We have begun to outline a consciousness-centered perspective on mental disorders, both those determined by defects in large-scale brain connectivity, and possibly by related failures of embedding goal contexts to constrain the topological dynamics of the global workspace. Further work in this direction might well focus on characterizing specific disorders from this viewpoint, and designing experiments to test such characterizations.Equation 9 and the arguments surrounding it, however, already provide, in the context of mental disorders, quite a ‘hard science’ basis for the evolutionary anthropologist Robert Boyd’s oft-repeated assertion that “culture is as much a part of human biology as the enamel on our teeth.”Not only culture and socioeconomic status, but historical trajectory, power relations between individuals and groups, and the effects of public policy, will write images of themselves onto the fundamental topology of individual consciousness, too frequently defining paths of debilitating developmental disorder which can blight lives.
via Theoretical Biology and Medical Modelling | Full text | A Global Workspace perspective on mental disorders, by Rodrick Wallace, Theoretical Biology and Medical Modelling 2005, 2:49.
Yes! Exactly. More on this later.
optical communicationsABSTRACT: Medical practice lacks a foundation in scientific behavior corresponding to its foundation in scientific knowledge. The missing foundation involves standards of care to govern how practitioners manage clinical information. These standards of care, roughly analogous to accounting standards for managing financial information, are essential to exploit the enormous potential of health information technology. Moreover, without these standards and corresponding information tools, evidence-based medicine in its current form is unworkable. Medical practice has failed to adopt the necessary standards and tools, because its historical development has diverged from the paths taken in the domains of science and commerce. The culture of medicine tolerates unnecessary dependence on the personal intellects of practitioners. This dependence has blocked the use of potent information tools, and isolated medicine from forces of feedback and accountability, that operate in the domains of science and commerce. If the necessary standards and tools are adopted, health care cost and quality could become an arena of continuous improvement, rather than a quagmire of intractable dilemmas.
via The Health Care Blog: Medicine’s Missing Foundation for Health Care Reform.
Emory’s recent quality initiatives are striving to plug the holes in the Swiss cheese by borrowing a page from an unlikely source—a car manufacturer. Specifically, Emory is adopting the LEAN process-improvement program originally developed by Toyota. In a nutshell, LEAN is a philosophy committed to customer service, elimination of waste, and continuous improvement. It provides tools to intentionally and thoughtfully design processes to meet these goals.
“The manufacturing industry has done a great job in pioneering many of these principles,” says Hal Jones, director of quality support services for Emory Healthcare. “For example, those of us who are prone to locking our keys in the car are grateful to car companies for building processes that now make that virtually impossible. We, in health care, need to learn to do the same thing—to build processes that make it virtually impossible not to do the right thing.”
To follow the LEAN model, health care needs to standardize processes as much as possible, quite a switch for an industry built on autonomy and individual accountability. “This philosophy definitely goes against the grain of what many of us have learned over the years,” says Bornstein. “Also, critics say health care is not the same as making cars or widgets. That is absolutely true. Patients are individuals. But there can be some similarities between making cars and treating patients. If, for example, we decide that every patient who meets certain criteria should get a flu shot, then we can use manufacturing and”Any doctor in our system can give you a personal example of the electronic prescription writer catching a medication error that was about to be made.” says Penny Castellano, CQO of The Emory Clinic production principles to achieve that goal. And we can reach a higher success rate with that approach than if we wait until we see each patient and then decide on the fly.”
via Momentum – Cookbook Medicine.
Look at him go!
I'm sorry that we have not been able to provide the medical services that we decide are needed. I called your insurance company and talked with a nurse, who told me that the test was not medically necessary. I guess I should have been a nurse so I could make the decisions needed for your health care. I'm sorry that the medical review director of the insurance company left the office at 3 pm that day so I couldn't talk to them and tell them it was medically necessary for the tests I wanted to do to get done right away. I'm sorry that you ended up in the ER at 2 am with a ruptured appendix. I'm sorry you stayed in the hospital an extra week because your appendix ruptured and you are still off work. I'm sorry your insurance company only wants to pay for 3 days of hospitalization when you were still throwing up, not eating, and requiring IV pain medication on that day. I'm sorry they wouldn't cover your medication I sent you home on.
via The Unconventional Doctor.
From tretinoin and retinoids in preventing skin aging to telomeres as the ultimate cause and target of all aging, dermatologist Dr. Gilchrest provides a thoughtful and insightful look into her research at Boston University studying aging in skin cells.
Link: Pieces of the Puzzle: An Interview with Barbara Gilchrest, MD.
Journal of Anti-Aging Medicine. 5:153-159, 2002.
