3 Strategies to Reduce Stress and Anxiety

Reducing Stress

Stress and anxiety will affect everyone at some point in their lives. It is a natural part of modern life and the challenges we face. So, is there anything we can do about it, other than grin and bear it? Research in Psychology suggests there are effective and simple ways to tackle the issue and reduce our levels of stressful thinking. Three key steps are described below: Read More →

Integrating Learning Health Systems into Medical Education

Medicine

The original concepts behind learning health systems (LHS) were meant to address myriad concerns within the field of Western medicine, ranging from the high cost of healthcare (and resulting need for clinicians to provide greater overall value of care to their patients) to the wasteful gap of time between scientific innovations and their implementation within clinical environments. Although LHS have displayed much promise, and have begun to hasten the pace at which new insights can be put into real-time medical practice, they have faced significant stumbling blocks along the way. The reasons for this slow progress revolve around the ways in which LHS demand that clinicians learn not only new skills, but also new ways of thinking and making inquiries. In this arena, clinicians entering the workforce for the first time have a distinct advantage. They learn the basic philosophy and applications of LHS as a part of their baseline training, without needing to unlearn ingrained mental habits that are the result of old practice models. The influx of a new generation of clinicians promises to expedite the growth of LHS into a universal standard.

Introduction

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Our technological progress has outstripped the capacity for traditional Western medicine to access and make constructive use of its innovations. New medical knowledge is generated at such a fast rate that it threatens to overwhelm clinicians. Our health system is constantly confronted with more options than it has the capacity to implement. High healthcare costs, and concerns about the quality of care being provided, have heaped further strain upon its resources. Clinical directors feel a financial imperative to ascertain what really works in medical practice, to draw upon practice-based evidence, and to implement this knowledge quickly.[i] Within such a climate, clinicians find themselves struggling to provide better and more affordable healthcare to a growing population of patients while continuing to educate themselves about the newest procedures that scientific innovation makes available.

Background and Significance

The concept of learning health systems (LHS) was first conceived as a means of rapidly converting scientific evidence into medical practice. It also envisioned a scenario wherein the relationship between medicine and scientific inquiry would be more reciprocal – i.e., research would be more closely aligned with the sorts of questions that practicing clinicians urgently needed answers for. Nowadays, the LHS model has begun to prove its efficiency in moving scientific innovations into the real world of clinical application. Figure 1: Learning Health Systems Data Flow to Outcomes

LHS FlowchartThe idea of LHS has essentially arisen in acknowledgement of the fact that innovation in itself cannot fix our nation’s healthcare system. In order for new information and evidence to have value, it must be put into use. Both clinicians and their patients benefit from the assurance that they are accessing the most state-of-the-art procedures. For too long, medical researchers and clinicians have operated in vastly different environments with incompatible timelines.[ii] This fragmentation of the health care system has taken a grievous toll in some crucial ways. Many innovations in the field of health care have taken years to finally become assimilated into common medical practice.[iii]

It isn’t economically feasible for established medicine to achieve the best possible results through the procedures that it has long relied upon. Evidence-based medicine seeks to do more with the knowledge that is generated by research. It focuses upon innovation, quality, value and safety, and continually seeks areas that are in need of improvement. LHS strive to make the best evidence available when it comes time for healthcare providers and their patients to make crucial decisions. As matters stand at the moment, many of the decision-making models that Western medicine employs were created during a time when it had access to vastly fewer information streams.

Entering a New Era

The key challenge inherent in implementing LHS is the actual dissemination of the new knowledge and evidence that is being generated by scientific research. Performing both research and clinical functions within the same organization can facilitate progress in this area. New insights and approaches must somehow reach clinical directors directly – and quickly. One key tool that has enabled the medical profession to begin adapting to the pace of change is electronic health records (EHR). Large EHR databases have been the most crucial development in the evolution of LHS.[iv] Studies of large populations can be conducted quickly and with much less expense than previously possible. Gone are the days of consuming valuable time sifting through mounds of paper records. Now a veritable mountain of health data can be aggregated, analyzed, and then disseminated throughout the medical community.

With 5.3 million patients and over 1,400 sites, the Veterans Health Administration (VA) created the largest integrated EHR of its time.[v] The journey began in 1982 with its creation of the Decentralized Hospital Computer Program (DHCH), one of the first programs to pull together various healthcare settings from multiple databases into one location. A network of other sites contributed to the evolution of this program over the next few years. Now known as VistA, it handles a wide array of functions to serve administrative, clinical and financial needs. Advances in EHR technology enable healthcare professionals to cull data from large populations and/or target their inquiries into specific health conditions. They can more easily draw conclusions about population measures of health and disease as well as the efficiency of their own performances – all while respecting the privacy of patients. Healthcare can be better coordinated between different branches of an organization. This is vital to optimizing resources within the medical infrastructure – i.e., improving the overall health of its patient constituency while reducing costs.[vi] It could be said that the overarching goal of LHS is to create an environment wherein clinicians are able to learn the best applications of new technologies at the same pace at which those technologies are being produced.

Current computer technology has opened avenues towards this reality in several ways. It’s become easier for different organizations to synchronize their efforts, both in research and implementation. This creates a kind of architecture for LHS on a national level. The evidence base that clinicians have access to has expanded significantly. Also, EHRs encourage patients to become more involved in the healthcare system. They can read their own records online as well as access other health information and online services. Some high-risk patients have in-home monitoring devices that can collect and transmit crucial information to care providers, enabling those providers to respond quickly in crisis situations. EHR also allow clinicians to identify more general trends that pertain to their practice. They can obtain a clearer picture of how well their care is working for a given individual over a period of time, for example. Data can also be cross-referenced to illustrate various drug interactions as well as low performance of certain medications across the board.

Short-Term Stumbling Blocks

EHR and other elements that are integral to LHS do not, as yet, compose a single system, but rather a series of interlinked systems – each with its own database. This limits a clinician’s ability to form general conclusions based upon all the evidence available in a certain area. Inquiries into the entire catalog of a particular patient’s history are difficult to make. Laboratory values have yet to be standardized across the field of medical practice, oftentimes making it hard to compare evidence between two or more systems. LHS can open up a much broader world of options and decisions for clinicians, and assimilate the constant stream of new evidence so that continual improvements can be made in the methods, philosophy and ideals of established medical practice. It is still in its nascent stages, however, and many changes must be implemented before it becomes a universal system. The question of data collection – particularly, when and how it may overstep a patient’s privacy rights – is one stumbling block.[vii] Concerns are often raised whenever clinicians desire access to data for any purpose beyond that of patient treatment (this is known as “secondary uses”).

Privacy laws on both state and federal levels govern how the healthcare system can collect and disclose identifiable health information. Determining when any disclosure contributes to the good of the general public is oftentimes a gray area. Federal research regulations can thus become an obstacle in the path of evolving LHS. Changes within any organization are oftentimes slow whenever they are profound enough to demand a shift in thinking. LHS represent a new model of the ways in which modern medicine can function. They essentially redefine every clinician’s role in the new paradigm. New kinds of patient-provider interactions fundamentally change the way in which medicine is practiced. How flexible can the medical profession be in examining its own belief systems and accepting new findings that contradict old “facts” – and thus call for new procedures? This can pose special challenges for clinicians who have been working in the field for a number of years. For such practitioners, old models of inquiry, research, education and procedure have become deeply ingrained. The process of unlearning must occur before the new system can be thoroughly accepted. For these reasons, LHS have not been broadly utilized by Western medicine, despite the fact that the Institute of Medicine and many prominent clinicians throughout the U.S. have long championed them.

A Possible Way Forward

These particular challenges won’t exist for clinicians entering the workforce for the first time, however. For decades, employment in the healthcare industry has been growing, undeterred even by our economic downturn. Health care opened its arms to 559,000 new employees between December of 2007, when the current recession began, and November 2009.[viii] The level of employment in healthcare-related occupations is projected to keep increasing, as well. Several factors can account for this growth. Technological advances in patient care allows for a greater number of health problems to be treated. Statistically, increasing numbers of people are seeking – and receiving – preventative care as well. What’s more, our nation’s population is both growing and aging. The baby boomers are entering a stage of life that typically involves more medical concerns and the need for added attention. Modern medical knowledge and procedure has extended the general life expectancy, creating a situation wherein our nation has a larger population of elderly people than it ever supported in the past. It is projected that by 2030 more than a fifth of the American population (70 million people) will be over the age of 65.[ix] This ensures the growth of career opportunities for geriatric health workers. The need for an influx of new employees in the field of healthcare is obvious. But advances in online educational opportunities have streamlined the training process for many people, as well, enabling them to qualify for certain positions much more quickly than workers of previous generations were able to. All of these workers entering into the field of healthcare will learn the fundamentals of LHS as part of their primary medical education.[x] [xi] This will include the increasing use of physics- and computer-based technology and training via simulation. They will not have to unlearn old mental habits before they assimilate these new models and procedures.

Using a computed health-knowledge base profoundly alters traditional roles and responsibilities within the clinical world. They demand changes in what a clinician needs to know as well as in the ways that he or she learns. But all of this is easier for people who are getting acclimated to the system for the first time, and are not steeped in older structures of medical thought. Such people will contribute greatly to the growth of LHS because they will absorb its basic principles as part of their fundamental medical education and then build upon that knowledge base for the remainder of their careers. Unhampered by previous (and now outdated) models and practices, they’ll be able to move forward with this new approach to medicine without having to fight against old ingrained habits. They will be more comfortable than their predecessors would have been in a working environment where new research constantly influences and changes existing practice.

Reference:

  1. Etheredge, L. (2007). A Rapid-Learning Health System Health Affairs, 26 (2) DOI: 10.1377/hlthaff.26.2.w107
  2. A ‘learning health system’ moves from idea to action,” Medicalxpress.com, August 2012.
  3. McGraw, Devin (2012) “Paving the Regulatory Road to the ‘Learning Health Care System’”  Stanford Law Review Online. http://www.stanfordlawreview.org/online/privacy-paradox/learning-health-care-system
  4. Etheredge, Lynn M. “Envisioning a Rapid-Learning Healthcare System”, Institute of Medicine (US) Roundtable on Evidence-Based Medicine; Olsen LA, Aisner D, McGinnis JM, editors. The Learning Healthcare System: Workshop Summary. Washington (DC): National Academies Press (US); 2007. 4, New Approaches—Learning Systems in Progress.
  5. Chou, A., Vaughn, T., McCoy, K., & Doebbeling, B. (2011). Implementation of evidence-based practices Health Care Management Review, 36 (1), 4-17 DOI: 10.1097/HMR.0b013e3181dc8233
  6. Elmore, Rich (2012) “Toward a learning health system” The Allscripts Blog.
  7. “The Common Rule and Continuous Improvement in Health Care: A Learning Health System Perspective,” Harry Selker, Claudia Grossmann, Alyce Adams, Donald Goldmann, Christopher Dezii, Gregg Meyer, Veronique Roger, Lucy Savitz and Richard Platt. October 2011. P.6.
  8. United States Department of Labor. Bureau of Labor Statistics: Health Care, 2009.
  9. “America’s aging will increase demand for geriatric health workers,” Explore Health Careers.org, 2009.
  10. The case for knowledge translation: shortening the journey from evidence to effect,”  Dave Davis, Mike Evans, Alex Jadad, Laure Perrier, Darlyne Rath, David Ryan, Gary Sibbald, Sharon Straus, Susan Rappolt, Maria Wowk, Merrick Zwarenstein. BMJ. 2003 July 5; 327(7405): 33–35.
  11.  “Training the Learning Health Professional.” Institute of Medicine (US) Roundtable on Evidence-Based Medicine; Olsen LA, Aisner D, McGinnis JM, editors. The Learning Healthcare System: Workshop Summary. Washington (DC): National Academies Press (US); 2007. 7.

Sending Odors and Tastes as an Email Attachment

Image Credit: Shutterstock/Andrea Danti

Image Credit: Shutterstock/Andrea Danti

Research into cybernetic organs has been largely focused on replacements for disabled individuals who have lost a limb. Electronic noses and tongues are designed for a radically different purpose. Humans perceive different chemicals as various tastes and odors. Many types of additives are industrially manufactured to replicate certain flavors or scents. Read More →

Symptoms of Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder (or GAD) involves a core group of physical symptoms along with frequent and uncontrollable worries that are often irrationally intense. It can be difficult to diagnose GAD, as its severity and nature may dramatically vary from person to person. However, the following eleven symptoms are the most common, so if you experience two or more of these in a short period of time, then you should make an appointment with your doctor to discuss how to improve your quality of life by managing your anxiety more effectively.

  1. Restlessness and concentration problems:
 If you have GAD, you probably fidget quite often and find it hard to sit still for long periods. You may feel on edge, as though you cannot relax even when you are in a safe environment. In addition, concentration problems are common. It might be tough for you to focus on studying or working, and your short-term memory may be worse than it used to be.
  2. A sense of impending doom:
 Most sufferers of GAD regularly experience a crushing and acute sense that something bad is about to happen. This feeling is baseless, but it can crop up in perfectly normal circumstances. When it does, you will suddenly feel as though you are about to die (or about to be in some form of life-threatening danger).
  3. Experiencing fear before or during social events:
 While going out to dinner or attending a party should be an exciting and fun event, you might find that such invitations fill you with dread rather than pleasure. GAD sufferers commonly find that they are disproportionately concerned about how to dress, what to say, and how to act in social groups. Additionally, even if you are being treated with kindness and respect during a social outing, you may still experience an increased heart rate, sweaty hands, and the desire to leave as soon as possible.
  4. Feeling out of touch with reality:
 This symptom is sometimes called depersonalization, and it tends to make you feel as though you are in a waking dream. You may also experience dizziness and feel as though you are moving at a slightly different speed to everyone else.
  5. Irritability and impatience:
 You might snap at other people without thinking, and will probably find that you easily become annoyed by unexpected slowness. Most people with GAD also respond defensively when questioned about their anxiety, knowing that they have irrationally intense fears but feeling extremely embarrassed that an outsider has recognized this.
  6. Obsessing about physical sensations:
 Although GAD does not have to be associated with any particular phobias, sufferers are often hypochondriacs. This means that they live in a constant state of fear that something is wrong with their bodies. You might interpret every ache or pain as a symptom of cancer, or you may habitually check yourself for signs that you are having a stroke. This obsession with physical sensations can be especially difficult to live with, as it can create an unproductive loop. Unusual sensations cause feelings of anxiety, but suffering from anxiety can cause unusual sensations (therefore creating even more anxiety).
  7. Heart palpitations:
 Anxiety problems are often connected to a fast or irregular heartbeat. Even when your pulse rate is normal, you might notice that you are uncommonly aware of your own heart beating. However, it is important to note that you should always have a racing or irregular heartbeat investigated thoroughly (in order to make sure that you do not have a potentially dangerous heart condition).
  8. Excessive sweating:
 GAD is connected to frequent and uncomfortable episodes of sweating. These are usually accompanied by racing heart or particularly strong worries about your own well-being (whether social or physical).
  9. Stomach aches and diarrhea:
 Being constantly or frequently anxious can easily leave you with a malfunctioning digestive system. As a result, those who have GAD commonly experience intestinal cramping and loose stools.
  10. Being scared that you are being negatively evaluated:
 GAD sufferers often experience acute anxiety at the thought of making a fool of themselves in public, and so social situations are regularly perceived as dangerous chances to be ridiculed. You might even find that you feel uncomfortable just walking down the street, worrying that strangers you encounter are thinking that you are unattractive or poorly dressed.
  11. Poor quality of sleep:
 Finally, insomnia is a common symptom of GAD. In addition to have trouble sleeping, you might feel unrested even after a full eight hours of sleep.

Suffering from general anxiety disorder can be very upsetting and confusing, as it often involves periods of intense anxiety during which the cause is not readily identifiable. If you suspect that you might have an anxiety problem, see your doctor as soon as possible. You may be worried that you’ll be viewed as being over-dramatic, but you shouldn’t be. Doctors regularly see and treat people with anxiety issues. Your feelings and concerns will be extremely familiar to your doctor, and they will put you on the path towards managing your anxiety more effectively (using medication, therapy, or a combination of both).

Reference:

Dupuy, J., & Ladouceur, R. (2008). Cognitive processes of generalized anxiety disorder in comorbid generalized anxiety disorder and major depressive disorder Journal of Anxiety Disorders, 22 (3), 505-514 DOI: 10.1016/j.janxdis.2007.05.010

Barrera, T., & Norton, P. (2009). Quality of life impairment in generalized anxiety disorder, social phobia, and panic disorder Journal of Anxiety Disorders, 23 (8), 1086-1090 DOI: 10.1016/j.janxdis.2009.07.011

Lawrence, A., & Brown, T. (2009). Differentiating Generalized Anxiety Disorder From Anxiety Disorder Not Otherwise Specified The Journal of Nervous and Mental Disease, 197 (12), 879-886 DOI: 10.1097/NMD.0b013e3181c29992

Additional Learning Resources:

ResearchBlogging.org

Learn About the Brain [App Review]

  Free App Download

The 3D Brain app is a great introduction to the human brain, and it’s free. Users shouldn’t have too much trouble getting it to run, and it’s compatible with a majority of iOS devices. Cold Spring Harbor Laboratory (the app developer) has quickly become known for a few different biology apps.

The software allows budding neurologists or neuroscientists to poke around the various structures of the brain. Artists have color coded the different sections, though the labels are also helpful. In fact, colorblind users should still be able to get plenty of use out of the 3D Brain app. While one might expect the program to cover physiological injuries, the presence of mental health information was honestly a pleasant surprise.

Fans of scientific research might be interested in the lineage of the app. Genes to Cognition (G2C) Online provided the knowledge bank that the software runs on, while financing came from the Dana Foundation and the Hewlett Foundation. Anyone who finds that they want to dig deeper than the lessons here can easily cross-reference 3D Brain with another free source. The classic 1918 publication of Gray’s Anatomy of the Human Body, for instance, is a great place to look up information after messing with the app for a while.

Marketers Reading Your Mind [Video]

Researchers in New York have shown that measuring human brain waves could help marketers develop more effective advertising campaigns. The team monitored brain wave activity in volunteers to determine what types of film scenes elicited universal responses. They say their data shows that the method could be far more effective than conventional market research techniques. Thoughts?

 

Adultlescence: A New Phase of Life

Adultlescence is a relatively new word. To some, it is defined as a period of life in which many young people seem stuck. Rather than behaving like proper grown-ups, getting jobs, and having children, these “adultlescents” have moved back in with their parents, are still addicted to video games, and show few or no signs of taking up the responsibilities of home and career.

Others, however, are looking at adultlescence in a slightly different light. Adultlescence, under this viewpoint, is not some sort of social malaise or disorder, but rather a new phase of human development, brought about by an uncertain economy and/or the reality of drastic increases in human life expectancy over the past hundred years or so.

The latter view of adultlescence gains some credence when compared to other phases of human development. Childhood as we think of it, for example, did not exist prior to the 18th century. At that earlier point in human history, children were seen not as children but as “little adults.” The clothes they wore were simply smaller versions of adult clothing, the toy industry did not exist, and most children were expected to pitch in and begin working to support the family as soon as they were able. They were not to be coddled or indulged. Today, however, there are child labor laws, and the idea of a child being required to do backbreaking labor in a field all day in the hot sun is practically unthinkable. This implies that there is no “proper” age for any particular stage of development and that it is, rather, a construct based on the values and beliefs of any given time and society.

Looking at emerging adultlescence as a function of humanity’s increased lifespan also benefits from examination of past trends. For example, as late as the early 20th century, average life expectancy from birth was as low as 31 years of age. The present average life expectancy is currently more than double that. Granted, a large portion of the increase can be attributed to the reduction in infant mortality brought about by modern medical advances. However, people are not only living longer, but more people are living longer. Many people are also working much longer. This leads to increased competition for jobs and resources, as well as a perception that working life may be much longer for young people now than it was for their parents or grandparents. Since adulthood ends later than it used to, it naturally follows that it can now begin later, too.

This ties directly into the economic perspective on adultlescence. Few children would relish the thought of living beneath their parents’ roof indefinitely.  Returning to the nest, so to speak, is as likely to be a result of economic pressure as desire. This would suggest there is a case to be made for adultlescence as a malaise of society—if it can be seen as a malaise at all—rather than as a malaise of a generation.

Whatever the underlying forces behind its creation, adultlescence is growing as a sociological term and as a phase of human development in its own right. Whether or not it grows out of it and into something different, or simply passes away entirely is something only time will tell.

Reducing Youth Suicide in America

Recently a young man committed suicide in a small East Texas town devastating his entire family (myself included). He had his whole life ahead of him, a family that loved him, and gave no warning that anything was wrong. One moment he was here, the next he was gone. This is the first time I’ve ever experienced suicide directly and it has shaken me quite badly. The study below struck a chord with me and I thought I’d share it with all of you. These conversations are never easy but I think perhaps they are something we all need to have on a regular basis. Young people are our future and losing even one is a tragedy. Thanks everyone.

Discussing guns in rural suicide prevention

While youth suicide is declining overall, the rate of youth suicide in rural America has remained steady. A key to helping rural families with children at risk of suicide is frank discussion of guns says Jonathan Singer, assistant professor of social work at Temple University and co-author of a new study that examined how clinicians, including social workers and counselors involve parents in prevention and treatment of youth suicide. The study, “Engaging parents of suicidal youth in a rural environment” (cited below) was published in the May issue of Child & Family Social Work.

Singer and his co-author, Karen Slovak of Ohio University, wanted to learn more about out how clinicians broke through barriers that keep parents in rural areas from getting help for their suicidal children. They were surprised to learn how clinicians addressed the issue of gun culture in this process.

“The clinicians in the study told us that guns were so prevalent in their communities, they were just part of the furniture,” said Singer. “So a big part of their job is making the invisible, visible.”

Once a clinician determines that a child is at risk for suicide, it is up to the parents to bridge the gap between the clinician’s initial assessment and follow-up treatment, which might include anything from short-term therapy to hospitalization to long-term counseling and medication. But there are several barriers to successfully engaging parents. Resistance, minimizing the risk, and shock are common reactions that parents have to the news that their child is suicidal. In addition to addressing these barriers, clinicians must address the immediate safety issue of a gun in the home. In rural communities this is a significant concern.

Guns are the most lethal means of suicide, said Singer. Even though girls attempt suicide four times more often as boys, boys die from suicide four times as often in large part because boys are more likely to use guns.

“In rural areas, we don’t need to educate parents about guns. Everyone knows how they work. Instead we need to remind families they have guns and they are lethal,” said Singer. “The conversation needs to focus on keeping guns secure and limiting access to guns. Clinicians need to say, ‘Your son could use one of your guns to kill himself.'”

The researchers found that clinicians who related their own experience with guns had more credibility with parents. They hope the study will help improve treatment for children in rural areas at risk of suicide.

Source: Temple University

Reference:

Slovak, K., & Singer, J. (2012). Engaging parents of suicidal youth in a rural environment Child & Family Social Work, 17 (2), 212-221 DOI: 10.1111/j.1365-2206.2012.00826.x

ResearchBlogging.org

Cybernetics – Left Ventricular Assist Device

Left ventricular assist device technology isn’t necessarily new, but it is one of the biggest harbingers of cybernetic technology. People with weak hearts that are waiting for a donor can use these sorts of heart pumps to bridge patients over until they can receive a full transplant. However, such LVAD machines are usually located in hospitals and are quite large. Likewise, LVAD machines are sometimes used immediately after heart surgery. Read More →

Robotic Telesurgery in Space

Telemedicine is a field that uses telecommunications technology to provide healthcare at a distance. Certain computer systems can be linked to a physician’s office for diagnostic purposes. Different clinics and hospitals can be linked together. In the future, telemedicine could be used to perform robotic surgeries in space. Read More →