Lot of news and views; but nothing on security breach in the parliament yesterday; is it media gathered 6 or kalisthan or cong protocol; and security failed to check the dresses and shoes is grave , gad it be tools of murders. Kanimozhi was blaming shortness of balcony but it is the sleeping over by securities deserving hanging till death. KR IRS 141223
---------- Forwarded message --------- From: Rangarajan T.N.C. <[email protected]> Date: Thu, 14 Dec 2023 at 09:32 Subject: Fw: {P}rescription - #12 To: ----- Forwarded message ----- *From:* Arjun Rajagopalan from {P}rescription <[email protected]> *To:* "[email protected]" <[email protected]> *Sent:* Wednesday, 13 December, 2023 at 11:00:26 am IST *Subject:* {P}rescription - #12 13 December, 2023 Forwarded this email? 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There are many similar cautionary epigrams that are familiar to doctors: "*The safest unit of blood is the one that is not administered*"; and not to forget, Oliver Wendell Holmes admonition that if mankind were to throw all the medicines and drugs that were available to it into the ocean, it would be so much the better for humanity and so much the worse for the fish! Even in the best of institutions, under the care of the best doctors and health care professionals, complications can arise, subjecting patients to emotional and financial consequences and, in extreme cases, even death. *There's a word for that:* *Iatrogenic*. In docspeak, the word refers to harm caused by a treatment or intervention, outweighing its intended benefits. *"Iatrogenic amplification."* This is a process wherein well-meaning efforts to rectify a problem inadvertently make it worse. Unintended negative consequences may arise when medical interventions result in new health complications and unforeseen challenges. *Like lemmings over a cliff.* Medical errors often occur as a cascade of events, each successive one compounding the effects of the previous. Healthcare professionals often come armed with solutions to solve first-order consequences of a decision but create worse second- and subsequent-order consequences. *Yet another term.* Nassim Taleb, the well-known, vocal, essayist, mathematician, and author, labels people who often intervene without fully understanding the consequences as “*interventionistas*.” In recent years, there has been a lot of noise about the need to institute procedures and fail-safe mechanisms to reduce medication-induced errors and mishaps that are the consequence of treatment. There is no denying the need for such an effort. Where are the nodes for error? Errors in healthcare delivery can arise from a variety of factors. Some of the most common reasons include: 1. *Medication errors*: These are easily the most common healthcare mistakes. Recent studies suggest that they are at the top of the list of causes of death during hospitalisation. 2. *Communication failures*: Studies indicate that communication failures are responsible for almost a third of malpractice claims, both between health professionals and with the patient. 3. *Diagnostic errors*: Despite the precision and accuracy of modern diagnostic, testing and reporting errors are one of the leading causes of medical malpractice claims. 4. *Handoff errors*: Errors during the transfer of patient care can lead to adverse events. The most common situation is when patients are transferred from high-intensity care units to general wards. Research suggests that up to 80% of serious medical errors involve miscommunication during handoffs between medical providers. 5. *Surgical errors*: These include wrong-site surgery, wrong patient surgery, and retained surgical items. Although they are rare, these events are significant. (We will talk about this further down in this essay.) 6. *Patient misidentification*: This can lead to medication errors, transfusion errors, and diagnostic testing errors. The consequences don't need elaboration. 7. *Healthcare-Acquired Infections (HAIs)*: Formerly known as "nosocomial infections," these complications are usually caused by highly antibiotic-resistant, invasive microorganisms. Deaths from HAIs are the leading cause of mortality after surgery. 8. *Failure to Follow Protocols and Checklists*: Non-adherence to established protocols can lead to preventable errors. For instance, not following surgical safety checklists can increase the risk of surgical complications. 9. *Systemic issues*: Factors like understaffing, inadequate resources, and administrative problems can contribute to errors. Nurse understaffing has been linked to an increase in healthcare errors and patient mortality. 10. *Technology-related Errors*: While technology improves healthcare delivery, it can also be a source of errors, especially with electronic health records and medication ordering systems. This list highlights the complexity of healthcare delivery and the importance of multi-faceted approaches to improve patient safety and reduce errors. Let's look at some. An ounce of prevention ... *Enter, Dr. Atul Gawande and his checklist.* People, especially doctors and healthcare professionals, get intensely annoyed when their knowledge of the steps in any procedure is questioned. Yet, it's the simple, repetitive, "mindless" tasks that are commonly the points where the error cascade starts. We will always remember the "big stuff"; it's the "small stuff" that will trip us up. Dr. Atul Gawande <https://link.sbstck.com/redirect/0aba24bd-6264-4f9a-9b75-42706ce4d40f?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4>, a well-known surgeon, writer, and public-health activist, was inspired to develop the surgical checklist concept from the aviation industry, which has a long history of using checklists to ensure safety. The success of these checklists in reducing errors and improving outcomes in the high-stakes environment of aviation led Gawande and his colleagues to explore how a similar approach could be applied in medicine, specifically in surgery. He aimed to create a simple yet effective tool to help surgical teams manage complexity and reduce the likelihood of human error. *The surgical checklist.* The check list is split into 3 stages, each with a small list of items to check. They are entered: - Before anaesthesia is given for the procedure. - Before the surgical incision is made. - Before the patient leaves the operating room. Here's what the checklist looks like. <https://link.sbstck.com/redirect/a211e8bf-319c-48fb-9b51-968ae190b133?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4> Surgical Safety Checklist *Proof of the pudding.* Dr. Gawande's preliminary study, reported in the prestigious New England Journal of Medicine, was conducted in eight hospitals around the world and found a decrease in major complications from 11% to 7% and in deaths from 1.5% to 0.8%. This is a huge success story. And to think, the technology was entirely pen-and-paper-based. Several subsequent studies have confirmed these results. *A star is born.* This idea was further developed and tested through a collaboration with the World Health Organization (WHO), leading to the creation of the Surgical Safety Checklist, which has since been implemented in hospitals worldwide with significant success in reducing complications and improving patient outcomes. (Dr. Gawande's bestseller, *The Checklist Manifesto*, is well worth reading) Offshoots and adaptations of the surgical checklist The success of this simple intervention in surgery led to the adoption of similar lists in clinical situations with a high potential for error. Some notable examples include: 1. ICU checklists - there are a whole range of them, considering the complexity of care in an ICU. 2. Emergency Room (ER) checklists - same situation as ICUs. 3. Medication management. 4. Patient handoff checklists. 5. Infection control Checklists. 6. Preoperative evaluation checklists. 7. Maternity and childbirth Checklists. 8. Preventive health checklists. These are used in primary care to ensure that patients receive all recommended preventive services, such as vaccinations, screenings, and health counselling, according to their age, gender, and health status. These examples illustrate the widespread adoption of checklists in healthcare, reflecting their effectiveness in improving patient safety, enhancing communication, and standardising care across various medical settings. Lessons in humility *"Guilty, afraid, and alone"* In the archives of the venerated New England Journal of Medicine (October 25, 2007), there is a "Perspective" piece by Drs. Delbanco and Bell that looks at the problem of treatment gone amiss from a unique and human perspective, provocatively titled "*Guilty, Afraid, and Alone: Struggling with Medical Error*." They begin by pointing out that efforts at reducing errors in medical practice have preferred to view the problem from the point of view that to err is human, while "little attention has been paid to the second half of the adage "to forgive, divine." In this well-written piece that can be read by anyone, despite it being published in the NEJM, the authors describe their experience with interviewing patients who had been victims of errors in the system. *First, the fear.* Of the three portions of the heading, fear is easily understandable. Doctors are afraid of facing up to the ire of patients and their families; patients are afraid of the outcome of the unforeseen event. The other two elements, guilt and loneliness, appear to have complex dimensions. *Then, guilt.* One can understand guilt on the part of the medical profession, but the authors highlight that there is an equally large burden that patients carry, particularly those who have taken decisions on behalf of others, typically children and the elderly. There is no attempt made to support them and counsel them through the emotion. *Isolation follows.* Those interviewed repeatedly pointed out their sense of loneliness. Care givers become formal, tight-lipped, and remote; the patient is treated like one who needs to be isolated in the interest of limiting the contagion. At a time when patients expect communication channels to be wide open, the opposite happens. One person is quoted as saying, "I was frightened to complain any more.... I was scared that I would get more mistreated." *The truth, the whole truth ...* It seems that most patients are not so much interested in getting redress for damages as in being treated honestly, openly, and with a sense of being human—doctors and patients alike. *"Sorry seems to be the hardest word."* Time and again, care givers react to errors by being evasive to various degrees, quite often even resorting to distortions of the truth and outright fabrications. The best approach under these circumstances would be to ask for forgiveness. "Yes, things went wrong under my care; this is what happened; I am sorry that it had to be this way." will defuse this explosive, highly charged situation more effectively than tinkering with systems and policies. A wonderful article; read it. (You can download a PDF of the article here <https://link.sbstck.com/redirect/4819d922-21e1-4c2c-9d36-e4b4ed6f9329?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4>—free access.) There will never be a time when healthcare is completely error-free. Doctors are human, and humans make mistakes. But it is equally a part of human nature to reflect on past errors and change behaviour in an effort to avoid future repeats. "*Primum non nocere*"—first, do no harm—was the entreaty of the greatest of physicians, Hippocrates. Good doctors and healthcare systems will strive constantly to live by this dictum. ------------------------------ ------------------------------ <https://link.sbstck.com/redirect/fb341bf8-f741-448c-88bb-89587bb76bc1?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4> ------------------------------ <https://link.sbstck.com/redirect/91cd1dae-6cbf-49ef-beee-0852d97d381a?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4> Chat GPT on its first birthday *🄿🅁🄾🄳🅄🄲🅃🄸🅅🄸🅃🅈* ChatGPT on its first birthday No question at all; this was the year of ChatGPT. Imitators have poured in, but it remains the "Coke/ iPhone/ Xerox" in terms of top-of-the-mind recall. Doomsayers have been swamping the airwaves, but I think that it is here to stay. I must confess that my Googling has come down significantly. The user-friendly chat-based interface of ChatGPT has played an important role in its success. Similar to past technical achievements such as Google and the iPhone, this approach to Artifical Intelligence, emphasising stark simplicity of the interface and ease of interaction, has been critical in promoting its mainstream acceptance. Speaking for myself, it's greatest value lies in making exceptional summaries of articles—a productivity tool par excellence. Rather than killing creative writing, I think it will enhance the quality of good writers. Here’s The Atlantic’s opinion. *One Year in, ChatGPT's Legacy Is Clear <https://link.sbstck.com/redirect/b0140a1e-c07a-41ae-ab37-aac615031fd3?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4>* *Warzel C, The Atlantic. December, 2023* ------------------------------ 𝕄𝕪 𝕥𝕒𝕜𝕖-𝕒𝕨𝕒𝕪𝕤 𝕗𝕣𝕠𝕞 𝕥𝕙𝕚𝕤 𝕒𝕣𝕥𝕚𝕔𝕝𝕖 - *Disruption of day-to-day writing*: ChatGPT has significantly impacted academic settings by altering traditional essay writing methods and challenging professors. It's also moonlighting as a book writer, political pundit, and summary maestro. - *Jack-of-All-Trades Bot*: ChatGPT is the Swiss Army knife of tech. ChatGPT is flexible and has been integrated into various aspects of daily life, from internet search to performing tasks that could potentially replace human labor, raising concerns about its impact on jobs and human interaction. - *Unexpected popularity*: Contrary to OpenAI's initial expectations of limited interest, ChatGPT gained immense popularity, reaching 1 million users within five days of launch, and has been used for a variety of tasks, including writing, debugging code, and assisting in small tasks. - *Brainy sidekick*: The tool is viewed as a "thinking companion," helping in summarising texts, brainstorming, and suggesting approaches to problems, indicating its potential to change the way we think and work. - *Cultural impact and future Potential*: Despite its limitations, ChatGPT's real legacy lies in its role as a cultural symbol and proof of concept for generative AI, signalling a shift towards more advanced AI technologies and their impact on society and culture. 🇪🇳🇩🇶🇺🇴🇹🇪 *“Computers can never completely replace humans. They may become capable of artificial intelligence, but they will never master real stupidity.”― Garrison Keillor* ------------------------------ ------------------------------ <https://link.sbstck.com/redirect/53ca7e7a-9e0c-4b00-b92d-28835c4c8dab?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4> What is time, really? *🄿🅁🄾🄳🅄🄲🅃🄸🅅🄸🅃🅈* What is time, really? It's in front of us, as plain as our noses, yet no one has a handle on what it really is. *The physical and philosophical problem of time <https://link.sbstck.com/redirect/df927588-4139-490e-acbd-bcedcb18ca8f?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4>* *Gleiser M, Big Think. November 2023* ------------------------------ 𝕄𝕪 𝕥𝕒𝕜𝕖-𝕒𝕨𝕒𝕪𝕤 𝕗𝕣𝕠𝕞 𝕥𝕙𝕚𝕤 𝕒𝕣𝕥𝕚𝕔𝕝𝕖 - *The tricky trio of time:* Time is currently considered to operate in three parts: the past, present, and future. The most difficult concept is the "present," which is a mathematically defined, imperceptible point in time. It's basically winking at us out of nowhere while we're busy searching for it. Theories from Einstein (relativity altering time perception) and Newton (absolute time) dominate our present knowledge. - *Einstein’s time-bending gymnastics:* Einstein's theories, particularly the special theory of relativity, first presented the concept that time varies with relative motion, expanding and contracting based on speed. Numerous scientific investigations have verified this truth. Furthermore, cognitive research has demonstrated that rather than being a discrete instant in time, our sense of the "now" is a mental construct. - *The Cosmic Clock conundrums:* Understanding the origin of the universe, particularly in relation to the Big Bang, is akin to resolving a massive enigma. For scientists who are interested in time, it presents a significant hurdle. Their understanding of time shifts as they gain greater insight into the possible nature of the universe in the far future, from the vast expanses of space to the ordinary moments of our lives. 🇪🇳🇩🇶🇺🇴🇹🇪 *“All we have to decide is what to do with the time that is given us.” ― J.R.R. Tolkien* ------------------------------ ------------------------------ <https://link.sbstck.com/redirect/88e6579e-5f4a-4ba4-8ee8-ec124fbbca67?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4> The population bust 🄴🅃🄲⊡ The population bust Malthusian doomsaying reached its peak in the 1960s. In 1968, the noted scientist Paul Ehrlich wrote a book called "The Population Bomb" that predicted a dire future for humanity from the population explosion. In 1972, The Club of Rome, an organisation of scientists, economists, businessmen, international civil servants, and heads of state, published a report titled “The Limits to Growth.” This report expressed an equally negative outlook on the long-term implications of continued population growth and the use of natural resources. It's now the 2020s—a good half century on. They couldn't have been more wrong. Although this article pertains to advanced economies, the shift is evident globally, even in poor countries of Africa and Asia. The southern states of India reached a net replacement rate of 2.1 almost two decades ago. It’s no accident that the GDP of these states is several times that of the Indian average. *You can’t even pay people to have more kids <https://link.sbstck.com/redirect/1524aca2-1cac-406e-a534-649465234d33?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4>* *North A, Vox. November 2023* ------------------------------ 𝕄𝕪 𝕥𝕒𝕜𝕖-𝕒𝕨𝕒𝕪𝕤 𝕗𝕣𝕠𝕞 𝕥𝕙𝕚𝕤 𝕒𝕣𝕥𝕚𝕔𝕝𝕖 - *The global baby bust.* From Taiwan to Texas, birth rates are in free fall. Governments are throwing everything at the problem, but with hardly any impact. - *... and statistics.*- Taiwan's worryingly low 0.87 birth rate.- Italy's grim ratio of 12 deaths for every 7 births.- South Korea is down to just 0.81 kids per woman. - *Please, pretty please.* Governments have employed various strategies, such as paid parental leave, child care investment, cash benefits, and even unconventional methods like singles mixers and pet incentives, to encourage childbearing. Despite these efforts, birth rates continue to fall.- Taiwan is throwing over $3 billion to persuade its citizens to procreate. - Austria’s maternity leave got a boost to 2.5 years.- Russia dangles about $7,000 for a third child. - *Personal freedom versus producing babies.* The decline in birth rates is partly due to increased opportunities and freedoms, especially for women. High costs of childrearing and a shift in societal norms contribute to fewer people choosing to have children. - *Time for Plan B.* Experts suggest that instead of focusing on increasing birth rates, policies should support individuals in forming the families they desire. With rising costs of childcare cited as a reason for smaller families, it's time for a shift from quantity to quality. This includes investing in health care, education, and family support systems. Adapting to ageing populations may be a more sustainable approach. Maybe it's time to focus on making the planet a better place for the little ones we already have instead of trying to turn back the clock to the baby boom era. ------------------------------ 🇪🇳🇩🇶🇺🇴🇹🇪 *“Expensive restaurants have bigger gaps between the tables. First class on airplanes has no middle seats. Exclusive hotels have separate entrances for guests staying in suites. The most expensive thing you can buy in the most densely populated places on the planet is distance.” ― Fredrik Backman* *“Beyond a critical point within a finite space, freedom diminishes as numbers increase. This is as true of humans as it is of gas molecules in a sealed flask. The human question is not how many can possibly survive within the system, but what kind of existence is possible for those who so survive.” ― Frank Herbert* ------------------------------ *SECOND HELPINGS* Good reading from all over 🄷🄴🄰🄻🅃🄷 *Obesity drugs are giving new life to BMI <https://link.sbstck.com/redirect/3da313b1-4c57-4dd4-bd59-2bab47295e84?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4>* *Miniature organs on chips could revolutionize health-care research <https://link.sbstck.com/redirect/42dc950b-766a-4f62-9495-0c1c1ae621b8?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4>* 🅆🄴🄻🄻🄽🄴🅂🅂 *How fast you need to walk to get real health benefits <https://link.sbstck.com/redirect/ace22534-d7c8-4675-b4ff-bccb36dabaf5?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4>* *'I can see the characters': how reading aloud to patients can break through 'cancer fog' <https://link.sbstck.com/redirect/23fc11ae-a264-456c-b522-f8a61f3874a5?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4>* 🄿🅁🄾🄳🅄🄲🅃🄸🅅🄸🅃🅈 *Neuroscience says one rather brainless activity can lower your stress and make you more productive <https://link.sbstck.com/redirect/9fc8b28b-9ea1-4222-bf2f-36ce2d370560?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4>* *Social media is not heroin <https://link.sbstck.com/redirect/6c455bb7-5325-499f-a77c-83c7f83e50da?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4>* 🄴🅃🄲⊡ *The first results from the world’s biggest basic income experiment <https://link.sbstck.com/redirect/a96dba52-0a5f-401b-8806-bf80762ee8e0?j=eyJ1IjoiMTlsYTgifQ.iTlMSa-ofU8MMajUMPC1aviBRNI5n2E7LFUtNlNs1L4>* ------------------------------ Subscribed <https://substack.com/redirect/2/eyJlIjoiaHR0cHM6Ly9wNGxpZmUuc3Vic3RhY2suY29tL2FjY291bnQiLCJwIjoxMzk2NjQ2MDUsInMiOjE5MDE3MjUsImYiOnRydWUsInUiOjIxMjcxMDQsImlhdCI6MTcwMjQ0NTQyMCwiZXhwIjoxNzA1MDM3NDIwLCJpc3MiOiJwdWItMCIsInN1YiI6ImxpbmstcmVkaXJlY3QifQ.T1Q0IidYQql_W_udRxy1bqgiC0LNDU_Ubm7TqRYg6x4?> If you like {P}rescription, please share it with your friends. 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