Monday, 18 September 2017

Sleeping well, a determinant of health

There are some health determinants that we can’t do much about such as those that are marked by our genetic endowment, our family, the place where we have to live and the historical moment that is contemporary to us. Other factors, however, are linked to the lifestyle we decide to lead, such as sleeping well (in quantity and quality) a factor that doesn’t yet occupy a prominent place in the collective imagination. However, many studies aim towards common sense: if one sleeps well, the next day is better, and vice versa. That is why I was not surprised by the finding of a Finnish research that associates sleeping insufficient hours with drowsiness and life quality for adolescents or another collected from Harvard Health Publications that limited sleep to five hours a night for one group of students at the Singapore institute for a week and compared their abilities to another group who had slept for nine hours each night, with predictable results of cognitive impairment due to lack of sleep. 

Sleep well and performance at work

A Harvard Business Review article focuses on the link between good sleep and personal performance. The study proves that, if a person is awake for 17 hours (at 11 o'clock at night if she has woken up at 6 o'clock in the morning), her ability to solve problems is reduced in a way equivalent to having a level of 0.05% alcohol in blood. Along the same lines, people who have slept well are twice as effective on several skill tests compared to those who slept less, and even those who have taken a nap score better in creative tests. Given this unsurprising data, it’s strange that we can see very few studies on sleep deprivation and performance among the medical guards. Despite this scientific shortage, work done with the collaboration of a group of Canadian paediatric anaesthetists has proven what we feared: a few simple cognitive tests and mood profiles taken at 7am from anaesthesiologists who came to work from home compared to those on duty have given demolishing results against a model of medical guards that breaks with all physiological logic.

Sleep well and protect against disease

It’s fairly intuitive that sleeping well ought to be healthy, but it’s not until recently that this function to which we dedicate, or ought to, one third of our lives, has attracted the attention of scientists. We have now started seeing published research on the influence of poor sleep as a factor related to the onset of some diseases such as depression, geriatric frailty, falls with fractures, dementia and even tuberculosis, but it has also been noticed that sleep can have an influence (sleep well for positive influence and poor sleep for negative influence) of some treatments such as Parkinson's or chemotherapy for breast cancer.

Tips for Better Sleep

Johns Hopkins experts advise against fighting the myths that many people have about sleep, such as that five or six hours of sleep is enough or the tendency that many people have to seek help from sleeping drugs which create addiction and don’t have a positive impact on the essential circadian rhythms. Harvard, meanwhile, has published 10 tips for sleeping well, which can be found in the original

Science, little by little, comes up with proof that sleeping well or badly is not neutral for people’ health or performance; for this reason, it’s up to the clinical practice to enter everything related to this health determinant into the personal history of the patients, in the health advice that we offer and in the therapeutic proposals that arise from clinical activity. In another order of things, it's obvious that we should change the current model of medical guards and the twelve-hour nursing shifts.

Jordi Varela

Monday, 11 September 2017

Value Based Medicine (VBM)

Evidence-based medicine (EBM), after 25 years, has generated substantial advances in research methodology and has made it possible to distinguish more clearly between good and bad treatments, to identify biases of any order and even evidence of conflicts of interest between research and industry. However, a group of English authors (The importance of values in EBM, Kelly MP 2016) believes that, despite the uncontested advances, EBM has put too much focus on the technical aspects and has forgotten that values ​​have a lot of influence at all stages of the evidence-building processes.

What do we mean when we talk about values?

Science strives to understand the world as it is, but conversely, values ​​are what humans reflect upon. Seen this way, the conflict is served and, therefore EBM should learn to navigate better between these two waters according to the authors of the article quoted below, "Values may act as heuristics – shortcuts in our thinking of which we are barely aware – which get us to quick answers to complicated problems. They form the lens through which we perceive and act on our world. Values are often tricky to pin down because they are such a pervasive part of things we take for granted. A necessary first step towards achieving this is to make our values as explicit as we can, so that we can reflect on them individually and deliberate on them collectively".

Monday, 4 September 2017

Do we need "bonsai" hospitals?

Joan Escarrabill

The ideal size of the hospital and the minimal activity (number of procedures) it has to do to ensure quality is a recurring debate. Sometimes the issue of the hospital size is related to the primary care’s ability to solve and, therefore, the possibility of closing acute beds (and redistributing the budget that was intended for its operation). In the 2009 EESRI edition, in Table 10 (page 21), there’s a very significant information: the number of acute beds per 1,000 inhabitants. According to this document, in Catalonia we have 2.4 beds per 1,000 inhabitants and in the whole of Spain 2.5. Only Turkey (2.3) and Finland (1.9) have fewer beds per 1,000 inhabitants than we do. Despite the data, there are people who insist on the convenience of closing acute beds if the primary care resolution capacity increases. It seems to me that there’s a better question: too many beds or too many hospitals?

Monday, 28 August 2017

Parachute trial: on the subject of knee arthroplasties

The concept "parachute trial" has been adopted to visualize that when a treatment is really effective perhaps one should not invest money in demonstrating what everyone knows, just as no one would think to make an essay on the effectiveness of the parachute. The New England Journal of Medicine has published a clinical trial (Skou 2015) that evaluates the clinical effectiveness of knee arthroplasty, and the journalist of the magazine asks: Did it have to be done? Arthroscopic knee replacements are one of the most significant advances in modern medicine. Everyone knows that many older people who could not leave the house, invalidated by pain, now not only go out every day to the market square but they often go cruising. Seen like this, is this not a "parachute trial"? A waste?

Monday, 21 August 2017

Keep calm and leave the mobile for a while

Josep Mª Monguet

The trade fairs tend to present the technological innovations somewhat passed by the commercial magic, which puts at risk the necessary objectivity to evaluate what they will actually contribute. This is aggravated if we consider that technology is nowadays advancing much faster than human capabilities. As technological innovation progresses exponentially, the adaptive and changing capacity of individuals and organizations is logarithmic.

In general, to take advantage of the new options that technology offers, you have to know where you want to go and what to do to get there; the problem is that we just grope. The good news, however, and the fair is a good exponent, is that so many of us are doing it that the possibilities for progress don’t stop multiplying. Remember Edison when he said he had discovered 10,000 ways of not making a light bulb.

Monday, 14 August 2017

Emergency services specific to the elderly

Elderly care is best resolved at the primary care level, with a geriatric orientation and in a community setting. However, sometimes older people need to go to the emergency room for a variety of reasons, such as a fracture, fibrillation, retention, sudden choking or blockage, to name just a few reasons. What happens then is easy to imagine, the geriatric patient is subjected to a triage that leads to a box full of devices, with many people asking the same things repeatedly, some of them with very little tact and almost always with little respect for intimacy, not to mention the discomfort caused by the racking in the corridor, bells and alarms, noise from machines and monitors, and a long etcetera, that easily produces the disorientation of the elderly patient, or delirium in the worst cases.

Monday, 7 August 2017

Improving by playing

David Font

Volkswagen launched a campaign, The Fun Theory, aiming to improve habits by introducing game techniques. Let's look at an example.

Anna Sort, a nurse, a professor at several universities and an expert in gamification (a new word) in health, in her blog Lost Nurse in the Digital Era defines gamification as "the use of playing techniques in activities that initially contained no play" with the objective of involving people and solving problems. She argues that we are all potential players and that video games have introduced the game into many aspects of our lives. Mechanics such as collecting, awarding points, providing feedback, promoting exchanges or personalizing, favour motivation and involvement. The challenge is to transform any activity into fun and to make the game difficult enough for people to be enthusiastic about solving it, without finding it impossible.