Saturday, 19 September 2015
Friday, 3 July 2015
"(1) CME does improve physician performance and patient health outcomes, and (2) CME has a more reliably positive impact on physician performance than on patient health outcomes. The 8 systematic reviews support previous research showing CME activities that are more interactive, use more methods, involve multiple exposures, are longer, and are focused on outcomes that are considered important by physicians lead to more positive outcomes."
This review reinforces confidence in good design principles of interactivity, multiple delivery methods, multiple exposures, over longer periods, and on important topics.
Tuesday, 2 June 2015
The dimensions are as follows:
|Open||How open the MOOC is|
|Massive||The scale of the MOOC/Number of participants|
|Diversity||The diversity of the participants|
|Use of multimedia||The amount and variety of multimedia|
|Degree of communication||The forms of communication|
|Degree of collaboration||The forms of collaboration|
|Amount of reflection||The extent to which reflection is encouraged|
|Learning pathway||The nature of the learning pathway (from learner centred to highly structured)|
|Quality Assurance||The form of quality assurance|
|Certification||Whether any form of accreditation is possible|
|Formal learning||Link into formal educational offerings|
|Autonomy||The degree of learner autonomy|
In her report she analyses a number of MOOCs over recent years using low / medium / high for each of the dimensions. "I would argue that at a glance this classification framework gives a far better indication of the nature of each MOOC than the simple classification as xMOOCs and cMOOCs."
I think it is also a useful classification for exploring the purpose of design features of any particular online course especially where platform constraints are being compared.
Wednesday, 13 May 2015
'Britain to end what he termed "passive" tolerance of extremism' David Cameron seeks new powers to combat extremism in Britain (NY Times)
'ending what he said was a culture of "passive tolerance"'
David Cameron to unveil measures against extremism. (FT)
'"conclusively turn the page" on passive tolerance of extremist views'
David Cameron revives moves for tough action against non-violent extremists to target radicalisation. (Independent)
and in 2011 we had
'Frankly, we need a lot less of the passive tolerance of recent years and much more active, muscular liberalism'
State multiculturalism has failed, says David Cameron. BBC
This is what annoys me.
You have a belief that extremism should be punished but the most effective counter-argument is that a thing called 'passive tolerance' exists, is a force for good, and would be harmed by such a belief. So, instead of trying to better understand the social science you diminish it; you use its name in your announcements and frame it as a bad thing so that journalists and voters are misled.
Now when we hear about 'passive tolerance' we remember our well-spoken leader telling us it was bad.
No it's not.
"Passive tolerance is probably not a concept many people have yet heard of. Let's hope that changes, because "passive tolerance" is the most hopeful bit of academic social psychology research to emerge in a long time. It is the idea that simply living in an area of high diversity rubs off on you, making you more tolerant of ethnic diversity." Madeleine Bunting. Guardian March 2014.
We should work to prevent the causes of extremism in the first place not punish it which will simply encourage it.
There's probably a very good word for the rhetorical technique used - like equivocation - but I'm not sure - I'd need some journalist friend to tell me that. :-)
Tuesday, 12 May 2015
LMS Is The Minivan of Education (and other thoughts from #LILI15) by Stephen Downes.
The French doctor who analysed the use of blood letting in pneumonia and settled the argument about whether it was helpful or harmful.
Numbers trump even the most strongly voiced opinions.
This US piece talks about disrupting medical school education and decreasing physician training costs with a national MOOC for the basic sciences. The most depressing part is the scale of junior doctor debt and how utterly distorts career choices away from primary care and improving health to increased specialization and the focus on treatment.
Saturday, 9 May 2015
It will benefit "local renewable power and renewable energy microgrids". However, some argue Powerwall may even encourage coal and nuclear - though that clearly isn't the intention.
"Powerwall is a home battery that charges using electricity generated from solar panels, or when utility rates are low, and powers your home in the evening. It also fortifies your home against power outages by providing a backup electricity supply. Automated, compact and simple to install, Powerwall offers independence from the utility grid and the security of an emergency backup."
Why should a mind-controlled exoskeleton stimulate neurone recovery in spinal injury?
The open wikipedia ranking search engine is available for you to see what's the most popular issue in any area.
The most important thing in Cornwall is the Song of Western Men.
The most important topic in Medicine is - to my great disgust - the 1810 book of laying out the irrational quackery of homeopathy. [link not provided! ... I'll send you to #ten23 instead]
However - moving on - the most important theorem is the Poincaré conjecture.
Facebook have 'scientists' researching Exposure to Diverse Information on Facebook which attempts to quantify this tendency.
"Take people whose friends shared at least one consistent and one cross-cutting story --- 99 percent of them were exposed to at least one ideologically aligned item, and 96 percent encountered at least one ideologically cross-cutting item in News Feed. When we looked at who clicked through to hard news content, we found that 54 percent---more than half---clicked on ideologically cross-cutting content, although less than the 87 percent who clicked on ideologically aligned content. "
Reported in the Independent.
Wednesday, 6 May 2015
Less aggressive diabetes care needed in hospice
Good example of the marketing MOOC promoting a popular exam prep textbook.
"This new MOOC is accessible to the more than 40,000 US medical students and thousands outside of the US preparing to take the USMLE Step 1. 'The success of the Crush Step 1 MOOC pilot will help Elsevier evaluate its ability to work within the MOOC model and develop trusted content that informs and engages medical students,' said Theodore O’Connell, MD, author of Crush Step 1. 'Using results from the pilot, Elsevier will understand how we might develop a full USMLE course and other course guides.'"
Thursday, 30 April 2015
This team hack cheap devices such as toys. They take ideas and parts and turn them into medical devices. "Unless you make somebody feel a little uncomfortable you're probably not being that innovative".
I think this is great - I'm going to go into the next toy shop I pass.
How does this type of innovation compare with that offered by corporations seeking to make the next ubiquitous - and patented - health device? Why not find out for yourself? Littledevices offer 7 medical technology projects you can try at home.
Monday, 27 April 2015
I was updating the links to it in our Postgraduate Diploma in Diabetes and noticed it has moved home within Rhode Island. 
Detailed overview of the Transtheoretical model of behaviour change. http://web.uri.edu/cprc/detailed-overview/
 The University of Rhode Island is the home of this theory and you'd think they'd take more care in preserving its links and not give an ugly 404 error.
Saturday, 18 April 2015
How significant this might be we will just have to see.
"I could remember everywhere, like flicking through the pages of a book. Every place I had ever been, but specifically the buildings."
Apparently her doctor is writing it up for a journal. Wonder if it's coming our way at BMJ Case Reports.
You need to sign in to view the full scientific detail but the abstract says it all.
"Evidence does not support that an apple a day keeps the doctor away; however, the small fraction of US adults who eat an apple a day do appear to use fewer prescription medications."
Another example of the relatively low quality research that comes from dietary recall.
Clearly we urgently need a prospective, randomized-controlled trial with placebo apples.
Picked up this story via Medgadget.
Providing the alternate sensation to the skin is one thing but filtering the speech from surrounding sound with a mobile app and reinforcing it is the real innovation here.
Hayl's Instagram feed is pictured below.
Having a conversation about food - even if it is only with yourself - can be helped by the low barrier and immediacy of a social media app like Instagram.
Friday, 17 April 2015
"A team from Brown University and the University of Rhode Island has developed a new technique to radically improve how radiation therapy acts on cancer cells. The method uses gold nanoparticles that are delivered to cancer cells using so-called pH Low-Insertion Peptides (pHLIP), compounds that are attracted to acidic environments. Since cancer cells tend to be more acidic than healthy ones, pHLIPs accumulate around tumor sites."
Tuesday, 14 April 2015
The Sverigelinux (Sweden Linux) aims at improving large deployments of Linux.
"The objective for the SverigeLinux project is to lower the threshold for deploying Linux in an organization. Deploy a server. Configure, install and change everything from there."Obviously it is very popular as their public download of the .iso has broken.
A video shows you how to set up a network of machines.
... on a blog by Allison Littlejohn about Open University.
Working closely with your media designers using the "module resources (as a 'mediating artifact')" is hardly disruptive but it does reflect some of the jargon-breaking methods and customer focus of Agile. If you don't talk the same lingo then what the professors mean and the media designers mean may be very different.
Small in-house teams would probably approach the production of learning media in this way quite naturally. It is when you become a bigger institution or outsource media expertise that flexibility and shared understanding risk being left behind.
There are plenty of website designers who are now emailing their customers offering an upgrade. Which is great news for the web design business.
However, if your a little suspicious Google have made a nice mini site explaining it all.
This includes a Mobile-Friendly Test as well. Just type your website address (or your web designer's website address and portfolio of customers if you want to check them out) and Google will give its opinion.
Google is pushing the responsive web design approach over the alternate mobile site which is great. Why maintain two websites when one will do? For many it means completely rebuilding a website designed with a focus on desktops not tablets or smartphones ... and that can be expensive.
The main thing to ask yourself is whether or not your visitors do so on mobile devices? More and more are doing so ... it's about time you asked the question.
Thursday, 9 April 2015
"Reporting for the first time on exam results and job applications, the data shows that ethnic minority doctors from UK medical schools do less well than their white counterparts. But, they do better than white doctors from a non-UK medical school."
"The data may help identify examples of good practice, where effective support has been given to doctors in training who have found it more difficult to pass exams or progress into specialty or GP training." Niall Dickson, Chief Executive of the GMC.
"Improvement FUNdamentals - your route to improve health and care!"
Since I only work with BMJ these days it's going to hard to reflect on clinical work challenges but I'm always up for trying something out. Don't suppose my recent clinical experience will be of great help.
Was asked to complete this template prior to starting the course:
"As part of the Improvement FUNdamentals MOOC you are asked to identify an area of work or challenge locally that you would like to improve during your time on the MOOC using quality improvement techniques.
Please complete and save this pre-MOOC template before you begin work on the Improvement FUNdamentals MOOC."
Hmm. OK so that's going to be tricky.
Will be exciting to read what others are doing and watching their progress. Hope to learn a lot about quality improvement in the process.
Wednesday, 18 March 2015
How to Teach Doctors Empathy
Interspersed talking heads and slides, invest in post-production.
Informal trumps high-fidelity
Digital tablets better than slides. Introduce motion!
Some more points and a nice summary of findings from EdX on student use of video. (via Michael O'Connor)
Not many surprises from an educational perspective but nice to have a little more evidence.
The two studies reported were an observational study and an under-powered randomized-controlled trial. An accompanying editorial bemoans the lack of evidence in this important clinical area and looks at tools like the Swedish registry-based randomization system for future innovation.
Wednesday, 4 March 2015
Hospital Doctor publishes "key findings of the Royal College of Emergency Medicine’s latest report - called Ignoring the Prescription - into tackling growing patient demand:"
"expect Fact Engine Optimization to become a new industry, and do exactly what SEO did to the reliability and utility of search engines [wreck them]"
Fascinating collection of 'facts' gleaned by Google from all over the internet and how those can be applied to a scoring mechanism for improving searches. Somewhat creepy that Google are the self-appointed guardians of truth but creepy is good only if it delivers good results.
"The latest review in the Fluids and Electrolytes series focuses on the safe removal of excess hydrogen ions, the administration of sodium bicarbonate, and the possible contribution of intracellular acidosis to the development of cerebral edema in patients with diabetic ketoacidosis. Several of the issues facing clinicians who care for patients with diabetic ketoacidosis are related to acid-base disorders."
The full article is here ... http://www.nejm.org/doi/full/10.1056/NEJMra1207788
"The team brought together data gathered using X-ray crystallography, NMR spectroscopy, cryoelectron microscopy, and lipidomics into what’s called a “coarse-grained molecular dynamics simulation.” This technique allows the model virus to be put through different virtual environments, each having varying temperatures and lipid compositions. The current simulations are still quite limited, but the technique should lead to more complicated tests involving potential therapies and different chemical agents"
Saturday, 28 February 2015
Robear: the bear-shaped nursing robot who'll look after you when you get old.
"Japanese robot can lift patients from beds into wheelchairs or help them to stand up, promising ‘powerful yet gentle care’ for the elderly"
Hospitals participating in ACS NSQIP significantly improve surgical outcomes over time.
"ACS NSQIP is a nationally validated, risk-adjusted, outcomes-based program designed to measure and improve the quality of surgical care in participating hospitals. The program employs prospective, peer-controlled, validated clinical data collection to quantify 30-day surgical outcomes and allows comparisons of outcomes among all participating hospitals.
The new study by the American College of Surgeons research team found that among hospitals currently participating in the program for at least three years, 69 percent reduced the rate of death; 79 percent reduced the rate of complications; and 71 percent reduced the rate of surgical site infections. It was estimated that, on average, these hospitals reduced their rate of death by 0.8 percent per year; reduced their rate of complications by 3.1 percent per year; and reduced their rate of surgical site infection by 2.6 percent per year (with respect to the prior year's rates)."
Wednesday, 25 February 2015
... is about as useful as hoping that water will run uphill ahead of the general election.
The Guardian view on the Welsh NHS: all in it together | Editorial
Do these ingestible sensors
spell the end of wearables?
Monday, 23 February 2015
Effect of Corticosteroids on Treatment Failure Among Hospitalized Patients With Severe Community-Acquired Pneumonia and High Inflammatory Response A Randomized Clinical Trial http://jama.jamanetwork.com/article.aspx?articleID=2110967
Sunday, 22 February 2015
New Scientist review of recent research on psychosis and cannabis use.
You'll end up buying more.
A reanalysis of the Diabetes Prevention Program.
Metformin seems to be of benefit only in those at greatest risk of developing type 2 diabetes.
Monday, 2 February 2015
Mike Broad of Hospital Doctor reports on how hospitals have objected to the proposed NHS pricing plans for 2015-16.
"the pricing authorities must either refer their proposals to the Competition and Markets Authority for review, or consult the health service again on revised prices taking into account the objections."
Thursday, 29 January 2015
Scientists 3D-Printing Cartilage For Medical Implants
"scientists and physicians at The Feinstein Institute for Medical Research, have discovered a way to use MakerBot’s 3D-printing technologies to create cartilage and repair tissue damage in the trachea."
Wednesday, 28 January 2015
Hospitalized Kids Go to School Using Virtual Presence Robots.
How cool is that? The robots move between classes allowing children to keep in touch with their friends and their schooling.
Standardized outcomes that would need to be reported by default in a specialty is urged by this systematic review. Authors studied the example of chronic lung disease in research of pre-term infants.
"When talking about cancer screening, survival rates mislead"
Useful explanation from Alexandra Barratt, Professor of Public Health at University of Sydney.
Sunday, 25 January 2015
"you might be wondering, how exactly does one go about 'gamifying' eLearning? Does it involve navigating the screen with a Playstation controller, or dishing out some playing cards?
Nope! Here are 15 ways you can gamify your online learning:"
This poker game is a different approach - the brute force approach - and is an interesting read.
But the New York-based web analytics startup has been awarded more than $1 million through a Defense Advanced Research Projects Agency (DARPA) program called Memex, focused on developing the next generation of web search.
"It's trying to explore all of the myriad use cases that search and webcrawling can do for you that aren’t just commercial web search," says Parse.ly cofounder and CTO Andrew Montalenti.
One early anticipated application, for instance: tracking and shutting down online transactions related to human trafficking and modern-day slavery."
Thursday, 22 January 2015
"Yesterday, The Australian ran a front-page article about what it called a 'groundbreaking' new study on wind turbines and their associated health impacts.
The study supposedly found a trend between participants’ perceived 'sensations' and 'offending sound pressure'.
The Australian’s environment editor Graham Lloyd claimed the (non-peer-reviewed) study shows that 'people living near wind farms face a greater risk of suffering health complaints caused by the low-frequency noise generated by turbines', adding that it may help to 'resolve the contentious debate about the health impact of wind farms'.
Carried out by Steven Cooper of The Acoustic Group, the study was commissioned by energy company Pacific Hydro near its Cape Bridgewater wind farm in southwest Victoria.
But this study is an exemplary case of what we consider to be bad science and bad science reporting."
Friday, 9 January 2015
"The growing sophistication of the Internet has spawned the proliferation of startups that could forever change the business of healthcare and create a market for on-demand care"
"The proposal, supported by more than 25 volunteers and half a dozen European institutions as project partners, aims to create a virtual research environment (VRE) that will enhance the project's capacity for freely sharing scientific data."
"In the 14 years I have been representing Londoners at City Hall, the problem of air pollution has rarely been off the top of the political agenda. Of all the environmental challenges the capital currently faces, air pollution is by far the most deadly."
Leap second: computer chaos feared as scientists let world catch up with clocks.
Only if coders were daft enough to make inflexible software.
Thursday, 8 January 2015
A new discovery reported in Nature could change everything.
Improving early recognition of delirium using SQiD (Single Question to identify Delirium): a hospital based quality improvement project.
"The MR CLEAN researchers sought to examine whether intraarterial treatment – defined as intraarterial thrombolysis, mechanical thrombectomy, or both – improved outcomes. The data from this trial offer reasons to believe that we may be entering a new era in the treatment of acute ischemic strokes."
"In patients with acute ischemic stroke caused by a proximal intracranial occlusion of the anterior circulation, intraarterial treatment administered within 6 hours after stroke onset was effective and safe." (1)
1 Berkhemer OA, Fransen PSS, Beumer D, et al. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke. New England Journal of Medicine 2015;372:11–20. doi:10.1056/NEJMoa1411587
What else are futurists ignorant of?
This is an interesting idea presenting the connections between papers back into history. It risks over-simplifying the connections between concepts published at different dates. I wonder if I should rework my (far from brief) history of the electrocardiogram into something that is a little more visual and ... er ... thready like this. Definitely wouldn't use Flash though.
Wednesday, 7 January 2015
Traveler’s Diarrhea A Clinical Review in JAMA.
"loss of life expectancy at age 20 years of approximately 11 years for men and 13 years for women compared with the general population without type 1 diabetes."
An accompanying editorial says that life expectancy has improved greatly but glycaemic control still suboptimal and therefore outcomes could be improved.
Do these types of 'hard facts' help or hinder discussions with people with diabetes? Will motivate some but not others. Would it be better to focus on quality not quantity of life? How do you explain how population averages might apply to the individual? Perhaps comparisons with other aspects of life might help especially where they add to risk in diabetes. What would the figures be for smoking for example, or hypertension?