Informasi Pilihan Perawatan Kesehatan Aternatif

Gejala Rematik (RA) adalah peradangan sendi
kronis yang disebabkan oleh gangguan autoimun. Gangguan ini  terjadi ketika sistem kekebalan tubuh yang
berfungsi sebagai pertahanan terhadap masuknya virus, bakteri, dan jamur, gagal
membedakan jaringan tubuh sendiri dengan benda asing. Sehingga system imun
akhirnya menyerang jaringan tubuh sendiri,

Tips Agar Komputer Tidak Lelet

Komputer yang seperti siput/ lelet kaya mbah-mbah jalan memang bikin jengkel kita. berikut tips agar komputer kita tidak lelet.1. Jangan Memasang program terlalu banyak2. Jangan menggunakan icon terlalu banyak pada destop, karena ini juga Memakan Kapasitas RAM yang      terpakai.3. Defrag hardisk minimal 1 minggu sekali.4. Perhatikan space hardisk5.  Gunakan satu Antivirus dalam satu komputer. Dalam beberapa komputer yang...

5 Hal Sepele Yang Bisa Membuat Wanita Jatuh Cinta

                Wanita memang mudah tersentuh dengan hal-hal yang bersifat sentimentil atau menguras sisi emosionalnya. Bahkan tindakan sekecil apapun, bisa membuat wanita merasa dihargai dan dicintai kekasihnya. Namun, banyak pria yang masih tidak mengerti bagaimana menyenangkan kekasihnya. Padahal, tidak perlu usaha yang sulit untuk membuat wanita merasa dicintai . 1....

Apakah Anak Anda Nakal?

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The New Paleo Diet Study: Paleo-type-style-ish Diets vs. "Paleo"

There's a new Swedish paleo diet study out: A Palaeolithic-type diet causes strong tissue-specific effects on ectopic fat deposition in obese postmenopausal women.  The title sounds promising, but my first reaction to it, sadly, not so much about the potential findings, but, what exactly is this paleo-TYPE diet??  It would appear to be based loosely on Cordain's original Paleo Diet (I hear that's trademarked).  This was a small study,...

From another happy EHR user: automatic data "corrections" that alter the past

From another happy EHR user:One of my patients was married in late 2012.   Her name changed from XXXX to YYYY. Today I incidentally reviewed this patient's chart.Can you guess what name appears on all progress notes (on the LCD screen and in printed form)…going back to early 2007?You guessed it…YYYY…even though her name was XXXX until late 2012.I've also seen this happen with providers.  Example:  an RN received her NP.  When...

Infeksi Kandung Kemih Juga Terjadi pada Pria

... In the NEJM article "The 'Meaningful Use' Regulation for Electronic Health Records", David Blumenthal, M.D., M.P.P. (ONC Chair) and Marilyn Tavenner, R.N., M.H.A. (10.1056/NEJMp1006114, July 13, 2010) available at this link, the opening statement is (emphases mine):

The widespread use of electronic health records (EHRs) in the United States is inevitable. EHRs will improve caregivers’ decisions and patients’ outcomes. Once patients experience the benefits of this technology, they will demand nothing less from their providers. Hundreds of thousands of physicians have already seen these benefits in their clinical practice.

I think it fair to say those are grandiose statements and predictions presented with a tone of utmost certainty in one of the world's most respected scientific medical journals.

Even though it is a "perspectives" article, I once long ago learned that in writing in esteemed scientific journals of worldwide impact, statements of certainty were at best avoided, or if made should be exceptionally well referenced. I note the lack of footnotes showing the source(s) of these statements.

I also note the lack of mention of literature refuting or potentially refuting these statements of certainty. I can think of more than a few examples of the latter just off the top of my head [ref. 1-15 below, certainly not a comprehensive list but merely skimming the surface].

... So, did the NEJM publish fact, or political platitude?

Can someone provide a list of peer reviewed, rigorous studies that back the assertions of certainty in 10.1056/NEJMp1006114, and override the body of literature that could cast doubt on these assertions of certainty?

The negative if not bitter reader comments to yesterday's New York Times article on the health IT lobby (link) certainly cast some doubt.

My respect has dropped several more notches in 2013.

The NEJM has served as a PR journal for health IT once again.

In a correspondence piece "Early Results of the Meaningful Use Program for Electronic Health Records", N Engl J Med 2013; 368:779-780,  February 21, 2013 by Adam Wright, Ph.D., Stanislav Henkin, B.A., Joshua Feblowitz, M.S., Allison B. McCoy, Ph.D., David W. Bates, M.D. and Dean F. Sittig, Ph.D., the following statement is published (emphases mine):

... The downstream effects of meaningful use on quality, safety, and efficiency are not yet known, and further increases in EHR adoption, functionality for clinical decision support systems, and research are needed to ensure the effectiveness of the meaningful use program

I note that Begging the Question is a fallacy in which the premises include the claim that the conclusion is true or (directly or indirectly) assume that the conclusion is true.

Further, I made the following points in my Jan. 2010 post "Meaningfully Experimental Protocols and Interfaces to Nowhere? Nagging Questions On Healthcare IT Remain":

... there is a major problem with the term "meaningful use" itself:

This [term "meaningful use"] is an example of putting the cart before the horse, and is a semantically-based, self contained logical fallacy of sorts. If a health IT system is harmful, the term "meaningful use" is itself Orwellian. If we don't know if HIT is beneficial, or have doubts, then such as term presupposes that health IT is inherently beneficial. A better term would have been "good faith use" - use based on the faith or hope that health IT will have an overall positive effect. The term "meaningful use" jumps the gun and is more a political slogan than a "meaningful term."

I go further. Use of a term that a priori assumes some outcome reflects the antithesis of science. The term "meaningful use" in the domain of technology implies that those following the recipe for use of some technology, as well as their subjects, will experience meaningful outcomes. A parallel is in the logical fallacy of begging the question or circular argument, where the conclusion of an argument is among its premises.

In this current NEJM passage, the "question" of MU effectiveness is shamelessly begged like a hungry puppy begging for a Snausage doggie snack.

"Ensure the effectiveness?"  The inherent assumption is that MU (developed by consensus committee without supporting rigorous evidence of effectiveness), whose 'downstream effects' are admittedly unknown, WILL be effective - if only we spend MORE billions of dollars on the technology.

At best, the appropriate statement to have been made is this:

... The downstream effects of meaningful use on quality, safety, and efficiency are not yet known, and further increases in EHR adoption, functionality for clinical decision support systems, and research are needed to determine if meaningful use will have any positive impact on healthcare quality, safety and efficiency."

From a physician commenter overseas who excels in demolishing health IT propaganda: 

Seriously, did they proof read the last paragraph? How did the NEJM editors let that get printed? 

Given the recent food scandal in the UK, it is like the PM saying we are not quite sure that there's horsemeat in the Burgers and Lasagna so we are going to need to import a lot more of this muck from France, Poland & Romania before drawing any conclusions...

Shame on the New England Journal.  My respect for them is even lower than after the 2010 health IT advert as above.  This current letter's conclusion is a high school-level faux pas and, in my opinion, should not have been published in its present form.

-- SS

Addendum:  Let's see if they publish my Letter to the Editor on this matter, submitted today.

Second addendum:  a reader opined that MU could have a negative impact on quality, safety and efficiency (cf. yesterday's NYT article and reader comments, link).  While less likely, we just don't know.

Addendum Mar. 18, 2013. 

I received this today from the NEJM:

Your letter referring to the Wright article of 21-Feb-2013  has been received.  Because of the limited availability of space, we can publish only a fraction of the letters we receive.  Although we will not be able to print yours, we have forwarded a copy to the authors in case they wish to reply directly to you.

 
This is why I blog.

-- SS

Gejala dan Pengobatan Demam Rematik Pada Anak

Demam Rematik adalah peradangan yang terjadi pada persendian (artritis) dan jantung (karditis), dan banyak terjadi pada anak-anak dengan usia 5-15 Tahun. Demam Rematik Pada Anak disebabkan akibat infeksi streptokokus pada tenggorokan. Dan merupakan suatu reaksi peradangan terhadap infeksi, yang menyerang berbagai bagian tubuh seperti; persendian, jantung dan kulit.Gejala ini akan mening...

Gejala Awal Kanker Prostat yang Mematikan

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