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Sunday, December 20, 2015

Data Never Sleeps Among the Last 5 Years

Data is being created all the time without us even noticing it. Much of what we do every day now happens in the digital realm, leaving an ever-increasing digital trail that can be measured and analyzed. Just how much data do our tweets, likes, and photo uploads really generates?

How much data is generated every minute in 2011 & 2013 & 2015 to make a comparison?

2011


2013


2015





Monday, December 14, 2015

The Ethics of Prescribing Worthless Treatments

Is it ever ethical for a physician to prescribe a treatment to a patient that they know to be entirely without efficacy? Is it ever possible to do this without deceiving the patient to some degree? I think the answer to both questions is a clear “no.”
Within the flipped reality of “alternative medicine,” however, it suddenly becomes acceptable to deceive patients and sell them worthless treatments, as long as the deception was minimally successful.
A recent editorial in Scientific American by Allison Bond addresses this question. She manages to hit upon many of the reasons placebo medicine is inappropriate, but her reasoning is a bit muddled and she comes, in my opinion, to the wrong conclusion. She wraps her commentary in an anecdote of a terminal patient for whom she cared who found relief from Reiki. She concludes:
Of course, when it comes to treating patients with painful, life-threatening diseases, the goal of our care should be to lessen suffering, regardless of where such relief originates. A few months after Ms. W left the hospital, I learned that she had died, and the news hit me hard. I thought back to her treatment under our care and hoped that even among the misery, we had eased her suffering through our therapies—“alternative” or not.
I think that Bond goes through the same thought process that many physicians go through. She has some understanding of the trade-offs, but in the end as long as their patients say they feel better, they are OK with using placebos. This position, however, is misguided.
Ineffective Treatments Are Not Necessary
Bond acknowledges that treatments such as Reiki and acupuncture may work solely through providing companionship, attention, and a moment of respite. That is, in fact, what the scientific research shows. Reiki is nothing more than a form of healing touch, promising to using non-existent energies to promote healing or the even more vague concept of “well-being.”
For both Reiki and acupuncture, when studies are properly controlled they find that the treatment is no more effective than the ritual of treatment without the actual intervention, or just having someone spend time with a patient. The time and positive attention seem to be the only variables that matter.
The most logical conclusion to derive from this fact, which seems obvious to me, is that we should provide companionship and positive attention without the pseudoscientific magical claims. In fact, you can do this while administering science-based treatments, or just as an intervention in themselves. We used to call this good bedside manner, or just good nursing care, now it is marketed to patients as a separate intervention wrapped in utter nonsense.
If there is a lesson to derive here it is that, if we wish to do more for patients in terms of their mood, quality of life, and overall experience, we can formalize giving them companionship and positive attention as a thing unto itself, without the pseudoscience. This is not a new concept to hospitals, but if you think we need to do more, then do more.
Ethical dilemmas in the paralegal field – and life!
The Downsides of Pseudoscience
Bond mentions only two negatives to relying upon ineffective treatments for their placebo effects, financial cost and opportunity cost. Delayed proper care or substitution for proper care may lead to bad outcomes. The implication is, as long as you don’t substitute alternative treatments for evidence-based care, there is no problem.
Although she mentions financial cost, she glosses over this point. When you essentially give someone license to sell magic and false hope to desperate sick people, it should come as no surprise that patients will be victimized by this. Many “alternative” clinic and practitioners charges tens of thousands or even hundreds of thousands of dollars for their ineffective treatments.
The financial costs can be devastating, and they are piled on top of the costs of regular medical care. The family of a terminal patient, who are essentially emotionally blackmailed into spending money they cannot afford on a dubious treatment, are left with an additional financial burden on top of the loss of a loved-one.
False hope can also be psychologically devastating. Properly managing a terminally ill patient can be very challenging. Practitioners need to walk a fine line between keeping them focused on the positive, emphasizing any legitimate chance they have for recovery, while preparing them and their family for the worst. You have to help them navigate through horrible choices, such as choosing between extra months of survival vs quality of life, or whether or not they will find life permanently dependent on a ventilator acceptable.
Into this delicate balance comes an alternative practitioner, like a bull in a china closet, making outrageous promises of a cure, and sowing seeds of discontent with the medical system. I have seen patients go to their graves convinced the alternative treatment was the answer, even when it was obvious it was doing nothing. I have seen others realize they were had, devastated by the lost precious time and their last hopes dashed.
Rather than being eased into a position of acceptance, they were kept in denial and then dropped off a cliff.
Perhaps the most insidious negative of hospitals providing Reiki or other such treatments to patients is that it legitimizes pseudoscience. Practitioners of dubious treatments are desperate for legitimacy, and association with a hospital or university is the golden ticket.
It is reasonable for patients to assume that a practice is legitimate if it has such as association. This puts them at the mercy of charlatans, who will then instill in them distrust of the medical establishments and belief in bizarre or pseudoscientific notions.
Even if initially patients are not using “alternative” treatments as a substitute for real care, the next time around (if there is a next time) they might, because they were convinced of its legitimacy by the hospital and well-meaning but naive physicians and academics.
Finally, I think it is unethical to deceive patients. Deception robs them of their autonomy and informed consent. It is also excessively paternalistic. There is simply no alternative treatment without some level of deception. You cannot talk about non-existent “energy” or go through the ritual of acupuncture with a straight face without buying into the underlying pseudoscience to some degree.
Even avoiding direct health claims, and couching the treatment as, “some patients report they feel better,” contains implied claims that some desperate patients will latch onto.
In all other aspects of health care the standard of care is for physicians to be completely honest. (Admittedly, there are nuances here, like not unnecessarily scaring patients with premature information, but deception is never acceptable.) The fact that calling a treatment “alternative” erodes the ethics of informed consent is just one more bit of evidence that the entire “alternative medicine” movement is about eroding the standard of care in order to allow for treatments that were previously considered fraudulent.
Conclusion – No, It’s Not OK
Physicians and academics, like Allison Bond, who have been convinced that it is OK to give patients ineffective treatments are mostly well-meaning, but profoundly naive. They miss the extremely harmful downsides of eroding informed consent and deceiving patients while legitimizing pseudoscience and giving power to practitioners who exist along a spectrum from self-deluded to heartless con-artists.
Physicians like Bond are seeing just the tip of the iceberg, and this is by design. The face of “alternative” medicine that is presented to hospitals, universities, and also politicians is a Trojan horse. It is the soft practices, like Reiki, offered as a “complementary” treatment in addition to standard care, for pure symptomatic relief.
It is meant to convince the establishment that this little deception is OK, as long as patients report that they feel better. Hospitals love it because they can charge a fee for additional services. Academics are just trying to have an open mind. Physicians like having additional options to help their patients. So what if a practitioner waves their hands over a patient and makes some vague claims about energy and healing?
This small (I would argue not-so-small) deception is the portal of entry into a world of horrible exploitation. “Alternative medicine” has been deliberately packaged as one thing, which is another deception. Legitimizing one alternative treatment is used to legitimize them all, and to promote the idea of placebo medicine and compromise patient autonomy just enough.
Physicians and academics need to hold the line. We need to be uncompromising in our advocacy of our patients, and that means zero tolerance for pseudoscience and deception. Do not be lulled by the soft veneer – beneath the surface is a world where our patients are horribly victimized by charlatans. We cannot be party to that, no matter our intentions.
 by Steven Novella on December 9, 2015

New London Underground map shows how expensive it is to rent stop-by-stop

 
 
Ever wanted to see what London rent looks like across the Capital? With this Tube map, now you can. Another handy London Underground map has been released, this time showing how expensive it is to rent at each Tube stop...

Website Thrillist has put together a rent map showing the median monthly cost for a one-bedroom flat within a km of each Tube station on the entire network.
It includes information from every Tube line except the Circle line, because every stop on the Circle line is present on another one.
 
The most expensive place to live is Hyde Park Corner on the Piccadilly Line at £2,920, and the cheapest is Hatton Cross, next to Heathrow Airport, at £324.
 
Unsurprisingly, the data - collected with the help of website Find Properly - showed that the closer you get to Central London, the higher prices climb.

The 10 most expensive places to live in London


London Underground Rent Map Victoria Line (North)

London Underground Rent Map Victoria Line (North)  Photo: thrillist.com
  1. Hyde Park Corner - £2,920
  2. Knightsbridge - £2,832
  3. Green Park - £2,384
  4. Bond Street - £2,276
  5. Oxford Circus - £2,260
  6. Piccadilly Circus - £2,256
  7. Canon Street - £2,156
  8. Regent's Park - £2,136
  9. Monument - £2,128
  10. Bank - £2,128

The 10 least expensive places to live in London


London Underground Rent Map

London Underground Rent Map - Piccadilly Line - WEST  Photo: thrillist.com
  1. Hatton Cross - £324
  2. Redbridge - £488
  3. South Ruislip - £552
  4. Ruislip Gardens - £552
  5. Elm Park - £552
  6. Croxley - £680
  7. Upton Park - £692
  8. Hounslow West - £732
  9. Ruislip Manor - £732
  10. Barkingside - £736
These prices may seem steep - if you aren't from London - but this doesn't come as a huge surprise after news that living in a tiny shed in someone's living room could set you back over £500 a month.
The London rent crisis is nicely summed up by the map, which shows just how far out you have to live if you are not earning much money. This has actually caused a job crisis - entry-level workers are being priced out of the capital because of soaring rents.

This has meant that employers are having a tough time finding workers for lower-paid jobs.
 

Connections are powerful: The industry strives for it. Providers need it. We all deserve it.






Connections are powerful because they unite us, teach us and help us accomplish more than we can achieve alone. Connections drive health and care, and our health system is only as strong as the ties that bind it.
 


From personal relationships to interoperability, health care relies on connections for information, guidance and healing. We need care teams that connect interactions with providers and insights throughout the continuum of care, empower us to take control of our health, and help us stay connected on a path to wellness. We need providers with complete access to our unique health histories and profiles to treat us as individuals, tailoring a health plan and treatments to our needs. We need systems that communicate seamlessly, piecing disparate data into full health stories and serving as evidence-based allies to the human art of medicine. We need family and friends that encourage us to achieve our health goals, then celebrate with us when we do.
 
It's connected care, and it transcends technology. It goes beyond organizational, political, national and geographic divides to unite us around what matters most – the people.















Care Navigator is a Microsoft Dynamics CRM–based and mobile-enabled healthcare technology platform

A Flowchart for Choosing Your Religion

A Flowchart for Choosing Your Religion

Looking for a JOB - How to Be the Next Hire

Making You the Most Viable Next Hire
Being flexible, creative and adaptable in today’s economy is the cornerstone to survival. The job search is no different and, with unemployment rising, requires just as much vigilance. One way you can keep your options open and make yourself even more marketable is by considering Consulting in addition to your quest for full-time employment. Often perceived as an “either-or” scenario, Consulting offers you just as many benefits as it does your “would be” employer:

Track record of Fixing Problems?
Career wise, people typically fall into one of two categories: those who thrive on problem solving and the prospect of a new challenge –or- someone who is exceptionally good at steering the ship once it is on course. If the thought of fixing something that is broken appeals to you (versus has you thinking about reaching for the Tylenol), then Consulting might be an avenue to explore.

A More Flexible Interview
Quite often, what a company needs is someone to tackle a specific problem, not a new full-time employee. Identifying this in the interview and being able to present yourself as the solution to their problem (at a lower cost), can ultimately create a job tailor made for you and your skill set. No one can compete against that.

Dating Before Marriage
A consulting engagement can give you the opportunity to see if this company is a nice place to visit or a great place to live. The only thing worse than a prolonged job search, is ending up in a position that results in you being unemployed again in 6-12 months. Consulting lets you do more due diligence than you could ever accomplish in an interview.

“Consulting” on Your Resume
To many recruiters, seeing “consulting” as your current role without any clients/engagements is just a way to dress up being out of work. But, with a list of key accomplishments at those engagements, you show that you are in demand, have more control over your search and are broadening your experience. The latter is extremely important if you are looking to transition industries.

Change Agent
For companies looking to make some sort of change internally (and you should like this if you have a track record of fixing problems), consulting is a more preferred approach versus hiring a permanent employee. It is much easier to come in as a consultant, effect the course correction and then hand it off to the internal leadership.

Money
Besides the obvious benefit of having income during your search, it also gives you breathing room to be more objective in selecting your next job.

It’s Easier to Find a Job When You Already Have One
So much of what makes this true is that fact that when you are employed, you tend to be a bit more objective because you have a “bird in hand.” Consulting (in addition to easing that financial strain, which helps here) can provide the self-assurance that comes along with being employed, which can get whittled away while unemployed.

Presenting yourself as a viable consultant or full time employee isn’t mutually exclusive. Rather, they are simply two sides to the same coin. For the companies where you interview, this will only make you more viable and versatile in your eyes. For you, there is nothing to lose. The worst thing that happens here is you generate some income to inevitable financial strain of your job search. On the other hand, you might just find through this process that you discover your next career move.

Bağdat Caddesi

Gel de parmaklara hakim ol, yapma bir Caddebostan, Bağdat Caddesi nostaljisi şimdi!...diğer bir deyişle 'Karşı taraf' . Cok uzun seneler yazları gittiğim, son yıllarda ise her Türkiye'ye gittiğimde kaldığım Istanbul'un bir başka eşşiz köşesi.
1960'lı 70'li yıllarda köşkleriyle, bahçelerinden salkım salkım sarkan ortancalarıyla, billur gibi denizliyle, 'sayfiye' yeri olmasıyla meşhur Erenköy, Suadiye, Caddebostan.

Dükkanların az, ağaçların çok olduğu, bunca yıl geçmesine rağmen hala güzelliğini koruyan Bağdat Caddesi. On, onbir yaşımdan itibaren yazlarım geçti oralarda. Sokaklarda oynanırdı o zamanlar, öyle pek araba filan geçmezdi. Doyasıya bisiklete binilir, el birakarak gitmek büyük marifet sayılır Erenköy, Saskınbakkal, Göztepe bisikletle rahat rahat gidilir dönülürdü. Deniz için bazı sokakların denize vardıkları noktalarda bulunan kayıkhanelerden saatlik ücretle kayık kiralanır, kadın erkek kürek çekmeyi bilir, kayıktan denize girilirdi. Bazı gençler dalıp iskele ayaklarından midye toplar bazıları ise sığ kumda zıpkınla vatos avlarlardı. Sokaklardan dondurmacılar geçerdi o zamanlar. Simdiki gibi binbir çeşit ne gezer 'Dondurma, Kaymaaak' diye bağıran dondurmacının küçücük arabasında sadece kaymaklı ve limonlu dondurma olur, bazen ise çeşit olsun diye vişneli bulunurdu.

Caddebostan Plajı'nın yanı sıra bir de üyelikle girilebilen klüpler vardı. Marmara Yelken Klubü başta olmak üzere, Balıkadamlar, Caddebostan Yat Klübü ve İstanbul Yelken. Eğer bunlardan birine üyeyseniz veya üye bir arkadaşınız varsa bazı sporları yapma veya izleme olanağınız olur, voleybol, ping pong oynar, kıyıdan yelkenlilerin yarışlarını izlerdiniz. Denizin ortasında ise köfteciler vardı. Bunlardan aklımda kalanı ise mayomuzun kenarına sıkıştırdığımız parayla yüzdüğümüz, veya kayıkla yanaştığımız 'Fıştak'tı. Dönerken yüzülüyorsa demirlemiş kayıklara tutuna tutuna, dinlene dinlene yüzülürdü.

Akşamüstüne doğru herkesi bir 'piyasa' heyecanı alırdı. Saçlar yıkanır, bildiğımız ütüyle ütülenerek düzeltilir, ve (Bağdat) Cadde'ye binbir tur atmaya çıkılırdı. Bir aşağı, bir yukarı. Parkur ise genellikle Santral Durağı'ndan Saşkınbakkala kadardı. O zaman 'cafe' adeti bir elin parmaklarını geçmez, 'Borsa'da yer bulabilmek için hızlı davranmak gerekir, 'Divan' ise gençlere çok pahalı geldiğinden ancak hafif 'yaşı geçmiş'lerin duraklama mekanı olurdu. Hali varaba sahiakti oldukça yerinde olan birkaç genç ise bir aşağı bir yukarı arabayla giderek Mustang veya Corvette'leriyle gelene geçene hava atarlardı.

Geceleri ise açık hava sinemalarının keyfine doyulmazdı. Caddebostan'daki Ozan Sineması'nda genellikle Türk filmleri oynar, çıkınca biraz aşağıda, Caddebostan Maksim Gazino'sunun (MIGROS)yakınındaki büfe'de 'zümküfül' yenirdi (Bir çeşit sosisli sandoviç ) Yabancı filmlerin mekanı ise Budak Sineması'ydı (Şimdiki CKM). Yastıgını kapıp tahta iskemlelere yerleştirdikten sonra, çekirdeğini çıtlatarak izlenirdi filmler. Bazen bu sinemalarda Cem Karaca gibi o zamanın ünlü sesleri konserler verir, bazıları ağaç tepelerinden konser izlerdi.

Sonra sonra o köşkler birer birer yıkılmaya, yerlerin uzun uzun binalar dikilmeye, Cadde'deki evlerin yerlerini dükkanlar almaya, arabalar çoğalmaya, faytonlar yok olmaya, tekerlekli dondurmacıların yerini Algida'cılar almaya başladı. Ama ne mutlu ki tüm büyümeler, kalabalıklaşmalar rağmen 'Cadde'yi bozmayı başaramadı! O hala 'Cadde', İstanbul'un ,Türkiye'nin en güzide caddesi hala boydan boya yürümekten zevk aldığım, bir yerde oturup geleni geçeni izlemenin keyfini her yıl bir iki hafta yaşayabildiğim bir yer.

Galata' ya dogru...

Galata' ya dogru...

The best way to improve health care requires physicians and other stakeholders

My honest approach for how to improve the care is to support a methodology such as being self-serving. I would like to start a program to introduce a software-based point-of-care tool for obtaining patient feedback. This real time information can be used with clients to positively impact the patient experience, nurse engagement, physician (soft skills) competence and overall quality. In my perspective the criteria for fulfilling the demand for finding the best way to improve healthcare is that it need be simple to implement, impactful and cost effective. The most impact to healthcare improvement will come from process improvement and healthcare provider recruitment AND retention. The by-products will be reduced cost of care and improved patient satisfaction. This applies to hospitals and private practices. Based on current studies and the economy, supplying adequate healthcare to the community is already tough and is going to get more challenging. Recruiting sufficient healthcare coverage will boost revenue and provide some improvement to patient satisfaction (wait time and access). However, failure to retain the medical staff will significantly hurt the outcome. With high demand and low supply, it will be well worth the time and money to present "we have the greenest pastures here". The method mentioned above may be called such as point-of-care through successful implementations that may turn in to popular key parts of process improvement. You need to have some feedback from the patients and the physicians in order to measure the processes that should be or are currently being improved. In order to achieve this you have to create the acronym HOSPITAL to help those in Healthcare recall the numbers of different types of inefficiencies in any medical facility. Those who have been exposed to Six Sigma and Lean have an appreciation for improvement opportunities and generally view things through differently trained eyes that can see within all those facilities. Publishing the results of the similar programs online may offer a transparent access to the consumers to monitor these inefficiencies. Welcoming any feedback relative to this and encourage your staff to consider this method or similar training methods for their teams will be highly critical for the outcome. We have to understand that it is impossible to solve a problem that we are unaware of. By providing even the most basic tools at the lowest level possible, these problems have a way of surfacing. While everyone recognizes that healthcare systems and organizations need to improve, I think not enough time is spent on firstly identifying the key stakeholders, and secondly properly ENGAGING them. I strongly believe that not enough time is spent trying to engage physicians in this process. In my experience too many of these "improvement strategies" are top-down decisions by non-clinical managers who failed to conduct any research into what physicians might want or what stumbling blocks there are/were to get them to adopt the new technologies. EMR/EHR/CPOE are prime examples - all of these require a breakdown in the normal activity flow of providers, as it requires them to either find and log on to a terminal or carry a bulky instrument. Almost all clients and colleagues I have worked with resent and resist those methods. And look how few MDs are part of Healthcare consulting firm teams. IMHO, I believe more energy should be spent engaging rather than alienating MDs as a first step, then doing the same for patients in order to get buy in from the two key stakeholders as I see it. I've always found that engaging these stakeholders on projects from the beginning results in more buy-in and most importantly, better recommendations/outcomes (a better product).

ULTIMATE RESULTS

ULTIMATE RESULTS

Ilhan Arsel

Ilhan Arsel

BJK FOREVER

BJK FOREVER
Karga kartalların sırtına oturur ve boynunu ısırır. Kartal cevap vermez, kargayla savaşmaz; kargaya zaman veya enerji harcamaz, bunun yerine sadece kanatlarını açar ve göklerde yükselmeye başlar. Uçuş ne kadar yüksek olursa, karganın nefes alması o kadar zor olur ve sonunda karga oksijen eksikliği nedeniyle düşer. Kartaldan öğrenin ve kargalarla savaşmayın, sadece yükselmeye devam edin. Yolculuk için gelebilirler ama yakında düşecekler. Dikkat dağıtıcı şeylere yenik düşmenize izin vermeyin....yukarıdaki şeylere odaklanmaya devam edin ve yükselmeye devam edin!! Kartal ve Karga dersi