The Checklist Manifesto – by Dr. Atul Gawande
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Dr. Gawande, himself a general surgeon, uses checklists a lot. He is, unequivocally, an expert in his field. He “shouldn’t” need a checklist to tell him to do such things as “Check you have the correct patient”. But checklists are there as a safety net. And, famously, “safety regulations are written in blood”, after all.
And, who amongst us has never made such a “silly” error? From forgetting to turn the oven on, to forgetting to take the handbrake off, it takes only a momentary distraction to think we’ve done something we haven’t.
You may be wondering: why a whole book on this? Is it just many examples of the usefulness of checklists? Because I’m already sold on that, so, what else am I going to get out of it?
Dr. Gawande also explains in clear terms:
- How to optimize “all necessary steps” with “as few steps as possible”
- The important difference between read-do checklists and do-confirm checklists
- To what extent we should try to account for the unexpected
- How to improve compliance (i.e., making sure you actually use it, no matter how tempting it will be to go “yeah this is automatic for me now” and gloss over it)
- The role of checklists in teams, and in passing on knowledge
…and more.
Bottom line: if you’ve ever tried to make tea without putting the tea-leaves in the pot, this is the book that will help you avoid making more costly mistakes—whatever your area of activity or interest.
Click here to check out the Checklist Manifesto, and make fewer mistakes!
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Stretching Scientifically – by Thomas Kurz
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People stretching incorrectly can, even if they don’t injure themselves, lose countless hours for negligible flexibility gains, and put the failure down to their body rather than the method. You can have better.
This book’s all about what works, and not only that, but what works with specific goals in mind, beyond the generic “do the splits” and “touch your toes” etc, which are laudable goals but quite basic. A lot of the further goals he has in mind have to do not just with flexibility, but also functional dynamic strength and mobility, because it’s of less versatile use to have the flexibility only to get folded like laundry and not actually actively do the things you want to.
He does also cover “regardless of age”, so no more worrying that you should have been trained for the ballet when you were eight and now all is lost. It isn’t.
As for the writing style… The author, a physical fitness and rehabilitation coach and writer, wrote this book while at the Academy of Physical Education in Warsaw during the Soviet period, and it shows. It is very much straight-to-the-point, no nonsense, no waffle. Everything is direct and comes with a list of research citations and clear instructions.
Bottom line: if you’ve been trying to improve your flexibility and not succeeding, let this old Soviet instructor have a go.
Click here to check out Stretching Scientifically, and stretch scientifically!
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Body on Fire – by Dr. Monica Aggarwal and Dr. Jyothi Rao
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There are times when you do really need a doctor, not a dietician. But there are also times when a doctor will prescribe something for the symptom, leaving the underlying issue untouched. If only there were a way to have the best of both worlds!
That’s where Drs. Rao and Aggarwal come in. They’re both medical doctors… with a keen interest in nutrition and healthy lifestyle changes to make us less sick such that we have less need to go to the doctor at all.
Best of all, they understand—while some things are true for everyone—there’s not a one-size-fits all diet or exercise regime or even sleep setup.
So instead, they take us hand-in-hand (chapter by chapter!) through the various parts of our life (including our diet) that might need tweaking. Each of these changes, if taken up, promise a net improvement that becomes synergistic with the other changes. There’s a degree of biofeedback involved, and listening to your body, to be sure of what’s really best for you, not what merely should be best for you on paper.
The writing style is accessible while science-heavy. They don’t assume prior knowledge, and/but they sure deliver a lot. The book is more text than images, but there are plenty of medical diagrams, explanations, charts, and the like. You will feed like a medical student! And it’s very much worth studying.
Bottom line: highly recommendable even if you don’t have inflammation issues, and worth its weight in gold if you do.
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Feminist narratives are being hijacked to market medical tests not backed by evidence
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Corporations have used feminist language to promote their products for decades. In the 1980s, companies co-opted messaging about female autonomy to encourage women’s consumption of unhealthy commodities, such as tobacco and alcohol.
Today, feminist narratives around empowerment and women’s rights are being co-opted to market interventions that are not backed by evidence across many areas of women’s health. This includes by commercial companies, industry, mass media and well-intentioned advocacy groups.
Some of these health technologies, tests and treatments are useful in certain situations and can be very beneficial to some women.
However, promoting them to a large group of asymptomatic healthy women that are unlikely to benefit, or without being transparent about the limitations, runs the risk of causing more harm than good. This includes inappropriate medicalisation, overdiagnosis and overtreatment.
In our analysis published today in the BMJ, we examine this phenomenon in two current examples: the anti-mullerian hormone (AMH) test and breast density notification.
The AMH test
The AMH test is a blood test associated with the number of eggs in a woman’s ovaries and is sometimes referred to as the “egg timer” test.
Although often used in fertility treatment, the AMH test cannot reliably predict the likelihood of pregnancy, timing to pregnancy or specific age of menopause. The American College of Obstetricians and Gynaecologists therefore strongly discourages testing for women not seeking fertility treatment.
The AMH test can’t predict your chance of getting pregnant.
Anastasia Vityukova/UnsplashDespite this, several fertility clinics and online companies market the AMH test to women not even trying to get pregnant. Some use feminist rhetoric promising empowerment, selling the test as a way to gain personalised insights into your fertility. For example, “you deserve to know your reproductive potential”, “be proactive about your fertility” and “knowing your numbers will empower you to make the best decisions when family planning”.
The use of feminist marketing makes these companies appear socially progressive and champions of female health. But they are selling a test that has no proven benefit outside of IVF and cannot inform women about their current or future fertility.
Our recent study found around 30% of women having an AMH test in Australia may be having it for these reasons.
Misleading women to believe that the test can reliably predict fertility can create a false sense of security about delaying pregnancy. It can also create unnecessary anxiety, pressure to freeze eggs, conceive earlier than desired, or start fertility treatment when it may not be needed.
While some companies mention the test’s limitations if you read on, they are glossed over and contradicted by the calls to be proactive and messages of empowerment.
Breast density notification
Breast density is one of several independent risk factors for breast cancer. It’s also harder to see cancer on a mammogram image of breasts with high amounts of dense tissue than breasts with a greater proportion of fatty tissue.
While estimates vary, approximately 25–50% of women in the breast screening population have dense breasts.
Dense breasts can make it harder to detect cancer.
Tyler Olsen/ShutterstockStemming from valid concerns about the increased risk of cancer, advocacy efforts have used feminist language around women’s right to know such as “women need to know the truth” and “women can handle the truth” to argue for widespread breast density notification.
However, this simplistic messaging overlooks that this is a complex issue and that more data is still needed on whether the benefits of notifying and providing additional screening or tests to women with dense breasts outweigh the harms.
Additional tests (ultrasound or MRI) are now being recommended for women with dense breasts as they have the ability to detect more cancer. Yet, there is no or little mention of the lack of robust evidence showing that it prevents breast cancer deaths. These extra tests also have out-of-pocket costs and high rates of false-positive results.
Large international advocacy groups are also sponsored by companies that will financially benefit from women being notified.
While stronger patient autonomy is vital, campaigning for breast density notification without stating the limitations or unclear evidence of benefit may go against the empowerment being sought.
Ensuring feminism isn’t hijacked
Increased awareness and advocacy in women’s health are key to overcoming sex inequalities in health care.
But we need to ensure the goals of feminist health advocacy aren’t undermined through commercially driven use of feminist language pushing care that isn’t based on evidence. This includes more transparency about the risks and uncertainties of health technologies, tests and treatments and greater scrutiny of conflicts of interests.
Health professionals and governments must also ensure that easily understood, balanced information based on high quality scientific evidence is available. This will enable women to make more informed decisions about their health.
Brooke Nickel, NHMRC Emerging Leader Research Fellow, University of Sydney and Tessa Copp, NHMRC Emerging Leader Research Fellow, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Nutrition To Combat Lymphedema & Lipedema
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Dr. Kelly Sturm is a rehab specialist (Doctor of Physical Therapy), and also a certified lymphedema therapist. Here’s what helps her patients with lymphedema and lipedema:
Don’t fan the flames
Lymphedema and lipedema are inflammatory lymphatic diseases affecting mostly women. As such, an anti-inflammatory diet will be important, but there are other factors too:
- Anti-inflammatory diet: this is to reduce the chronic inflammation associated with lymphatic diseases. This means eating plenty of fruit and vegetables, especially berries and leafy greens, and avoiding things like sugar, alcohol, caffeine, and processed foods. And of course, don’t smoke.
- Intermittent fasting: this also helps by giving the body a chance to correct itself; when the body isn’t digesting food, it has a lot more resources to devote to its favorite activity: maintenance. This results in lower inflammation, and better fat redistribution.
- Weight loss: not a bandwagon we often get on at 10almonds as it’s rarely the most important thing, but in this case it is of high importance (second only to dealing with the inflammation), as excess weight around the lymph nodes and vessels can lead to dysfunction and swelling. Thus, reducing the weight can ease that and allow the body to heal.
For more details on all of the above, enjoy:
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Want to learn more?
You might also like to read:
- Eat To Beat Inflammation ← also some non-dietary advice in there too
- Ask Not What Your Lymphatic System Can Do For You…
- Lose Weight, But Healthily ← more useful than just trying to run a calorie deficit
Take care!
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Alzheimer’s may have once spread from person to person, but the risk of that happening today is incredibly low
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An article published this week in the prestigious journal Nature Medicine documents what is believed to be the first evidence that Alzheimer’s disease can be transmitted from person to person.
The finding arose from long-term follow up of patients who received human growth hormone (hGH) that was taken from brain tissue of deceased donors.
Preparations of donated hGH were used in medicine to treat a variety of conditions from 1959 onwards – including in Australia from the mid 60s.
The practice stopped in 1985 when it was discovered around 200 patients worldwide who had received these donations went on to develop Creuztfeldt-Jakob disease (CJD), which causes a rapidly progressive dementia. This is an otherwise extremely rare condition, affecting roughly one person in a million.
What’s CJD got to do with Alzehimer’s?
CJD is caused by prions: infective particles that are neither bacterial or viral, but consist of abnormally folded proteins that can be transmitted from cell to cell.
Other prion diseases include kuru, a dementia seen in New Guinea tribespeople caused by eating human tissue, scrapie (a disease of sheep) and variant CJD or bovine spongiform encephalopathy, otherwise known as mad cow disease. This raised public health concerns over the eating of beef products in the United Kingdom in the 1980s.
Human growth hormone used to come from donated organs
Human growth hormone (hGH) is produced in the brain by the pituitary gland. Treatments were originally prepared from purified human pituitary tissue.
But because the amount of hGH contained in a single gland is extremely small, any single dose given to any one patient could contain material from around 16,000 donated glands.
An average course of hGH treatment lasts around four years, so the chances of receiving contaminated material – even for a very rare condition such as CJD – became quite high for such people.
hGH is now manufactured synthetically in a laboratory, rather than from human tissue. So this particular mode of CJD transmission is no longer a risk.
Human growth hormone is now produced in a lab.
National Cancer Institute/UnsplashWhat are the latest findings about Alzheimer’s disease?
The Nature Medicine paper provides the first evidence that transmission of Alzheimer’s disease can occur via human-to-human transmission.
The authors examined the outcomes of people who received donated hGH until 1985. They found five such recipients had developed early-onset Alzheimer’s disease.
They considered other explanations for the findings but concluded donated hGH was the likely cause.
Given Alzheimer’s disease is a much more common illness than CJD, the authors presume those who received donated hGH before 1985 may be at higher risk of developing Alzheimer’s disease.
Alzheimer’s disease is caused by presence of two abnormally folded proteins: amyloid and tau. There is increasing evidence these proteins spread in the brain in a similar way to prion diseases. So the mode of transmission the authors propose is certainly plausible.
However, given the amyloid protein deposits in the brain at least 20 years before clinical Alzheimer’s disease develops, there is likely to be a considerable time lag before cases that might arise from the receipt of donated hGH become evident.
When was this process used in Australia?
In Australia, donated pituitary material was used from 1967 to 1985 to treat people with short stature and infertility.
More than 2,000 people received such treatment. Four developed CJD, the last case identified in 1991. All four cases were likely linked to a single contaminated batch.
The risks of any other cases of CJD developing now in pituitary material recipients, so long after the occurrence of the last identified case in Australia, are considered to be incredibly small.
Early-onset Alzheimer’s disease (defined as occurring before the age of 65) is uncommon, accounting for around 5% of all cases. Below the age of 50 it’s rare and likely to have a genetic contribution.
Early onset Alzheimer’s means it occurs before age 65.
perfectlab/ShutterstockThe risk is very low – and you can’t ‘catch’ it like a virus
The Nature Medicine paper identified five cases which were diagnosed in people aged 38 to 55. This is more than could be expected by chance, but still very low in comparison to the total number of patients treated worldwide.
Although the long “incubation period” of Alzheimer’s disease may mean more similar cases may be identified in the future, the absolute risk remains very low. The main scientific interest of the article lies in the fact it’s first to demonstrate that Alzheimer’s disease can be transmitted from person to person in a similar way to prion diseases, rather than in any public health risk.
The authors were keen to emphasise, as I will, that Alzheimer’s cannot be contracted via contact with or providing care to people with Alzheimer’s disease.
Steve Macfarlane, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Staying Strong: Tips To Prevent Muscle Loss With Age
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Dr. Andrea Furlan, specialist in physical medicine and rehabilitation with 30 years of experience, has advice:
Fighting sarcopenia
Sarcopenia is so common as to be considered “natural”, but “natural” does not mean “obligatory” and it certainly doesn’t mean “healthy”. As for how to fight it?
You may be thinking “let us guess, is it eat protein and do resistance exercises? And yes it is, but that’s only part of it…
Firstly, she recommends remembering why you are doing this, or because understanding is key to compliance (i.e. your perfect diet and exercise program will mean nothing if you don’t actually do it, and you won’t do it enough to make it a habit, let alone keep it up, if the reasons aren’t clear in your mind).
Sarcopenia comes with an increased risk of falls, reduced physical capacity in general, resultant disability, social isolation, and depression. Of course, this is not a one-to-one equation; you will not necessarily become depressed the moment your muscle mass is below a certain percentage, but statistically speaking, the road to ruin is laid out clearly.
Secondly, she recommends being on the lookout for it. If you check your body composition regularly with a gadget, that’s great and laudable; if you don’t, then a) consider getting one (here’s an example product on Amazon), and b) watch out for decreased muscle strength, fatigue, reduced stamina, noticeable body shape changes with muscle loss and (likely) fat gain.
Thirdly, she recommends more than just regular resistance training and good protein intake. Yes, she recommends those things too, but also getting enough water (can’t rebuild the body without it), avoiding a sedentary lifestyle (sitting leads to atrophy of many supporting and stabilizing muscles, you know, the kind of muscles that don’t look flashy but stop you falling down), and getting good sleep—vital for all kinds of body maintenance, and muscle maintenance is no exception (there’s a reason bodybuilders sleep 9–12 hours daily when in a gaining phase; you don’t need to do that, but don’t skimp on your 7–9 hours, yes, really, even you, yes, at any age).
Lastly, she recommends continuing to learn about the topic, as otherwise it’s easy to go off-track.
For more information on all of the above and more, enjoy:
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Want to learn more?
You might also like to read:
- Protein: How Much Do We Need, Really?
- Resistance Is Useful! (Especially As We Get Older)
- Resistance Beyond Weights
- HIIT, But Make It HIRT ← this is about high-intensity resistance training (HIRT); confusing the muscles like one confuses the heart in HIIT, which thus yields improved results
- Sleep: Yes, You Really Do Still Need It
Take care!
Don’t Forget…
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