Friday, June 30, 2017

The fallacies of Pay for performance

The Fallacies of Pay for performance

The quality measures used in pay-for-performance generally fall into the four categories described below.

• Process measures assess the performance of activities that have been demonstrated to contribute to positive health outcomes for patients. Examples include whether or not aspirin was given to heart attack patients or whether patients were counseled to quit smoking.( No siree number of patients who really quit smoking no amount of nagging  from me will help

• Outcome measures refer to the effects that care had on patients, for example, whether or not a patient's diabetes is under control based on laboratory tests. Use of outcome measures is particularly controversial in pay-for-performance because outcomes are often affected by social and clinical factors unrelated to the treatment provided and beyond the provider's control. For example, providers may follow practice guidelines regarding monitoring blood sugar levels and counseling diabetic patients regarding their diet, but ultimately, the patients' eating and exercise behaviors will determine control of their diabetes. Increasingly, outcome measures also include cost savings.

• Patient experience measures assess patients' perception of the quality of care they have received and their satisfaction with the care experience. In the inpatient setting, examples include how patients perceived the quality of communication with their doctors and nurses and whether their rooms were clean and quiet.
see my blogpost Press who? Catering to Patients Can Be Harmful to Their Health!
See the  forbes article

• Structure measures relate to the facilities, personnel, and equipment used in treatment. For example, many pay-for-performance programs offer incentives to providers to adopt health information technology.
The pentagon and the VA have been using HIS for decades has it made a dent ?



Pay for performance the " NEW COKE" lessons to learn from paralysis from analysis


Pay-for-performance has become popular among policy makers and private and public payers, including Medicare and Medicaid. The Affordable Care Act expands the use of pay-for-performance approaches in Medicare in particular and encourages experimentation to identify designs and programs that are most effective.

The typical pay-for-performance program provides a bonus to health care providers if they meet or exceed agreed-upon quality or performance measures, for example, reductions in hemoglobin A1c in diabetic patients. The programs may also reward improvement in performance over time, such as year-to-year decreases in the rate of avoidable hospital readmissions.

Pay-for-performance programs can also impose financial penalties on providers that fail to achieve specified goals or cost savings. For example, the Medicare program no longer pays hospitals to treat patients who acquire certain preventable conditions during their hospital stay, such as pressure sores or urinary tract infections associated with use of catheters.

Thin-slicing

You do not have to pay attention to everything that is happening. We can often make sense of situations based on the “thinnest slice of experience.” On the surface it can seem almost magical however, delve deeper and you will find the logic and rationale.

"There are many interesting stories in the book and I was intrigued with Gladwell’s account of New Coke. I think this story provides an excellent insight into how the best and brightest minds with the best research and fact based analysis can often bamboozle themselves into a most disastrous course of action.
We know the history – The Pepsi Challenge, Pepsi tastes better, Coke responds with New Coke and then kaboom.
  • Pepsi gaining market share
  • The Pepsi Challenge – the majority of tasters preferred Pepsi
  • Additional market research shows a preference for Pepsi – tastes must have changed
  • New Coke under development
  • New Coke – sweeter and more like Pepsi starts to perform better in taste tests
  • Launch New Coke
  • Major crisis launches the return of Classic Coke
In the author’s words, “Coke has gone head to head with Pepsi with a product that taste tests say is inferior, and Coke is still the number one soft drink in the world. … This story is a good illustration of how complicated it is to find out what people really think.”"
Gladwell’s insights:
  • Taste tests don’t tell the real story – there is always a bias for sweetness in a sip. (People knew that.)
  • Drinking a whole bottle or can is a more accurate comparison – sweetness can get overpowering. (People knew that as well.)
  • Home use tests over time will give you better information. (Most people knew that.)
  • The entire principle of a blind taste test was ridiculous – in the real world no one drinks Coca-Cola blind!
  • Pepsi’s success in the blind taste tests never translated to much in the real world.
  • The error was in attributing the loss of market share to the product, as opposed to the good things Pepsi was doing with branding.
  • All of the unconscious associations and emotions we have of the brand, the image and the packaging were lost to “the guys in white lab coats.”
There is so much more in Blink that I appreciate, including unconscious “micro expressions”, the Facial Action Coding System, stereotyping and how that mind view can be altered, why tall men are often perceived as leaders, the downside of rapid cognition, the effect of stress and arousal, the tragic results of collective thinking and how one police officer in a car might just be a better thing.

My thinslice Blnk judgement 
Pay for performance is going to go the new coke way


*

Blink: The Power of Thinking Without Thinking by Malcolm Gladwell



Wednesday, June 28, 2017

Learning from our plant friends

Learning from our plant friends
Humans and animals often find themselves in competition with other organisms and thus operate with a focus on survival. A neurogeneticist colleague pointed out that “survival of the fittest” can also mean “demise of the least fit” and so competition can be especially vigorous, particularly as resources become scarce. Competition is not limited to organisms with a brain, also being seen across plant species. Moreover, plants, like humans and other animals, can also behave cooperatively and benefit from one another. For instance, the shade provided by one species allows a second to remain moist and hence more likely to survive under blistering sun. The use of nutrients is sometimes also shared between different species. As a situation becomes increasingly threatening for the survival of plants, their behavior might change, but it might not entail an “every plant for himself” strategy. In fact, actions that might have hindered a neighbor’s growth actually diminish, especially in highly competitive species (grasses) so that more vulnerable species (trees) are more likely to survive. Remarkably, when a bug starts to graze on a seemingly helpless plant, the plant actually responds by producing and releasing chemicals that might cause the bug to leave. But, more than this, once these chemicals are released into the air, nearby plants respond to these signals by manufacturing chemicals that similarly repel predatory insects. Unfortunately for the plants, some well‐adapted insects have developed so that these protective plant signals are used as markers that help them locate potential plant prey. The latter unfortunate outcome aside, it seems that plants can teach humans a fair bit in relation to social behavior. If they aren’t mowed down by natural and unnatural challenges, they might have still more to tell us. For the moment, however, the essential message is that having friends who can be counted on is a great way of coping with challenges.

You have full text access to this content

Stress and Your Health: From Vulnerability to ResiliencePublished Online: 24 APR 2015


http://onlinelibrary.wiley.com.ezp-prod1.hul.harvard.edu/doi/10.1002/9781118850350.ch4/pdf

"yosprala" Fantastic math of pharmaceutical companies

 Compound A=cost 30 cents
Compound B= cost 4$

New compound containing A+B= 164$
Only in USA where the  so called cutting edge research in Pharmaceuticals  takes place, and   politicians  say we have the best healthcare system in the world and  they are trying to make it even better is this kind of  math possible .
I am talking  about a medication  brand calle " yosprala"

ASPIRINOMEPRAZOLE is used in people who have had heart problems or strokes caused by blood clots to help reduce their risk of further heart problems or strokes and in people who are at risk of developing stomach ulcers with aspirin."
let us stop the  pharmaceutical companies from fooling the American Public with their tall tales about cutting edge research  and  stop them from looting  us.


Sunday, June 25, 2017

This pill could make your dog (and maybe you) live longer

This pill could make your dog (and maybe you) live longer

By Elizabeth Cohen, Senior Medical Correspondent

Source: CNN

Pill could make your dog live longer 01:28
Story highlights
Scientists are trying an anti-aging drug in dogs and humans
The Dog Aging Project says the drug may one day give dogs two to five more years of life

(CNN)See Momo.

See Momo run.
See Momo run faster, farther and with far more vigor, energy and youthfulness, his owners say, now that he's taking a drug meant for humans with cancer.
"It's been remarkable," Paola Anderson said as she watched Momo, her 13-year-old white Pomsky, run around the backyard, keeping up with dogs a third his age.
The drug is called rapamycin. After nearly a decade of research showing that it makes mice live up to 60% longer, scientists are trying it out as an anti-aging drug in dogs and humans.
Rapamycin was discovered nearly 50 years ago in soil collected from Easter Island in the South Pacific and studied in a Canadian lab, and it's the most promising drug to fight aging that Arlan Richardson has ever seen.
A professor at the Reynolds Oklahoma Center on Aging, Richardson has been doing this kind of research for 40 years.
"It's the best bet we have," he said.
Now, scientists are moving forward and testing the drug in dogs.
Researchers at the University of Washington's Dog Aging Project gave rapamycin to 16 dogs and imaged their hearts.
"It started to function better. It started to look like a more youthful heart," said Matt Kaeberlein, co-director of the Dog Aging Project, who has presented this research at conferences but hasn't yet published it.
Those dogs took rapamycin for only 10 weeks. Here's what happened to Momo and his "brother," Sherman, who took it for much longer.
Sherman the Pomeranian
Sherman the Pomeranian
Sherman and Momo's story
For many years, Momo and Sherman were regular visitors to the Laguna Pet Spa in Laguna Hills, California, getting baths and haircuts.
Then, on Christmas Eve 2010, their owner dropped them off and never came back.
Anderson, who runs the spa, said she called the owner, but her phone had been disconnected.
Anderson was horrified but not shocked. This was during Southern California's housing loan crisis, and this owner wasn't the first to abandon a dog to her care.
But this was more than a foreclosure. Sherman was sick, very sick.
On Christmas Day, the tiny 8-year-old Pomeranian was vomiting and howling in pain. Anderson rushed him to the emergency room. It was an attack of acute pancreatitis.
Anderson nursed him back to health and became, in her words, "mom" to Sherman and Momo.
The dogs had another mom, too: Anderson's partner, Sarah Godfrey, who was then living in Northern California but moved a few years later to Laguna Hills to live with Anderson and "the boys."
Can dogs smell cancer?

Can dogs smell cancer? 02:21
All was well until one day in May 2015, when Sherman fell over. He'd had a stroke.
"They gave him two weeks to live, unless he had surgery," Anderson remembers. Even with an operation, he had only a 20% chance of surviving.
Anderson and Godfrey were wary of surgery for a fragile dog who was already 13 years old; that's equivalent to 68 years old for a human being, according to the American Kennel Club.
Over the years, the couple had sought help from an herbalist for people problems, and now they desperately turned to him for help with their pooch problem. The herbalist did some research and came up with a possible treatment: rapamycin.
Excited but also skeptical, Anderson and Godfrey went online and ran across Kaeberlein and the Aging Dog Project, which was recruiting canine subjects for the rapamycin research.
They begged Kaeberlein to enroll Sherman, but the answer was no. Dogs had to be healthy and over 40 pounds. Sherman was neither.
The couple calculated their next step.
"We knew we could go to Mexico and get rapamycin or order it online, but we wanted to be guided by a veterinarian, by a professional," Anderson said.
That proved to tougher than they thought.
Five vets refused to prescribe the drug. Finally, a sixth vet agreed to prescribe rapamycin, but only after consulting with Kaeberlein to determine the best dose for Sherman.
By this point, a month after his stroke, Sherman was so weak, he had to be fed by hand and carried everywhere.
But rapamycin changed all that, Anderson and Godfrey said.
"The third day after taking rapamycin, he could eat on his own. By the seventh day, he was walking on his own," Anderson said.
Sixteen months later, the dog who had been given two months to live is still alive, and while clearly old, he's still active and able to run around the yard.
That got the moms thinking about Momo. He wasn't sick like Sherman, but at 13, he was getting old and achy and losing stamina. The couple decided to try rapamycin on him, too.
"Why not have your dog live longer if you can?" Godfrey said.
She said that within days of taking the drug, Momo was able to run for hours, whereas before, just a 30-minute walk would tire him out. On a hot summer day when CNN visited, he was able to keep up with Anderson's parents' dogs, who are 4 and 5 years old.
Anderson and Godfrey couldn't be happier.
"We call Sherman and Momo our rapamycin babies," Godfrey said.
Arlan Richardson with his Tibetan terrier, MoMo.
Arlan Richardson with his Tibetan terrier, MoMo.
But there's a catch
Take a look at the labels for Rapamune, made by Pfizer, and Afinitor (PDF), made by Novartis, two drugs that are essentially the same as rapamycin and are used to treat cancer patients and organ transplant recipients. The list of things that can go wrong is long and horrifying: cancer, diabetes, infections and more.
"You have to be concerned about these side effects," Kaeberlein said. But that hasn't stopped him from doing research on the drug.
First, Kaeberlein thinks the side effects seen in cancer patients and transplant recipients might not be because of rapamycin per se but because those patients were very sick to begin with, because they were taking a whole host of other drugs as well, or both.
Secondly, he uses a much lower dose of the drug on his healthy dogs compared with the dose used on sick people.
Richardson, the aging expert at the University of Oklahoma, agrees with Kaeberlein. He's so convinced that he gave a low dose of rapamycin to his own dog, coincidentally named MoMo.
MoMo had a heart problem, and Richardson said it stabilized after he started taking rapamycin. He said the Tibetan terrier looks and acts younger than his 14 years, which would be around 80 or 90 in human years.
Plus, he said, there have been no side effects.
"We've been doing blood chemistries on her the whole time, and there's nothing bad," Richardson said.
The researcher was quick to note that one dog's experience did not constitute proven scientific data -- but he added that he's given rapamycin to tiny monkeys called marmosets and hasn't see any negative side effects for them, either.
But what about humans?
Rapamycin has had very limited testing in healthy humans. Novartis gave rapamycin to 218 elderly volunteers, and it enhanced their response to the flu vaccine by 20%.
The results "raise the possibility that (rapamycin) may have beneficial effects" on the decline in immune function that occurs naturally as we get older, the study authors wrote.
They reported that the side effects of rapamycin were "relatively well-tolerated." Severe side effects, they wrote, occurred at a "similar" rate as those experienced by the patients in the study who took a placebo, or a sugar pill.
Of the 53 patients on the lowest dose of rapamycin, 22 suffered some side effect, most commonly mouth sores.
Dr. Monica Mita, who's done her own research with drugs like rapamycin, said she thinks the side effects can be managed.
"It's really a matter of using the right dose and keeping an eye on the patients," said Mita, co-director of experimental therapeutics at Cedars-Sinai hospital in Los Angeles.
The future of rapamycin
Kaeberlein, the professor of pathology at the University of Washington, is nervous about this article.
He wants readers to know that Momo and Sherman's story is a tale of two dogs -- that's it -- and not scientific evidence in any way, shape or form, especially considering the placebo effect, meaning Momo and Sherman's owners might subconsciously be seeing what they want to see because they believe so much in rapamycin and fought so hard for it.
He doesn't want Momo and Sherman's seeming success to "encourage dog owners to go off to their veterinarians and demand rapamycin."
And Kaeberlein, who's also president of the American Aging Association, is nervous for another reason, too.
He dislikes the term "anti-aging," as it conjures up images of snake oil salesmen peddling the fountain of youth.
Join the conversation
See the latest news and share your comments with CNN Health on Facebook and Twitter.

Instead, he prefers to think in terms of treatments that will delay the onset of diseases of aging, such as dementia or heart disease. In mice, rapamycin has been shown to slow these two types of declines, as well as several others.
Over the next year, Kaeberlein will be studying rapamycin in a much larger group of dogs: about 150, compared with the 16 he studied earlier.
He said other groups are looking at doing more aging studies in rapamycin in humans, too.
It's been a long journey for the compound discovered more than half a century ago in the dirt of a South Pacific island.
"The rapamycin story is one of the most surprising, enticing, satisfying and unique stories in the history of medicine," Mita wrote in a medical journal five years ago. "And the end is not near."
CNN's John Bonifield contributed to this story.

why Alphabet sucks while Google used to rock? and their new motto "stock-market capitalization at any cost"



When Google became Alphabet, the rationale seemed simple: that a company of companies can innovate faster than a single large beast. But that’s only the start.

“It’s kind of counterintuitive,” Google cofounder Larry Page remarked a couple of years ago. “Normally in a business, you think about, ‘What’s the adjacent thing that I can do?’ But maybe you can actually do more projects that are less related to each other.”
Back then, Page was explaining why his company—whose mission, officially, is to organize the world’s information and make it universally accessible and useful—had expanded to address everything from teaching automobiles to drive to researching ways to extend the human life span. At the time, the insight seemed classic Page, a heartfelt defense of unconventional thinking. Today it feels like something more: a premonition of perhaps the most radical, labyrinthine corporate restructuring of the digital era.
Page released a letter last August announcing the reconfiguring of Google into a conglomerate called Alphabet. It described Alphabet as a new holding company that would be composed of independent operating units. The Google search engine and related businesses—including Android, Gmail, and YouTube, to name a few—would be just one of them, and although it wasn’t initially clear, Alphabet would be home to nine other companies, including Calico (the health care company whose goal is to lengthen life expectancy), Verily (the home of the company’s “smart” contact lens), X (its R&D arm), DeepMind (artificial intelligence), and Access (all of the company’s high-speed Internet initiatives). In February, Alphabet added its 11th unit when it elevated the think tank/tech incubator formerly known as Google Ideas into its own entity called Jigsaw.

"We are excited about…
  • Getting more ambitious things done.
  • Taking the long-term view.
  • Empowering great entrepreneurs and companies to flourish.
  • Investing at the scale of the opportunities and resources we see.
  • Improving the transparency and oversight of what we’re doing.(transparency=nothing is seen)
  • Making Google even better through greater focus(profits)
  • And hopefully… as a result of all this, improving the lives of as many people as we can."/I do not know about this .
  • every technology is  double edged, previously i used to call people and ask for directions to their house before   visiting them . in spite of directions  I still sometimes  had to ask  strangers and  neighbours for directions now with  gooogle maps  all I do is  turn right  then  a right  and  then  another right again !
 5 years ago When a contributor used to contact the translate team  they used to get a response at least within a week but nowadays it looks like  even when the web forums are full of complaints about some major problem the company as well as the technical assistance people Seem to act like that is no such problem which is typical ostrich mentality of any overgrown and   uncaring  large Corporation.
For example they suddenly decided to restrict the number of words which can be translated.
I could understand that they are now to restrict some in order to conserve the resources ( they have only 97+ billions of cash in hand !)  which itself is quite dubious. Even when multiple requests have been made my contribution to have worked at improving the translation of languages which are less used on the internet there seems to be absolutely no response.
the left hand doesn't seem to be knowing what the right hand is doing. it should be quite simple and obvious 4 people to know that in order to edit a particular non-english / romanized language we need that particular input Gadget available  on the side of the frame where the editing needs to be done, it's been more than 6 months and at least six request made for this and absolutely there is no response.
voice recognition typing is available for Hindi but this is not available in the translator toolkit!,blogger,or gmail!
This is more like the thumb not knowing what the index finger is doing
This is more like the thumb not knowing what the index finger is doing
And it is very appropriate That the spell checker suggest “ do you mean annoying” 4” knowing what the” That is very deep mind indeed!

one of my relatives gave me Nexus 5 phone which was working okay for about a month and then suddenly it started having a problem which has made it almost useless. I am talking about and blank dark screen when a call comes in the only way you can respond to t that call is  by switching off the phone and switching it on and if you are lucky and extremely fast with your fingers you may be able to go to the call in progress otherwise you'll have to call them back.
this problem has been going on for the last two years at least according to the postings on the web forums but so far if you go to the Nexus help  page on Google there is no mention of a solution. I may just have to ditch this Nexus phone and go back to my  old HTC.
So instead of doing "noevil"
put up this slogan
 "stock-market capitalization at any cost"