Low Carb Diets – Good Or Bad
The fad of diets come and go like the tides in the ocean and he low carbohydrate (aka Atkins Diet) continue to resurface in different forms. For many these diets represent a roller coaster of weight loss followed by similar weight gain but a new study in the Annals of Internal Medicine Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet (PDF version here) demonstrated some surprising findings……
Both groups lost about 7% of their weight but what was surprising was the Low Carbohydrate diet had better cholesterol levels in their blood including an increase in the HDL (good cholesterol) all representative of factors that reduce heart risks.
Don’t celebrate too much yet though. Both groups had very intensive monitoring and support and this was probably as important if not more important to the success of the weight loss program. The results do seem to suggest a counter intuitive improvement in cholesterol levels despite a low carbohydrate diet that contained more fats.
Key learning point here – focus and support to improve compliance and adherence to weight loss and fitness programs is successful in achieving and maintaining weight loss
Voice is Ready for Prime Time
Mike Elgan said so……: Say it with me: Voice is ready for prime time, It’s time for the victory of voice to shout down the tyranny of text in this enlightening piece that had many comments all in the positive relative the to advance of technology
Talking is the best user interface…Language is natural to people and universal to all cultures. Language is a spoken medium. Written language is merely the symbolic representation of spoken language. It’s an abstraction, but a necessary one.
And he asked But is the technology there yet?. You bet!
In the future, we’ll talk to our computers and they’ll talk back. We know this is true because talking is the most natural way for human beings to communicate. The evolution of the human-machine interface always moves the workload of interaction from the person to the computer. The perfect UI would be a natural conversation, just like you have with other people.
Could not have said it better myself! This is especially true in the healthcare setting where clinicians are overwhelmed with paper work and documentation requirements. As Mike points out there are hurdles, no insurmountable
- Technology: creation of software (supported by powerful hardware) that can understand spoken language
- Technology: content must be searchable. Text can be indexed, and we’ve grown addicted to the ability to search for and find the things we’ve written, and
- Cultural: the barrier to voice-based computer interaction is one of habit. We’ve grown used to typing on keyboards. Although speaking is natural, speaking to a computer feels a little weird at first. And people generally don’t like learning a new way to do things.
In the piece he features three products that address these issues and go much farther VoiceBase for indexing and searching, DialtoDo to convert spoken utterances into action, and as he puts it the Mother of All Voice Applications, Dragon NaturallySpeaking 11 from Nuance.
Dragon NaturallySpeaking takes dictation so accurately that it begins to approach Steve Jobs’ favorite word: “Magical.” For the first week of use, I was actually shocked when it correctly recognized obscure names, extremely technical terms, brand names with correct capitalization (for example, iPhone) and performed other unlikely feats. Since I started using it, I’ve written the first drafts of all of my columns and blog posts, including this column, using Dragon NaturallySpeaking.
But as Mike points out the downside to this innovations, speed and accuracy that is especially relevant to healthcare is the lack of time to think. Many of us use typing time as thinking time….if you lose the typing time you lose the thinking time and generating content becomes a little more challenging at first:
The accuracy has an unexpected and very welcome side effect: It makes it easier to write. I assumed that typing was automatic, requiring little brain power. But using Dragon has demonstrated that mental energy was diverted from the task of typing to the task of thinking, which is what makes writing so much easier. I can also write faster using Dragon.
This requires a change in behavior and an adaptation to the lost thinking time that can make clinicians feel less productive as they have to pause during dictations. But for those that already adapted to dictation and that process is easy (think existing dictating clinicians who use a telephone or hand held recorder device to dictate and generate clinical notes using traditional dictation and transcription) then a move to dictating directly to your PC is one step closer.
But be warned as he identified “It’s not feasible yet for most people to completely abandon keyboards, mice and text and interact entirely via the spoken word.” – so don’t try to make that happen or expect it to happen. Again think of the telephone and texting – in some respects Texting could be considered a retrograde step but for many (read millions) texting is preferable to actually using the phone to speak to someone.
Embrace the tools that make sense in your work and home life and importantly as I said in this piece at HealthCareIt Guy Blog: Top 10 tips for successfully using speech recognition in EHRs and healthcare apps spend the money on a good microphone
I’ll leave you with Mike’s closing comments:
And what can I say about Dragon NaturallySpeaking 11? It’s the biggest user interface advance since the iPhone. The bottom line is that voice is finally ready for prime time. I’ve decided to continue my experiment indefinitely and to keep pushing the voice envelope as far as it will go. Voice makes using a computer faster, easier and a lot more fun.
How about you – have you made the jump? Can it work for you in your environment and if not what is is the barrier to using voice in your world?
Fish oil studies
Dementia to increase by 85% over next 20 Years
MedIcare moves to Fingerprinting
Length of Compression stocking Matters in DVT Prevention
Junior Doctors Hours
The topic of hours and fatigue in medicine continues to rumble on with no real resolution in site. A couple of recent articles and news items highlighted the continuing challenges.
The Daily Mail reported the Coroners’ comments and verdict in this piece (Coroner hits out at doctors’ hours after patient dies) and Doctors.Net also featured the report: Junior Hours Blamed at Inquest (membership required)
An elderly man died in hospital after waiting five hours to see a doctor. After being told how Roland Holbrow died without seeing a doctor, a coroner yesterday criticized European rules that restricting junior medics’ working hours.
Michael Rose described the European Working Time Directive….’Hospitals are running into problems,’ he said. ‘I can see the clear warning signs, although I am not going to refer this to Mr Lansley as I think he will already be aware of it.
There’s no shortage of views from both sides of this discussion:
Those in favor of restricting hours
..I don’t agree that anyone should work that amount of hours, its not safe, and it courses problems in the future.
..criticise the PCT for not employing enough Doctors.
..Hospitals at fault here for NOT recruiting sufficient staff to provide proper shift cover… instead, they’ve been reducing manning levels instead so as not to exceed the WTD hours limit
..At the end of the day though do we really want to be treated by a doctor who has been on duty for over 12 hours. Pilots and the like are restricted on hours worked for safety reasons so should we really be seeing a doctor who is dead on his/her feet and then expect them to make the correct diagnosis first time every time. I doubt if many hospital administrators have a clue what happens overnite in their hospital and how bad things are they will have left by 5 30 in any case
And those that think we need to return to longer hours so junior doctors get “more experience”
..Good to see such a courageous coroner and Clinical Director, both willing to speak unpopular truths. We must unshackle Juniors from the restrictions of the “New Deal”, and EWTD, whilst maintaining a sensible work / not work life balance. Also we need a 24/7 365 days a year fully active acute sector i.e. more flexible working all round, and likely more doctors
..can some one explain to me why FY1’s were taken off doing night shifts and regular weekends? It seems ridiculous that we have a national shortage of doctors yet a massively under used resource of Dr’s needing exposure so as to mature into decision making
..A few facts about EWTD. 1. It was never intended for the professions. I know of no professional (or other successful person in other walks of life) who has worked ONLY 48hrs pw when ‘on the way up’ (or indeed having ‘arrived’!)
Even some senior surgeons weighed in in a letter to the Telegraph suggesting limiting hours will have a significant adverse impact on patient care. In fact they have been arguing that junior doctors need to work more hours
The College and others have consistently argued that junior doctors need to work more than the 48 hours per week permitted by the European Working Time Directive in order to amass enough experience and learning to become safe and competent surgeons.
Interesting a study just out in the Journal of Amarican Medical Association: “Presenteeism Among Resident Physicians” and was featured in the NPR Shots Blog Doctors-In-Training May Give More Than Medical Care:
nearly 60 percent of respondents said they had worked while sick at least once and nearly a third reported having worked while sick more than once. At one “outlier” hospital not named in the study, 100 percent of the respondents reported having reported to work while sick.
A related problem, the survey found, is that busy medical residents (who are already known to not get enough sleep in the early years of post-medical school training, despite rules attempting to ensure they do) also reported not having enough time to see a doctor for their own medical care.
One thing is for sure – tired people are not giving their best. As one junior doctor put it
In the last 2 weeks I have worked 105 hours without a day off. This is my rota and includes no overtime. I would say my patient care was compromised at the end as was my love for the job. ….I have maximum 2 hours of teaching every other week as the wards are too busy to leave the rest of the time
Managing the hours and providing a good working environment is going to be essential. Technology will play a role in helping reduce work burdens and creating efficiencies but updating our training system must be included in the update to our health systems
Shout Out to Dr Frances Oldham Kelsey – Iconic Image for the FDA
She was hired sight unseen by Dr. Eugene Geiling, a renowned pharmacology professor at theUniversity of Chicago, because he read her name as Francis. When she got the acceptance letter, in 1936, she realized his mistake and asked a professor at McGill University whether she could accept the job.
Dr. Kelsey demanded better tests for thalidomide. She also distrusted Merrell, a company that had a history of confrontations with the F.D.A. She soon discovered that Kevadon had been linked in Europe with reports of nerve damage — reports the company had failed to provide her.“I had the feeling throughout the day,” she wrote after a meeting with company executives, “that they were at no time being wholly frank with me and that this attitude has obtained in all our conferences, etc., regarding this drug.”
3-D Printing WIll Impact Joint Replacements Soon
>>>http://www.nytimes.com/2010/09/14/technology/14print.html?_r=1&nl=technology&… imagine the possibilities for grafts, artificial organs and joints built customized to the individual. We are starting to see customized drugs – it won’t be long before we see customized implants and even artificial organs.
Health Care Wastefulness Is Detailed in Studies
Health Care Wastefulness Is Detailed in Studies A heavy reliance on emergency rooms care is seen as a sign of weaknesses in the primary health care system.
http://nyti.ms/cFqcED If there’s a lesson here it’s the fixing of the healthcare system involves everyone of us. Making good choices, intelligent use of resources and an acceptance that things are going to change in the way we decide on care, who receives what and when
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Navigating Healthcare - Patient Safety and Personal Healthcare Management 
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