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Where Medicine Went Wrong explores how the idea of an average value has been misapplied to medical phenomena, distorted understanding and lead to flawed medical decisions. Through new insights into the science of complexity, traditional physiology is replaced with fractal physiology, in which variability is more indicative of health than is an average. The capricious nature of physiological systems is made conceptually manageable by smoothing over fluctuations and thinking in terms of averages. But these variations in such aspects as heart rate, breathing and walking are much more susceptible to the early influence of disease than are averages.It may be useful to quote from the late Stephen Jay Gould's book Full House on the errant nature of averages: ?? our culture encodes a strong bias either to neglect or ignore variation. We tend to focus instead on measures of central tendency, and as a result we make some terrible mistakes, often with considerable practical import.? Dr West has quantified this observation and make it useful for the diagnosis of disease.
The field of solid state ionics deals with ionically conducting materials in the solid state and numerous devices based on such materials. Solid state ionic materials cover a wide spectrum, ranging from inorganic crystalline and polycrystalline solids, ceramics, glasses, polymers, composites and nano-scale materials. A large number of Scientists in Asia are engaged in research in solid state ionic materials and devices and since 1988. The Asian Society for solid state ionics has played a key role in organizing a series of bi-ennial conferences on solid state ionics in different Asian countries. The contributions in this volume were presented at the 10th conference in the series organized by the Postgraduate Institute of Science (PGIS) and the Faculty of Science, University of Peradeniya, Sri Lanka, which coincided with the 10th Anniversary of the Postgraduate Institute of Science (PGIS). The topics cover solid state ionic materials as well as such devices as solid state batteries, fuel cells, sensors, and electrochromic devices. The aspects covered include theoretical studies and modeling, experimental techniques, materials synthesis and characterization, device fabrication and characterization.
Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine
Originally published in 2012, revised edition published in 2013, by Fourth Estate, Great Britain; Published in the United States in 2012, revised edition also, by Faber and Faber, Inc.
In 1998, Nicholas Gonzalez, M.D. received National Cancer Institute approval for a clinical trial to evaluate his nutritional-enzyme approach in the treatment of patients with pancreatic cancer. Though Dr. Gonzalez hoped the venture would initiate an era of cooperation between conventional scientists and serious alternative researchers, problems plagued the study from its beginning. The design discouraged patient participation; conventional oncologists discouraged patients from joining and at times pressured those already admitted for nutritional therapy to change to more conventional treatment. Then in 2000 the NCI insisted that all patient selection decisions be turned over to the Principal Investigator, who as it turned out helped develop the chemotherapy protocol used as the control treatment.Repeatedly, the Principal Investigator approved patients for the nutritional treatment who did not meet the entry requirements, or who were too ill or uncommitted to follow the self-administered regimen. An evaluation by government scientists in early 2005 confirmed that so many patients had failed to follow the prescribed nutritional therapy that the data had little meaning. Despite such problems, without Dr. Gonzalez¿ knowledge the Principal Investigator published an article implying the study was properly run, patients complied fully and that the nutritional therapy had no effect.In response, Dr. Gonzalez, a former journalist, has written What Went Wrong, to bring the truth of this project to light, and show how bias, indifference, and at times incompetence undermined a promising research effort that, if properly run, might have ushered in a new direction in cancer treatment.
Medical mistakes are more pervasive than we think. How can we improve outcomes? An acclaimed MD’s rich stories and research explore patient safety. Patients enter the medical system with faith that they will receive the best care possible, so when things go wrong, it’s a profound and painful breach. Medical science has made enormous strides in decreasing mortality and suffering, but there’s no doubt that treatment can also cause harm, a significant portion of which is preventable. In When We Do Harm, practicing physician and acclaimed author Danielle Ofri places the issues of medical error and patient safety front and center in our national healthcare conversation. Drawing on current research, professional experience, and extensive interviews with nurses, physicians, administrators, researchers, patients, and families, Dr. Ofri explores the diagnostic, systemic, and cognitive causes of medical error. She advocates for strategic use of concrete safety interventions such as checklists and improvements to the electronic medical record, but focuses on the full-scale cultural and cognitive shifts required to make a meaningful dent in medical error. Woven throughout the book are the powerfully human stories that Dr. Ofri is renowned for. The errors she dissects range from the hardly noticeable missteps to the harrowing medical cataclysms. While our healthcare system is—and always will be—imperfect, Dr. Ofri argues that it is possible to minimize preventable harms, and that this should be the galvanizing issue of current medical discourse.
Exploring the most fascinating and significant scientific missteps, the author presents seven cautionary lessons to separate good science from bad.
"Christopher Wanjek uses a take-no-prisoners approach in debunkingthe outrageous nonsense being heaped on a gullible public in thename of science and medicine. Wanjek writes with clarity, humor,and humanity, and simultaneously informs and entertains." -Dr. Michael Shermer, Publisher, Skeptic magazine; monthlycolumnist, Scientific American; author of Why People Believe WeirdThings Prehistoric humans believed cedar ashes and incantations could curea head injury. Ancient Egyptians believed the heart was the centerof thought, the liver produced blood, and the brain cooled thebody. The ancient Greek physician Hippocrates was a big fan ofbloodletting. Today, we are still plagued by countless medicalmyths and misconceptions. Bad Medicine sets the record straight bydebunking widely held yet incorrect notions of how the body works,from cold cures to vaccination fears. Clear, accessible, and highly entertaining, Bad Medicine dispelssuch medical convictions as: * You only use 10% of your brain: CAT, PET, and MRI scans all provethat there are no inactive regions of the brain . . . not evenduring sleep. * Sitting too close to the TV causes nearsightedness: Your motherwas wrong. Most likely, an already nearsighted child sits close tosee better. * Eating junk food will make your face break out: Acne is caused bydead skin cells, hormones, and bacteria, not from a pizza witheverything on it. * If you don't dress warmly, you'll catch a cold: Cold viruses arethe true and only cause of colds. Protect yourself and the ones you love from bad medicine-the brainyou save may be your own.
A brilliant and courageous doctor reveals, in gripping accounts of true cases, the power and limits of modern medicine. Sometimes in medicine the only way to know what is truly going on in a patient is to operate, to look inside with one's own eyes. This book is exploratory surgery on medicine itself, laying bare a science not in its idealized form but as it actually is -- complicated, perplexing, and profoundly human. Atul Gawande offers an unflinching view from the scalpel's edge, where science is ambiguous, information is limited, the stakes are high, yet decisions must be made. In dramatic and revealing stories of patients and doctors, he explores how deadly mistakes occur and why good surgeons go bad. He also shows us what happens when medicine comes up against the inexplicable: an architect with incapacitating back pain for which there is no physical cause; a young woman with nausea that won't go away; a television newscaster whose blushing is so severe that she cannot do her job. Gawande offers a richly detailed portrait of the people and the science, even as he tackles the paradoxes and imperfections inherent in caring for human lives. At once tough-minded and humane, Complications is a new kind of medical writing, nuanced and lucid, unafraid to confront the conflicts and uncertainties that lie at the heart of modern medicine, yet always alive to the possibilities of wisdom in this extraordinary endeavor. Complications is a 2002 National Book Award Finalist for Nonfiction.
Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.