my iPhone displayed, without requesting my acceptance, a very basic health app but boasting a great potential. After a few days of mulling over the applicability of the tool, I read the news that Mayo Clinic of Rochester announced that its strategy of personal clinical record will from now on pass through this app from Apple, which means dismantling the current one and maintaining it only for  Android. Mayo Clinic is one of the American hospitals, along with Cleveland Clinic who understand very clearly that the new health is global.

The shared clinical decision is a two way street

Peter Ubel is a doctor specialized in the field of bioethics and the research of human behaviour. As he confesses in his blog, he likes to explore the dialectic of rational and irrational forces that affect the people’s health, their happiness and the way society works.

I attached a promotional video for his book "Critical Decisions" which delves into the realm of shared clinical decisions. "The attitude of people to the risk of contracting a disease, argues Dr. Ubel in this video, does not depend on whether they understand the numbers explained to them, but on how they interpret them and, thus, very often important clinical decisions are taken based on the subtlety of perception." For example, many patients are more inclined to opt for an intervention with a 90% survival rate than for one with a 10% mortality rate. Given a risk, fear always wins over reason.

Safety daily huddle meetings

I had the opportunity to visit the Scottish NHS hospital group Ayrshire & Arran in the context of a professional event. The meeting, as expected, was very helpful, and one of the things that I took home was a working tool that for me, was as novel as it was simple: "Hospital Daily Safety Huddle," which roughly means the daily meeting of "circle time" for the patient’s safety. The management of the Crosshouse Hospital, the largest in the group, satisfied with the functioning of the experience, invited us to attend their huddle, that since June 30, 2014, they hold every day at 8:15.

What is a huddle?

According to Wikipedia, the huddle concept comes from the world of team sport. It’s joining in a circle, in the same area, standing, concentrated and often intertwined with the aim of remembering together the strategy and tactics that they have learned but also with the purpose of becoming more motivated for the game. Therefore, you see that "circle time" meeting is an approach of the concept of huddle.

Hunting zebras in Texas or why doctors order so many tests

Bayes’s theorem estimates the probability of an event occurring if another one occurred before. If we hear thunder, it’s very likely that soon it will start to rain. However, biomedicine is more interested by the inverse probabilistic formulation because often when an observation is made we look for the cause: "If, for example, you find yourself on a ranch in Texas and hear the sound of trotting horses, what is the probability that a herd of zebras will approach? ”Dr. Saurabh Jha, radiologist, blogger and contributor to the BMJ, says that we hunted zebras in Texas for long enough. "The clinical reasoning of many doctors today - explains Dr. Jha - forgot the Bayesian thinking and embraced instead the thesis that it’s better to manage a false positive than a false negative."

When, in the second decade of the last century, he was asked why he wanted to climb Everest, George Mallory, an English mountaineer, replied that it’s because the mountain was there. According to Dr. Jha, many doctors feel the same as Mallory: they ask for tests because they can. In his article in the BMJ, the radiologist explained the case of a patient of Dr. Watson, a well read doctor emerged from a refined education who pays a lot of attention to detail but lacks the deductive ability of the famous Sherlock Holmes’ assistant. If you have a chance to read the letter, you will see how for the study of this case, nothing seems elementary to Dr. Watson, to the extent that for every horse he sees an opportunity for a zebra hunt. "Zebras are intellectually exciting," Dr. Jha ends up saying.

"Nature" echoes the unpublished biased research

"Social sciences suffer from severe publication bias" says Nature http://t.co/jA6gmQbxSP pic.twitter.com/MT8WeUlPpl

— Matthew Hankins (@mc_hankins) 28 agost, 2014

The British epidemiologist, Matthew Hankins, leads us to an article in Nature, but before going, I think it's worth commenting on the graph illustrated in his tweet. Note that from almost half a million studies published in Nature, the number of results without statistical significance (p> 0.5) is almost testimonial.