Category: Medicine

Video ethnography for quality improvement

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Watching patient/provider interactions in realtime can make it easier to see the process from the patient perspective and spot opportunities for improvement. In healthcare interactions, as in just about any people-oriented service, issues that are obvious when seen in context can get lost when an interaction is described by bare data. In an era where structured data is so important, it can be very useful to step back and look for a richer picture of the service you are providing, without a preconception of what is going to be significant.

I was interested to read about Kaiser Permanente’s use of video ethnography to observe patients as they receive care in order to gain insight into unmet patient needs and overlooked issues. From an article on collaborations between insurers and providers to use data owned by the insurer to improve population health:

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Fish oil prevents onset of schizophrenia: treatment breakthrough

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Research starting in the early 90’s has suggested a neurodevelopmental basis for schizophrenia. Other studies suggest a biochemical basis for this abnormal development in schizophrenics related to insufficient fatty acids – fatty acids that contribute to the phospholipids which are the building blocks of neuronal membranes. Growth of axons and dendrites, making new synaptic connections and pruning of old ones, involves the synthesis and breakdown of phospholipids.

Based on findings of reduced fatty acids in people with schizophrenia, researchers have been studying whether giving Long-chane omega-3 polyunsaturated fatty acids (PUFAs) to patients at high risk for developing psychotic disorder would prevent them from developing psychotic disorder.

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Infectious cancer in Tasmanian Devils

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Around 15 years ago, Tasmanian Devils, those cute little bad-tempered creatures from Down Under, began vanishing as a consequence of a new disease spreading rapidly among the population. Around 1996, a photographer documented severe facial tumors in the Devils in the northeast of Tasmania. By 1999, similar tumors appeared in Devils on the east coast. By 2003 it was clear that the entire population was in decline because of the disease. At first, it was assumed a virus or retrovirus was the cause.

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Folic acid supplements in late pregnancy increase risk of asthma

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According to CDC statistics, U.S. childhood asthma prevalence more than doubled between 1980 to the mid-1990s and has since plateaued at those historically high levels. Although many triggers and risk factors for asthma have been identified, the reasons behind this increase are not yet understood.

A recent study by University of Adelaide researchers Whitrow, Moore, Rumbold, and Davies may shed some light on the rise in asthma in young children. The study appears to show that the use of folic acid supplements in late pregnancy can lead to increased allergic asthma in children of 3.5 years of age. This human study corroborates earlier studies in mice which indicated that supplementation with folate in pregnancy leads to an allergic asthma phenotype in mice via epigenetic mechanisms (changes in gene expression).

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Breakthrough in Down Syndrome – Cognitive dysfunction reversed in mice

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Back in the 90’s, a woman named Dixie Lawrence made a splash on the internet by describing how her daughter with Down Syndrome experienced improved growth, health and cognition after starting a regimen of nutritional supplements and piracetam. I recall reading that she noticed that her infant daughter was not actually retarded – at least not yet.

Dixie’s routine for changing diapers always ended with a playful rub of Madison’s stomach. One morning, when Madison was eight months old, a fatigued Dixie said to her, “Well, honey, I’m tired, you’re going to have to rub your stomach yourself.” And Madison did just that.

It hit Dixie like a ton of bricks. She realized that her daughter was not retarded, and that if she wasn’t retarded, she would develop retardation. If this was the case, there had to be something that could slow it down or stop it! In a modest bedroom in rural Louisiana, Dixie Tafoya “looked through the telescope,” and in spite of what everyone “knew,” she saw perfectly round planets. With that insight, she jumped light years ahead of all the “experts.”

from Looking Through A Telescope, by Julian Whitaker M.D., Whitaker Wellness Institute

In other words, this was a view of Down Syndrome as a developmental problem, where the cognitive deficits increase with age.

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Decision support tools, performance support systems and just-in-time learning

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Where is the best spot for an educational (or other) intervention?

When there is a workforce performance or knowledge gap to fill, trainers understandably think first of using training to fill it. But is more training really always the best answer? Depending on the skills involved and the characteristics of the audience, process improvement, usability improvement, training or performance support may all be worth considering.

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Progress in the fight against Hospital Acquired Infections

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The problem:

Over the last few years, public attention has been focused increasingly on the problem of nosocomial or hospital acquired infections (HAI’s). Why is there so much concern? A study by the CDC published in the March/April 2007 issue of the journal Public Health Reports, estimated that 1.7 million hospital patients per year ― 4.5 of every 100 admissions ― become infected, causing or contributing to the deaths of nearly 100,000 people per year. (IHI.org) 100,000 people per year is about 1/5 of the total deaths from cancer per year in the US, or about the same as the total stroke or accidental deaths. Or, another way to understand the size of this number, picture the population of South Bend Indiana, dying every year of mostly preventable causes. This is an epidemic.

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