Monthly Archives: settembre 2013

The case for change slidepack @Medici_Manager @WRicciardi

Our Time to Think Differently programme has made the case for change and highlighted the trends that will influence the way health and social care is delivered in future.

To help you explore and share this work, we are creating a series of downloadable slidepacks. We hope that they will inform your thinking and discussions about the future of care.

The first pack in this series explores the pressures on the health and social care delivery system and why it needs to change to meet the challenges of the future.

You can download a powerpoint version of these slides here: The case for change slide pack. These slides cannot be edited in this format, but you can copy individual slides across to your own presentations. Please credit The King’s Fund www.kingsfund.org.uk/think if you use the slides elsewhere.

King’s Fund http://bit.ly/15mI8Sk

Atul Gawande: Future of healthcare requires constant reinvention @Medici_Manager @muirgray

Atul Gawande,  MD, professor of surgery at Harvard Medical School and staff writer at The New Yorker, offered a reflective presentation earlier this month at Health Datapalooza IV, taking the audience back through what the healthcare system used to look like, and showing and how data innovations have helped set the stage for big transformations.

“There was a period in time where there was no analytics, no effort to look at the data, no effort to understand what was happening,” Gawande said. In his mind, healthcare is at least heading in the right direction.

Despite these innovations, all this progress and the potential power of big data, however, Gawande made sure to differentiate between technology and medicine – arguing that it was crucial to remember the human element.

[See also: Slideshow: Health Datapalooza IV.]

Gawande referenced Lewis Thomas, MD, who got through medical school by selling poetry and blood. Lewis went on to head Memorial Sloan-Kettering and eventually won a National Book Award for his essays.

Gawande cited one of Thomas’s essays in particular that would become the topic of his presentation, one titled, “Technology of Medicine.”

“What I love about it, is it looked at how we pay for technology in healthcare, what it goes for, but did it at a time where people really weren’t thinking about this,” Gawande said. “The opening you will love because it’s incredibly quaint. He says, ‘Somehow medicine, for all the $80-odd billion that it is said to cost the nation has not yet come in for much analytical treatment.’”

He added that Thomas “knew it was coming. He knew people would be here.” Gawande continued, “And then addressing himself to you, he said, ‘I wish you well, but I imagine you are having a bewildering time.’ The answer is, ‘Yes.’”

Gawande cited Thomas’s idea of three technologies. The first, non-technology, represents the supportive care that’s deployed in our current system – care for ailments like cirrhosis or multiple sclerosis.

[See also: ‘Data drunks’ and ‘dataholics’ unite.]

The second technology is complete technology. The polio vaccine is emblematic, Gawande said. Complete technology is a full solution for a particular disease.

The third technology – incomplete technology – is where innovation most needs to occur. These technologies are designed to manage the process of disease but not prevent it or reverse. He cited heart transplantations, chemotherapy and complex treatment for cardiac disease as examples. These technologies, Gawande explained, are both “highly sophisticated and highly primitive.”

There exist only a few examples of complete technologies. “The rest has not found its complete technology,” he added. “It’s squeezing out the rest of life and society. We’re experiencing growth again in our economy, but what often goes unmentioned is that although the healthcare costs have slowed down, if you look over the last decade, virtually all of the economic growth that has occurred has been shunted to paying for healthcare goods and services, with virtually no increases in investment in our infrastructure, in education and other core elements of what our future of this country will require.”

Gawande explained that the healthcare business has gone from the most primitive level of, ‘You ought to do X’ to the medieval period of standards and guidelines being developed, which transformed into, ‘You really ought to do X, and here are the guidelines on how to do it.’

He recalled when the Harvard standards came out, they finally outlined that anesthesiologists could not leave the room when with a patient, a common occurrence in the day.

“My dad was a surgeon in rural Ohio,” said Gawande. “He used to complain and come home shouting almost that the damn anesthesiologist left to go smoke a cigarette. When those Harvard guidelines got published, he came in waiving them at the anesthesiologist.”

Then came checklists and feedback loops both of which improved healthcare safety enormously. A pulse oximeter on the finger gave people the feedback loops to see, “Hey, you might have turned the oxygen down to zero. They’re not breathing.”

The next stage was the forcing function: Machines got made that prevented one from turning the oxygen to zero.

Modern quality, he continued, is a “combination of processed innovations like simple checklists and feedback loops, ways of knowing if you are making your way more successfully than you were before.” But, he said, that “still is not the future of what we can do.”

The future is innovation, Gawande said. It’s “the automation of the best possible ways of doing things while constantly reinventing them.”

http://ht.ly/mKvb3

Quanto guadagnano i medici nei diversi Paesi del mondo? dal @nytimes [@giovanimedici]

Andrea Silenzi, MD, MPH

In response to Uwe Reinhardt’s recent post on “rationing” doctors’ salaries, a number of readers wrote in asking about physician compensation in other countries. Doing a direct comparison of remuneration across different countries is tricky because the same salary may allow for different standards of living in different places. But here are two possible ways to think about these comparisons, taken from a 2007 Congressional Research Service report entitled “U.S. Health Care Spending: Comparison with Other OECD Countries.”

GPpay

Source: Congressional Research Service analysis; see notes in table below

One way to compare cross-country data is to adjust the salaries for purchasing-power parity — that is, adjusting the numbers so that $1,000 of salary buys the same amount of goods and services in every country, providing a general sense of a physician’s standard of living in each nation. These numbers are in the second, fourth and sixth columns of the chart below. They…

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The power of ideas and the ideas of power @Medici_Manager @muirgray @HarvardHSPH

Julio Frenk

“It would be naive to assume that decision-makers always base their decisions on objective evidence about the best means to achieve the desired ends. Often, such evidence is not available. Even when it is, the decision-maker, particularly in the public sector, must balance off the weight of evidence against the economic and political feasibility of following the desired course of action. While it is clear that decisions are made on the basis of many other forces apart from scientific information, it is also true that good evidence can steer those who have the power to decide into a better course of action. In other words, the power of ideas can help to shape the ideas of power.”

See the whole text: http://www.slideshare.net/carlofavaretti/frenk-power-ideas

How clinical commissioning groups are handling new responsibilities @Medici_Manager @muirgray

by Steve Kell http://bit.ly/1bxypvV

One hundred days have now passed since 1 April and the official birth of clinical commissioning groups (CCGs). As a GP and CCG chair it has been one of the most exciting, frustrating and meaningful periods of my career.

For most CCGs, delegated authority from primary care trust clusters, and therefore responsibility, had been in place for some time before April. However the process of authorisation and establishing organisations undoubtedly became a necessary distraction, with process and structure the focus.

Authorisation was essential to ensure we build robust, patient-focused organisations capable of fulfilling our statutory duties. CCGs were the only part of the new system to have been through this process, despite the number of new structures in the commissioning system. Since authorisation it has been good to get back to what we are here to do — commissioning health services and working with patients and practices to ensure we understand local services and their quality.

Bassetlaw CCG is a comparatively small CCG, with 12 practices and 112,000 patients in north Nottinghamshire. We have the same issues as many of our neighbours – high mortality and morbidity levels, areas of significant deprivation, obesity and substance misuse. We have a two-tier local authority system and we are members of Nottinghamshire health and wellbeing board. However, 90% of our patients use acute health services based in northern England – in South Yorkshire (including Bassetlaw hospital as part of Doncaster and Bassetlaw hospitals foundation trust).

Much of our time, therefore, is spent developing partnerships. Many of the commissioning organisations we work with are new, including NHS Englandpublic health teams and the health and wellbeing board. Practices and providers are important as pre-existing parts of the system, and have been essential in understanding our local health services and outcomes. We have built transparent relationships with our providers, openly discussing services, capacity and performance. We meet neighbouring CCGs regularly to discuss commissioning on a regional level such as cardiology services and networks.

Quality assurance forms a significant part of our role. Performance indicators and targets are a key part of this, but we have also reviewed issues raised by member practices and patients. Service development has been one of our most important work streams. It is essential that we seek continuous improvement in services for patients, and not simply monitor what we already have. GPs work closely with managers to improve pathways and we have successfully commissioned new musculoskeletal, dermatology, cardiac rehabilitation and community paediatric pathways for local patients.

As a CCG we have a strong sense of responsibility for our local population. Patient engagement is central to this. We have well established practice patient groups and groups within the CCG, and this role is led by our new lay member who has worked hard to ensure we have a new, meaningful approach. We have developed a series of summits with patients, carers and providers including extremely successful dementia and learning disability events.

We have a number of commissioning priorities as a CCG. Some, such as developing integration of services and pathways, have been enhanced by the development of an integrated care board chaired by the local authority. Some have arisen due to performance issues, such as A&E performance. We have worked closely with practices, visit A&E weekly and have commissioned increased capacity within the department and acute medical services with significant results. Targets are now being met and we have services with better access to senior staff over seven days and diagnostics.

There are significant challenges. Being allowed access to patient information is essential if we are to improve outcomes and commission effectively. Running cost, set at £25 per patient, is a blunt tool that does not take into account organisational size and fixed costs, or local health needs. CCGs, particularly those such as Bassetlaw, who have natural communities but are relatively small, are extremely lean organisations where clinical and managerial time is limited and we have learned to work as an efficient, effective team. It is essential that this is valued when we have assurance meetings and that reporting upwards does not distract us from our role.

We operate as just one part of a complex commissioning system. We need to ensure we are active partners alongside public health, regulators and NHS England, and that our clinical involvement and patient engagement lead to better outcomes.

After 100 days I’m optimistic. Clinical commissioning is delivering. The NHS needs it to succeed.

Dr Steve Kell is chair of Bassetlaw CCG and co-chair of NHS Clinical Commissioners Leadership Group

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

NHS needs clinical leaders at all levels @Medici_Manager @muirgray @helenbevan

by Stephen Brooks and Anthony Surley http://bit.ly/13HjsXF

The Francis report into the Mid Staffs NHS foundation trust identified poor leadership as a key factor in the disastrous failures in patient care. It recommended the creation of a “leadership staff college to provide common professional training in management and leadership to potential senior staff”.

Since this college should have a “physical presence” – a virtual organisation is ruled out – it will take a long time to establish. It will take even longer to deliver skilled leaders and the college will be forced to focus on senior managers; it would be a miracle if such a college could make any measurable impact on the NHS in the next decade.

Yet it is clear that improving leadership skills needs to be addressed with greater urgency. The nature of healthcare and the way it is delivered is set for radical change over the next decade. These changes will mean leadership roles are devolved down to more junior professionals and across a wider range of disciplines. As a result, it is not only senior managers who will need leadership training but clinicians at all levels.

Strategic initiatives such as community-based care, the use of clinical pathways (the standardised care provided for specific conditions), telemedicine and the pressures of an aging population will increase the need for clinical leaders, often at junior levels, to co-ordinate the delivery of care to patients.

For GPs, the challenge will be to move away from a culture of referral to one where they take ownership for all of the patient’s care and provide strategic co-ordination of the care pathways used to treat patients with multiple conditions. Within this framework, the practical day to day treatment may well be managed by a more junior clinician.

They too require skills such as planning, prioritisation, decision making, influencing, as well as knowledge of multi-disciplinary team working, and the ability to mentor and learn from others. Leadership needs to be a central part of clinical education.

All these pressures underline that now is the right time for the NHS to give leadership training greater priority. A new body, Health Education England (HEE), has been established that operates through 13 local education and training boards (LETBs). Training strategies are under review and we should expect changes in the content and delivery of training within and across professions as LETBs flex their muscles.

As ever, some will say that a greater emphasis on leadership training might be desirable, but no money is available and boosting it would be at the expense of vital clinical training. There are two key responses to this. Firstly, HEE will spend £4.8bn annually – just 1% of that could provide initial training for up to 100,000 NHS leaders each year.

Secondly, leadership training would improve patient care not undermine it. Good leadership skills result in better clinical outcomes by ensuring that correct values and standards are maintained, that clinicians are motivated and can focus on using their talents for the benefit of patients.

To achieve a lasting boost in leadership, the LETBs need a two-pronged strategy. Firstly, they need to meet the immediate needs of the NHS by delivering training to the existing workforce. They need to work with employers to identify those in leadership roles and deliver appropriate training to them. The NHS has recently set up a leadership academy, which has made a start on developing programmes for some of the mid-level professionals.

To meet longer term needs, HEE and LETBs should work with royal colleges, universities and medical schools to build leadership skills into the initial professional training. It should be built around the core NHS values and ensure that newly qualified professionals start with skills they can build on as their careers develop.

This is essential because good leadership is necessary to deliver high quality 21st century healthcare. Just as patients would not want to be treated by untrained clinicians, they should not be expected to receive treatment in facilities led by those who have had no training in leadership.

Stephen Brooks is a specialist in people, change and leadership, and Anthony Surley is a specialist in talent management and healthcare atPA Consulting Group

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

Preventing excess @Medici_Manager @pash22 @helenbevan @muirgray

by Ray Moynihan http://bit.ly/15CMup6

IN recent weeks the world’s leading medical journals have published articles about the overtreatment of mild hypertension, the risks of breast cancer overdiagnosis, and the lack of effectiveness and potential harms of general health checks.

As the studies of dangerous excess mount, so too does the effort to raise awareness about the problem. JAMA Internal Medicinenow has a regular “Less is more” feature, the BMJ has just launched its “Too much medicine”  campaign, and professional societies in the US are running the “Choosing wisely” initiative, highlighting overused tests and treatments.

In the field of mental health few could have missed the global fight over the DSM–5 and vociferous claims it will further fuel the medicalisation of normal life.

There’s little doubt that the market-based system in the US is the epicentre of excess — where health care now comprises almost one-fifth of the entire economy — but the problem affects many nations.

With breast cancer for example, estimates based on incidence studies suggest one-third of invasive cancers diagnosed by screening mammography in NSW may be overdiagnosed — in other words, the cancer would not have gone on to harm the woman.

The probable causes of overdiagnosis and overtreatment are complex — technological change, commercial gain, professional imperialism, fears of litigation, perverse incentives and our deep cultural faith in early detection. But despite the complexity and enormity of the challenge, it’s surely time to try to work out how we can wind back the harms of too much medicine.

A group of Australian researchers are a key driving force behind the first international scientific conference on overdiagnosis to be held in the US this September. The Dartmouth Institute for Health Policy and Clinical Practice is a logical host for the Preventing Overdiagnosis conference, with its proud history of medical scepticism and impeccable credentials on the dangers of too much medicine.

Resulting from a small meeting on Queensland’s Gold Coast last year, the conference is being run in partnership with the BMJ and one of the world’s most influential consumer organisations,Consumer Reports. It will feature 90 scientific presentations on the problem and its solutions, and keynote speakers include Dr Virginia Moyer, the chair of the US Preventive Services Task Force, Dr Allen Frances, chair of the DSM IV, and Dr Barry Kramer, a senior director at the National Cancer Institute, which has made overdiagnosis one of its research priorities.

Along with the research and the conferences, the time is ripe for a lot more discussion about what can be done in the clinic and the classroom, how we can communicate the counterintuitive message that less is sometimes more, and how we can develop and evaluate effective policy responses.

The aim, after all, is not just more meetings and peer-reviewed papers, but fewer healthy infants labelled unnecessarily with gastro-oesophageal reflux disease, less distress overdiagnosed as mental illness, and fewer of our elders assailed by out-of-control polypharmacy. The less we waste on unnecessary care, the more resources there are for those in genuine need.

Along with innovations in genetics and information technology, one of the exciting areas in medicine in the 21st century will be how to wind back unnecessary excess — safely and fairly.

Ray Moynihan is a senior research fellow and PhD student at Bond University, and co-organiser of the Preventing Overdiagnosis conference being held at Dartmouth, US, 10–12 September 2013. www.preventingoverdiagnosis.net

@HarvardBiz: Gli studenti apprendono meno e peggio laddove i sindacati dei professori sono più influenti #italystandup

Andrea Silenzi, MD, MPH

La Scuola funziona peggio e gli studenti sono meno preparati laddove i sindacati degli insegnanti sono più forti ed influenti: io l’ho sempre pensato ma per fortuna ora lo afferma e prova anche uno studio riportato dall’Harvard Business Review della University of Chicago Law School e della University of Florida

Link: http://s.hbr.org/13TireM

Immagine

 

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Cost Containment: The Importance of Nurses @Medici_Manager @helenbevan @pash22

by September Wallingford, RN, BSN http://bit.ly/1aBpqvv

Due to ever increasing healthcare costs, stakeholders in the healthcare system rely heavily upon front-line workers to assist in containing costs to help make healthcare more affordable. Since nursing is the largest sector of front-line workers, the field has an opportunity to greatly impact cost containment. Currently, there are 2.7 million nurses in the workforce, with an expected growth rate of 26% over the next decade; however, there has been limited discussion on how nurses can help contain healthcare costs.

Why are nurses not usually integrated into the cost containment discussion? Why have we not been invited to the table? Likely, it is because we don’t have the power to order (or discontinue) tests, labs, or medications, all of which are major factors in the rising costs of care. Even so, a nursing perspective can be important and should be considered when doctors make treatment decisions.

For example, I recently treated a patient who had undergone abdominal surgery. Despite uncomplicated post-operative days 1 and 2, on day 3, he developed nausea, vomiting, and an increasingly distended abdomen. I administered intravenous anti-nausea medications, along with back rubs and cool cloths on his forehead. None of the treatments worked. While waiting for the doctor, I sat with the patient and spoke to him about the possibility of receiving a nasogastric tube to alleviate his symptoms. Given an understanding of the process, the patient agreed to this possibility and I paged the doctor once again. The doctor eventually placed the nasogastric tube, the tube was connected to suction, and out came a liter of gastric contents.

I then noticed that the doctor had put in an order for an abdominal x-ray to “check nasogastric tube placement.” Seeing this, I initiated a conversation with the doctor to discuss the patient’s symptomatic improvement as well as his current state of exhaustion. I assured the doctor that nurses would be at the patient’s bedside to monitor for signs and symptoms of tube malfunction. As a result, the doctor cancelled the x-ray, which not only eliminated an unnecessary test for the patient, but also reduced the cost associated with his care.

Situations like these are commonplace to nurses across the country. We witness daily that more is not necessarily better, and we are in a position to help make decisions that lower costs without negatively impacting the patient’s care. Nurses bring a unique perspective to the healthcare cost conversation, so include us in the discussions, give us a seat at the table, and utilize us as active participants in the fight against rising healthcare costs.

September Wallingford is a registered nurse at an academic medical center in Boston, Massachusetts. She is currently completing her graduate nursing education to become an Acute Care Clinical Nurse specialist.

Doing what’s right for patients demands a culture change @muirgray @Medici_Manager @pash22 @helenbevan

We are pleased to announce the dates of our 2013 Lown Conference:
From Avoidable Care to Right Care 

For more information on the 2013 conference, please visit our website:
http://lowninstitute.org/project/2013-lown-conference/

2013 LOWN CONFERENCE: FROM AVOIDABLE CARE TO RIGHT CARE

June 24, 2013   Avoidable Care Admin   

This year’s Lown Conference, From Avoidable Care to Right Care, will take place on December 3-4, 2013 in Boston, MA.

The 2013 invitation only conference will gather clinicians, patient advocates, and civic leaders to deepen our mutual understanding of the cultural, scientific, and ethical issues surrounding the overuse of medical services.

Attendees will leave this meeting with priorities for addressing this pervasive problem, and collaborators who are prepared to begin building bridges to the right care in their communities.

Major themes at this year’s event:

  • fostering a new kind of conversation among clinicians, patients, and civil society
  • envisioning health and health care 25 years from now
  • the global epidemic of overuse

Speakers include:

  • Don Berwick, MD, MPH, Former Administrator, Centers for Medicare and Medicaid Services (invited)
  • Katy Butler, Author of Knocking on Heaven’s Door
  • Bernard Lown, MD, Professor Emeritus, Harvard School of Public Health; Senior Physician (ret.), Brigham and Women’s Hospital, Boston
  • Richard Smith, MD, Former Editor BMJ
  • Rabbi Richard Address, D.Min, Senior Rabbi, Congregation Mkor Shalom

Our working groups for Medical Education, Community Engagement, International Collaboration, and Setting the Research Agenda will convene for a working session on December 5, 2013 following the conference. If you are interested in participating on one of these working groups, please email us for more information atinfo@lowninstitute.org.

For more information on the conference, including how to register, please visit the Lown Institute website at www.lowninstitute.org.

Competitività e servizi pubblici nell’Unione europea: la Direttiva “cross­border healthcare” 2011/24/EU

Andrea Silenzi, MD, MPH

Un esempio concreto per coniugare mercato e servizi pubblici per la tutela della salute.

Nell’attuale ripartizione delle competenze tra Stati Membri e Unione Europea, i sistemi sanitari, trattando un tema altamente delicato per la sicurezza e la protezione dei consumatori – la Salute – rimangono ancora di forte competenza nazionale. Non si è ancora avviato un processo di integrazione dei differenti sistemi sanitari esistenti nell’UE. Questa è di fatto una contraddizione, dal momento che proprio la salute, cuore del Welfare State, fenomeno che identifica e caratterizza l’Europa nei confronti di altre potenze mondiali, non ha un modello uniforme ed integrato di Welfare sul territorio dell’Unione. E’ pur vero però che proprio il settore dell’assistenza sanitaria ha un impatto rilevante sull’equilibrio economico e finanziario dei singoli Stati, e uniformare i modelli significa di conseguenza uniformare le modalità di finanziamento dei servizi, la programmazione, come anche sottostare a obblighi stringenti che prescindono…

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More Treatments Equal Better Care? @Medici_Manager @pash22 @helenbevan

by

American HealthScare : 

How the healthcare industry’s scare tactics have screwed up our economy — and our future http://bit.ly/18TFCaf

There are multiple lines of evidence that doing more things to patients doesn’t always result in better health. I summarize a few examples here.

Dartmouth Studies

Researchers at Dartmouth University examined the relationship between medical resources used and the resulting health outcomes in people nearing the end of their lives in two California regions, Los Angeles and Sacramento.

In Los Angeles, the patients used 61% more hospital beds, 128% more intensive care unit (ICU) beds, and 89% more physician labor in the management of chronically ill patients during the last two years of life compared to Sacramento. In spite of this intense use of medical resources, the quality of care for patients with heart attacks, heart failure, and pneumonia was worse in Los Angeles. Patients did not enjoy this aggressive care either. Patients rated 57% of Los Angeles hospitals as below average compared to 13% of Sacramento hospitals.

What are the cost implications of the overly aggressive care in Los Angeles? If the Los Angeles hospitals had functioned at the same level as the Sacramento hospitals over the five years of the study measuring these differences, the savings to the Medicare system would have been approximately $1.7 billion.

Brain Aneurysms

Researchers studied immediate family members of patients who had symptomatic brain aneurysms. The researchers wanted to know if finding and surgically fixing aneurysms in the healthy family members who had no aneurysm symptoms would prevent strokes and deaths. The results were basically that many people were injured as a result of the surgery, which the researchers didn’t feel justified the few saved lives.

The Medical Outcomes Studies

In the late 1980s and early 1990s a series of studies called the Medical Outcomes Studies were completed. Their purpose was to measure differences in medical resources used and health outcomes in patients with common conditions who saw different kinds of doctors. They wanted to know if ologist care led to better health compared to primary care, and how the doctors differed in practice styles. The researchers studied patients with high blood pressure and diabetes.

For high blood pressure, patients of cardiologists had more office visits, more prescriptions, more lab tests per physician visit, and were more likely to be hospitalized. There was no difference between the three physician types for average blood pressure, complications, or physical function.

For diabetes, patients of endocrinologists were found to have higher hospitalization rates, more office visits, more prescription drugs, and more lab tests per physician visit than family physicians. There was no difference between the three physicians for average sugar levels, physical functioning, and almost all diabetic complications.

Summary

These are just a few examples of how more aggressive medical care doesn’t always result in better health. All of the GIMeC members typically support the notion that more is better. Overcoming this aggression bias will be one of our big challenges in reforming our healthcare system.

References

Wennberg DE, Fisher ES, Goodman DC, Skinner JS, Bronner KK, Sharp SM. Taking care of patients with severe chronic disease: the Dartmouth atlas of health care 2008. The Dartmouth Institute for Health Policy and Clinical Practice Center for Health Policy Research [online]2008 [cited 2009 May 2]. Available from: http://www.dartmouthatlas.org/atlases/2008_Chronic_Care_Atlas.pdf.

Risks and benefits of screening for intracranial aneurysms in first-degree relatives of patients with sporadic subarachnoid hemorrhage. N Engl J Med. Oct 28 1999;341(18):1344-1350.

Vernooij MW, Ikram MA, Tanghe HL, et al. Incidental findings on brain MRI in the general population. N Engl J Med. Nov 1 2007;357(18):1821-1828.

Greenfield S, Nelson EC, Zubkoff M, et al. Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study. JAMA. Mar 25 1992;267(12):1624-1630.

Greenfield S, Rogers W, Mangotich M, Carney MF, Tarlov AR. Outcomes of patients with hypertension and non-insulin dependent diabetes mellitus treated by different systems and specialties. Results from the medical outcomes study. JAMA. Nov 8 1995;274(18):1436-1444.

Ten Essential Skills for Doctors @Medici_Manager

Medical  Humour  http://on.fb.me/12km3Pu

We look at some of the essential skills a doctor would need to have a great career.

1.Verbal communication skills. A doctor needs to be able to speak clearly, hear well and observe patients to effectively diagnose their ailments.

2. Motor skills. Doctors need to have a high degree of hand-eye skills to be able to safely and effectively examine patients, use instruments like the stethoscope, otoscope and ophthalmoscope, as well as a wide range of diagnostic equipment. You’ll need to have motor skills appropriate to perform general and emergency medical care to patients.

3. Intellectual skills. As a doctor, you’ll need to be able to calculate, analyze in a timely fashion, and under sometimes stressful conditions.

4. Social skills. To effectively care for patients, doctors must be emotionally healthy, mature, sensitive and honest. You’ll need to have good judgment and compassion when diagnosing and treating patients.

5. Observational skills. To work effectively as a doctor, you’ll need to be able to observe patients so that you can assess and evaluate patients’ conditions.

6. Physical skills. Healthcare involves a lot of walking and standing, and you’ll sometimes be required to maneuver patients in or out of bed, into chairs, onto gurneys and even up off the floor.

7. Written skills. Doctors must be able to note patient information on charts, make notes about medications and patient behavior, leave notes for nurses, pharmacists and aides.

8. Computer skills. Your schooling will involve a certain degree of computer use in labs and when writing papers. In the profession, you’ll find that computers have become a common tool in health care, and you’ll need to feel comfortable updating patient information on computers.

9. Continuing education skills. You must be able to continually stay abreast of developments in your profession through conferences, classes, and journal reading.

10. Business skills. Whether you choose to practice in a hospital or a private setting, your ability to understand basic business procedures is essential.

Doctors are some of the most respected individuals in the world, and if you have the desire to become a part of this field and these skills, you’re well on your way to success.

Playground, Italy @Medici_Manager @helenbevan @pash22 @muirgray @WRicciardi

from   http://bit.ly/18uB6tj

Met a bunch of amazing Italian strangers in the northern region of Trentino, Italy who took me way up into the Italian alps to go hiking and mountain biking. People have been asking me to make a sports video, so thought it would be fun to try it out! A week of run and gun fun! I feel like I now have a second family deep in the mountains of Italy!

Thank you everyone who guided me through and took me in with welcoming smiles and giving me such a great adventure! Special thank you to Mikaela Bandini, Chiara De Pol, Paolo Pincelli, and Caspar Diederik.

And to all the bikers and hikers who took me way up into the mountains to show me the Italian way of life! You guys are truly an inspiration! I hope to be as cool as all of you someday, haha! 🙂

Shot and edited by Matty Brown (7D and Sony Vegas)
Music by awesome Icelandic band called PORNOPOP (Song is called “Centre”) Check them out! facebook.com/twolazytigers
Produced by Mikaela Bandini of Cant Forget Italy cantforget.it
Huge thank you to the region of Trentino, Italy for having me as a guest in your epic wonderland! visittrentino.it/en