#i want to be in the clinical phase of my cohort

[juuheizou]

not to be egotistical but writing is such a case of 'love the product, hate the process' no matter what kind

[hillarykylie]

y’all it honestly annoys me so much when people think me suffering from Borderline Personality Disorder and my host of other mental health issues is a “choice”. - all of them are intertwined btw

like excuse me what the fuck? the first time I got diagnosed with clinical depression was when I was 12. fucking twelve years old. (I’m 18 now, it’s been 6 years with depression, 5 years with generalised anxiety disorder, 4 years on and off Anorexia and 1 year with BPD, and panic disorder. I’ve been on SSRI for almost a year now)

a lot of it has to do with my chaotic childhood, being sent away and abused by someone who wasn’t my biological parent, and losing some of my loved ones whilst I was growing up. but as usual, people think they know shit just because both my parents are wealthy business people, and assume that my life has been a bed full of roses this whole time and that I’ve been spoilt and pampered my whole life lmao

despite all of my traumatic experiences and struggles, I’ve never been the sort of person who’d wallow in my self-pity or see my mental illnesses as a justifiable “excuse” to not do my best in life or treat people with the respect they deserve? neither do I ever ask anyone for “help” or unload my problems onto them, I’d like to think I’m extremely self-sufficient.

Also I was taught when I was younger than telling people about your problems is essentially useless, but also unnecessary, redundant and dangerous.

trust me, if I could undo my mental illnesses with a snap of a finger and my relentless self-loathing or trade it with anything else, I would instantly do it in a heartbeat.

I know I shouldn’t be ashamed of my mental health, as none of it is my fault, but it makes me feel intrinsically shit when people think this is something I have active control over, or that I don’t deserve to suffer just because I hail from a well-to-do family and seem to be performing impeccably in life.

I’ve been to 4 different Psychologists, psychotherapists and 3 different psychiatrists, all of whom have treated and diagnosed me. If that’s not enough evidence, then idk what is.

With that being said, I’ve been a consistent high-achiever throughout school, or like a “nerd” as everyone refers me to LOL, with the exception that I’m incredibly open-minded and rebellious and a secret party animal. Being awarded with top in cohort for English Language, passing with distinction and commendation multiple times, playing the piano reaching grace 6th and Swimming competitively, being a dancer and winning trophies in my school’s Badminton team, being on the top students’ list for GCSE, getting a scholarship for A Levels, clinching the top for Politics, got A*AA in 7 months - and second best for Law, (and this was when my grandma passed away btw), having variegated interests such as dabbling in boxing and Muay Thai (before I dislocated my knee and when my health was more robust)and being a present writer and editor at my Uni’s magazine.

I practically embody the “perfect all-rounder”, but little do people know that I’d accomplished all of these through sheer hard-work and resilience, something that society in general would NEVER in a million years expect someone struggling with so many physical health, but also mental health issues to do so.

That’s precisely what I mean. I seem to have everything going for me on the surface, portraying the glitz and glamor of my life on Instagram - but internally - I’m struggling every single day with my mind, a whole contrast to my exterior and facade.

The reason why I don’t share in-depth accounts of my feelings, mental health, problems and past is because I know that I’d be trivalised and dismissed. It has happened to me all the time and it still happens, sadly.

Besides, I was raised in an environment where I was always told to keep my problems to myself, as people would eventually use my vulnerabilities against me. I was told to always analyse situations with a healthy amount of skepticism and doubt.

The stuff I’ve been through has made me incredibly wary of people in general, growing up witnessing violence and instability has had a profound impact on how I view myself, the world and others around me.

And oddly enough, whilst girls in school would obsess over finding their Prince Charming and envisioning happily-ever-after scenarios, I was that one morbid soul who’d never imagined myself getting attached to someone else. I saw attachment and trusting someone as the root of all evil. I thought the girls around me were simply naive, juvenile and blissfully ignorant and had always believed that marriage was nothing but an illusion. LOL I’m not kidding, my family was mortified when they heard me utter that at the age of 14/15.

Their look of terrified, aghasted faces were everything. I loved being alone and the idea of having someone romantically involved with me was beyond TERRIFYING. Hence why in relationships, I tend to emotionally distance myself when I sense intimacy being slowly established. I would NEVER tell my ex’s what I would be feeling and panicked at the prospect of them getting to see the raw parts of me. I was so self-sufficient and independent that some of them lamented on how I got so ‘distant’ and ‘cold’ as I gradually pushed them away.

Whilst I did get into relationships as I grew older, I never really saw a future with anyone I got with. I mainly just wanted to feel validated, if that makes sense. I struggled with an unstable self-identity at the point in time, as well as an alarmingly low self-worth. I did get terribly hurt and destroyed along the process of dating these people, but some of these “breakups” and “endings” were instigated by me.

Instead of hurting more intensely should they abandon me after, I’d self-sabotage my own relationship back then and distance myself as far as I could from them, breaking up with them before they could break up with me, so the pain would hurt less eventually.

Rather, I went through a phase where I was simply cruising through a series of unstable casual relationships. Not proud of it, don’t recommend it.

My motto has always been “do it now, and it’ll hurt less later. No one stays forever”. It’s a little sad and distressing that I still believe in that now, but I think a lot of this has to do with what I witnessed within my upbringing when I was a child, which’s all been ingrained in me.

I was never optimistic about anything growing up, instead - I was the biggest pessimist and nihilist you’d ever meet. I find it very very hard to navigate romantic relationships, extremely impossible for me in fact. I never even thought about marriage when I was younger. Yeah I had childhood crushes, but I was literally that girl who couldn’t care less about finding a significant other. Whilst all my friends were madly in love, I was the kid who’d lost hope in humanity and faith in human relationships. Honestly I’ve just never thought I was worthy of love? I always think I’m too broken and damaged for someone to care for me, and the idea that everyone will leave eventually has been so ingrained in me that it’s almost impossible to abandon. I just never thought anyone would ever get me.

I feel like a lot of it has to do with people invalidating me when I was younger, and the fact that BPD itself is such a misunderstood disorder in itself that I feel wronged and maligned all the time. I also have an inherently hard time expressing my emotions.

I’m not the sort of person who’d explode on someone, rather, I’d implode and ‘act in’ on myself and keep myself in isolation when things go awry. I start pushing every single person away as soon as I find them inching a little too close to me.

I do miss people, but I wouldn’t say I’m clingy. I’m far from clingy, literally the complete opposite. Distant, aloof, indifferent, guarded.

[mrjohntsnyder]

50 Most Influential OT Research Articles

We become occupational therapists so we can provide holistic care to our clients.

We want to flex our creative muscles and exercise our compassion. We want to work alongside patients, sharing their joy and their pain—serving as guides as they reclaim their lives.

But for all the “softer” reasons that draw us to the profession, we OTs also have a strong analytical side.

We choose our career, on some level, for love of the science that holds it all together.

I say this because I want you to dive into this article with true love for OT in your heart. With a deep commitment to why we fell in love with our profession in the first place, and why it is vital that we stay current with research, even when we feel pulled in 10 different directions in a single day.

But let me step back for a moment, and let you know why I’m writing this article :-)

Why keeping up with medical developments is the biggest challenge of our OT generation

It’s no secret that medical professionals are having a tough time these days.

We shuttle from patient to patient, focused more on billable units and clunky EMRs than actual therapy.

And when we feel this way for too long, our thirst for new knowledge dies down.

We stop thinking about research as a method to further improve our patients’ lives, and instead consider it just another task to be completed. And, sadly, it’s a task that keeps getting pushed to the side as we focus on slogging through our days.

We OTs are affected each day by decreasing reimbursement and stagnating salaries—not to mention increased productivity expectations—and there’s no secret about it.

At least we’re talking about it, which is great.

However, the focus on burnout, productivity, and EMR headaches has masked an even more massive shift––and this might be the most troubling one at all. In fact, I will go so far as to say this will be the true challenge of our generation of occupational therapists:

We are not keeping up with medical advancements.

Recent years have shown an exponential growth of medical knowledge and discoveries—but we’re doing a TERRIBLE job of keeping up with these advances.

Here’s what I mean.

Consider this excerpt from a medical journal, where the authors are discussing the rapid advancement of medical knowledge (discoveries, advancements, research, etc.):  

It is estimated that the doubling time of medical knowledge in 1950 was 50 years; in 1980, 7 years; and in 2010, 3.5 years. In 2020 it is projected to be 0.2 years—just 73 days. Students who began medical school in the autumn of 2010 will experience approximately three doublings in knowledge by the time they complete the minimum length of training (7 years) needed to practice medicine. Students who graduate in 2020 will experience four doublings in knowledge. What was learned in the first 3 years of medical school will be just 6% of what is known at the end of the decade from 2010 to 2020.

That’s a lot of numbers, and I had to read it about ten times to really absorb what it meant, and how profound its implications are. The gist is that we’re making insanely huge medical advancements and discoveries, but the info just isn’t being delivered to the actual clinicians for integration into our practice.

To quote the author:

“Knowledge is expanding faster than our ability to assimilate and apply it effectively; and this is as true in education and patient care as it is in research.”

Yes, it’s scary, but we OTs are hardly alone; this phenomenon is a problem throughout the medical field.

But, that does not let us as OTs off the hook.

I created this platform in 2012 with a simple mission: to share what is (and isn't) working in our OT practice.

Recently, my heart has really been pushing me to undertake the issue of evidence-based practice. I am so eager to help fight this information underload problem in our profession and help point you in the direction of resources that can elevate your profession—and are backed by science.

Will we be able to do it perfectly?

No.

Will it be a huge learning curve?

Yes.

But here’s to trying...together.

With that said, I’d like to share:

The 50 most-cited OT articles from the past five years

Just looking at this title makes my blood pump a little faster. Sifting through mountains of articles just to get to the top 50 articles is a lot of work, and when I started researching for this article, it felt overwhelming.

Luckily, I was able to team up with a research librarian to make this article happen.

I wanted to begin by looking at which articles were having the biggest impact throughout the medical community, and also mentioned OT.

Here are the articles, ranked by the number of times they were cited throughout medical literature:

An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: A randomised controlled trial (2014) The Lancet Respiratory Medicine

Interdisciplinary chronic pain management (2014) American Psychologist

Increased hospital-based physical rehabilitation and information provision after intensive care unit discharge: The RECOVER randomized clinical trial (2015) JAMA Internal Medicine

Stem cells as an emerging paradigm in stroke 3 enhancing the development of clinical trials (2014) Stroke

Effect of a task-oriented rehabilitation program on upper extremity recovery following motor stroke the ICARE randomized clinical trial (2016) JAMA - Journal of the American Medical Association

Is a specialist breathlessness service more effective and cost-effective for patients with advanced cancer and their carers than standard care? Findings of a mixed-method randomised controlled trial (2014) BMC Medicine

Efficacy of occupational therapy for patients with Parkinson's disease: A randomised controlled trial (2014) The Lancet Neurology

An intervention for sensory difficulties in children with autism: A randomized trial (2014) Journal of Autism and Developmental Disorders

Geriatric assessment-guided care processes for older adults: A Delphi consensus of geriatric oncology experts (2015) JNCCN Journal of the National Comprehensive Cancer Network

Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: The Activity and Cognitive Therapy in ICU (ACT-ICU) trial (2014) Intensive Care Medicine

Rehabilitation of motor function after stroke: A multiple systematic review focused on techniques to stimulate upper extremity recovery (2016) Frontiers in Human Neuroscience

Universal newborn screening for congenital CMV infection: What is the evidence of potential benefit? (2014) Reviews in Medical Virology

Feasibility of articulated arm mounted oculus rift virtual reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients (2014) Cyberpsychology, Behavior, and Social Networking

2016 update of the EULAR recommendations for the management of early arthritis (2017) Annals of the Rheumatic Diseases

An International Definition for "Nursing Home" (2015) Journal of the American Medical Directors Association

Screening for autism spectrum disorder in young children US preventive services task force recommendation statement (2016) JAMA - Journal of the American Medical Association

A task-specific interactive game-based virtual reality rehabilitation system for patients with stroke: A usability test and two clinical experiments (2014) Journal of NeuroEngineering and Rehabilitation

Rehabilitation for Parkinson's disease: Current outlook and future challenges (2016) Parkinsonism and Related Disorders

Connectivity measures are robust biomarkers of cortical function and plasticity after stroke (2015) Brain

A perioperative cost analysis comparing single-level minimally invasive and open transforaminal lumbar interbody fusion (2014) Spine Journal

Complex regional pain syndrome : An optimistic perspective (2015) Neurology

Occupational therapy code of ethics (2015) American Journal of Occupational Therapy

Cognitive symptom management and rehabilitation therapy (CogSMART) for veterans with traumatic brain injury: Pilot randomized controlled trial (2014) Journal of Rehabilitation Research and Development

Intravenous Bisphosphonate Therapy of Young Children with Osteogenesis Imperfecta: Skeletal Findings during Follow Up Throughout the Growing Years (2015) Journal of Bone and Mineral Research

Work-focused cognitive-behavioural therapy and individual job support to increase work participation in common mental disorders: A randomised controlled multicentre trial (2015) Occupational and Environmental Medicine

Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care (2016) The Lancet

Priority setting partnership to identify the top 10 research priorities for the management of parkinson's disease (2015) BMJ Open

PLAY project home consultation intervention program for young children with autism spectrum disorders: A randomized controlled trial (2014) Journal of Developmental and Behavioral Pediatrics

Cortical changes underlying balance recovery in patients with hemiplegic stroke (2014) NeuroImage

Belonging, occupation, and human well-being: An exploration (2014) Canadian Journal of Occupational Therapy

Feasibility of high-repetition, task-specific training for individuals with upper-extremity paresis (2014) American Journal of Occupational Therapy

Virtual reality for upper extremity rehabilitation in early stroke: A pilot randomized controlled trial (2014) Clinical Rehabilitation

Upper limb robot-assisted therapy in cerebral palsy: A single-blind randomized controlled trial (2015) Neurorehabilitation and Neural Repair

Locomotion improvement using a hybrid assistive limb in recovery phase stroke patients: A randomized controlled pilot study (2014) Archives of Physical Medicine and Rehabilitation

EFNS/ENS Consensus on the diagnosis and management of chronic ataxias in adulthood (2014) European Journal of Neurology

Burnout among physicians (2014) Libyan Journal of Medicine

Effect of early rehabilitation during intensive care unit stay on functional status: Systematic review and meta-analysis (2015) PLoS ONE

Improving functional disability and cognition in parkinson disease randomized controlled trial (2014) Neurology

The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer (2015) Journal of Geriatric Oncology

Extended roles for allied health professionals: An updated systematic review of the evidence (2014) Journal of Multidisciplinary Healthcare

A qualitative study exploring the usability of nintendo wii fit among persons with multiple sclerosis (2014) Occupational Therapy International

Physiotherapy and Occupational Therapy vs No Therapy in mild to moderate Parkinson disease (2016) JAMA Neurology

An environmental scan for early mobilization practices in U.S. ICUs (2015) Critical Care Medicine

Impact of early mobilization on glycemic control and ICU-acquired weakness in critically ill patients who are mechanically ventilated (2014) Chest

Patterns of sensory processing in children with an autism spectrum disorder (2014) Research in Autism Spectrum Disorders

Translating knowledge in rehabilitation: Systematic review (2015) Physical Therapy

Collaborative approach in the development of high-performance brain-computer interfaces for a neuroprosthetic arm: Translation from animal models to human control (2014) Clinical and Translational Science

Structural white matter changes in descending motor tracts correlate with improvements in motor impairment after undergoing a treatment course of tDCS and physical therapy (2015) Frontiers in Human Neuroscience

Professional perspectives on service user and carer involvement in mental health care planning: A qualitative study (2015) International Journal of Nursing Studies

The effect of multidisciplinary rehabilitation on brain structure and cognition in Huntington's disease: An exploratory study (2015) Brain and Behavior

Conclusion

I’m so grateful to have this list and, starting around mid-March, we are going to be having weekly discussions on the articles below, on my soon-to-be launched The OT Potential Club.

To stay tuned on updates, please join my mailing list:

Join OT Potenial! Join OT Potential Mailing List!

Name * Name First Name Last Name

Email Address *

Thank you!

Hopefully, some of the topics speak directly to your practice. But, even if they don’t, I hope you consider joining in the discussion.

Because, the heart of the conversation I want to be having is this:

How do we keep up with and incorporate best practices into our treatments and notes?

And how in the world do we stay focused on patients in the midst of all this change?

from OT Blog - OT Potential https://ift.tt/2Tc1CKI

[richard1lauritsen-blog]

Test Bank LPN to RN Transitions 3rd Edition

For Order This And Any Other Test

 Banks And Solutions Manuals, Course,

 Assignments, Discussions, Quizzes, Exams,

 Contact us At: johnmate1122@gmail.com

   Chapter 01: Honoring Your Past, Planning Your Future

Test Bank

 MULTIPLE CHOICE

      1.   A nursing advisor is meeting with a student who is interested in earning her RN degree. She knows that LPN/LVNs who enter nursing school to become RNs come into the learning environment with prior knowledge and understanding. Which statement by the nursing advisor best describes her understanding of the effect experience may have on learning?

a.

“Experience may be a  source of insight or a barrier.”

b.

“Experience is usually a  stumbling block for LPN/LVNs.”

c.

“Experience never makes  learning more difficult.”

d.

“Once something is  learned, it can never be truly modified.”

  ANS:  A

Experience accentuates differences among learners and serves as a source of insight and motivation, but it can also be a barrier. Experience can serve as a foundation for defining the self.

 DIF:    Cognitive Level: Application          REF:   Page 3            

OBJ:   Identify how experiences influence learning in adults.   TOP:   Adult Learning

      2.   There is a test on the cardiovascular system on Friday morning, and it is now Wednesday night. The student has already taken a vacation day from work Thursday night so that she can stay home and study. She is considering skipping her exercise class on Thursday morning to go to the library to prepare for the test. Which response best identifies the student’s outcome priority?

a.

Exercise class

b.

Going to the library

c.

Avoiding work by taking a  vacation

d.

Doing well on the test on  Friday

  ANS:  D

The outcome priority is the most important goal, and other tasks are prioritized in order based on their importance toward meeting the identified goal.

 DIF:    Cognitive Level: Application          REF:   Page 2            

OBJ:   Identify motivations and personal outcome priorities for returning to school.

TOP:   Motivation to Learn  

      3.   A nurse who has been an LPN/LVN for 10 years is meeting with an advisor to discuss the possibility of taking classes to become an RN. The advisor interprets which statement by the nurse as the driving force for returning to school?

a.

“I’ll need to schedule  time to attend classes.”

b.

“I’ll have to budget for  paying tuition.”

c.

“I’ll have to rearranging  my schedule.”

d.

“There is a possibility of  advancement into administration.”

  ANS:  D

Driving forces are those that tend to lead toward making the change, as opposed to restraining forces, which are those that usually present a challenge that needs to be overcome for the change to take place or present a negative effect the change may initiate.

 DIF:    Cognitive Level: Application          REF:   Page 8            

OBJ:   Identify motivations and personal outcome priorities for returning to school.

TOP:   Motivations for Change

      4.   An RN is caring for a diabetic patient. The patient appears interested in changing her lifestyle and has been asking questions about eating better. The nurse can interpret this behavior as which stage of Lewin’s Change Theory?

a.

Moving

b.

Unfreezing

c.

Action

d.

Refreezing

  ANS:  B

The patient is in the first phase of Lewin’s Change Theory, known as unfreezing. This phase involves determining that a change needs to occur and deciding to take action. Moving is the second phase and involves actively planning changes and taking action on them. Refreezing is the last stage, and it occurs when the change has become a part of the person’s life.

 DIF:    Cognitive Level: Analysis               REF:   Page 8            

OBJ:   Understand Change Theory and how it applies to becoming an RN.

TOP:   Change Theory        

      5.   An LPN is talking with her clinical instructor about her decision to return to school to become an RN. The clinical instructor interprets the LPNs outcome priority based on which statement?

a.

“My family wanted me to go  back to school.”

b.

“I want to better my  financial situation.”

c.

“I really enjoy school.”

d.

“I would like to advance  to a teaching role someday.”

  ANS:  B

The outcome priority is the essential need that must be addressed, determined by internal and external factors, such as needing to better a financial situation. The other statements indicate reasons for returning to school, but they are not essential needs or issues to be addressed.

 DIF:    Cognitive Level: Analysis               REF:   Page 2            

OBJ:   Identify how experiences influence learning in adults.   TOP:   Adult Learning

      6.   A nurse notices a posting for a management position for which she is qualified. If the nurse is in the moving phase of Lewin’s Change Theory, which statement reflects the action she is most likely to take?

a.

Does nothing to obtain the  position

b.

Applies for the position

c.

Identifies that change is  needed

d.

Settles into the routine  of her job

  ANS:  B

Unfreezing begins when reasons for change are identified. The moving phase involves active planning and action. Refreezing occurs after the change has become routine.

 DIF:    Cognitive Level: Application          REF:   Page 8            

OBJ:   Understand Change Theory and how it applies to becoming an RN.

TOP:   Change Theory        

      7.   An Orthopedic Nurse is contemplating changes in her professional life and identifying goals. Which action should the nurse take if she is interested in pursuing a long-term goal?

a.

Studies for a telemetry  exam scheduled for next week

b.

Enrolls in a Nurse  Practitioner program

c.

Attends a seminar to  become a charge nurse

d.

Continues to work on the  orthopedic floor full-time

  ANS:  B

A short-term goal is one that can be attained in a period of 6 months or less. Short-term goals include becoming a charge nurse and passing the telemetry exam. A long-term goal is attained in greater than 6 months and includes studying to become a Nurse Practitioner. Continuing to work on the orthopedic floor does not represent either a short-term or a long-term goal.

 DIF:    Cognitive Level: Application          REF:   Page 7            

OBJ:   Identify both short- and long-term personal and professional goals.

TOP:   Setting Goals            

      8.   A group of cardiac nurses with common experiences meet monthly for a staff meeting to discuss ways to improve patient care. This group is known as a:

a.

scheme.

b.

cohort.

c.

team.

d.

unit.

  ANS:  B

A cohort is a group of people who share common experiences with each other. A scheme is a web of connections, a team is a group linked together for common purposes, and a unit consists of groups or individuals that make up a whole.

 DIF:    Cognitive Level: Knowledge          REF:   Page 3            

OBJ:   Identify how experiences influence learning in adults.   TOP:   Adult Learning

      9.   Although experience may be a source of motivation for the adult learner, it may also serve as a(n) __________ to new learning.

a.

stepping stone

b.

barrier

c.

avenue

d.

detour

  ANS:  B

Experience accentuates differences among learners, serves as a source of insight and motivation, can be a barrier to new learning, and serves as a foundation for defining the self.

 DIF:    Cognitive Level: Knowledge          REF:   Page 4            

OBJ:   Identify motivations and personal outcome priorities for returning to school.

TOP:   Adult Learning        

 MULTIPLE RESPONSE

      1.   A student nurse and the staff RN are discussing recent changes on the nursing unit. Which of the following are examples of change processes? (Select all that apply.)

a.

Coercive

b.

Collaborative

c.

Technocratic

d.

Planned

e.

Organized

  ANS:  A, C, D

Coercive is a type of change that is forced or pushed on another. A decision for change made by the most knowledgeable person is known as technocratic. Planned change involves careful thought and decision making. Collaborative and organized are not considered to be types of change.

 DIF:    Cognitive Level: Application          REF:   Page 9            

OBJ:   Understand Change Theory and how it applies to becoming an RN.

TOP:   Change Theory        

 COMPLETION

      1.   A(n) ________ effect experience is one in which movement of the learner toward the desired outcome was constructive.

 ANS:  

positive

Experiences may be either positive or negative in effect based on the influence on the ultimate outcome.

 DIF:    Cognitive Level: Knowledge          REF:   Page 4            

OBJ:   Delineate both positive and negative effect experiences.           TOP:    Adult Learning

[thereallazaruslady]

Criminal Sociopath Hackers Abound......

Supposedly my son posted this to his certain social media account:

“ My mom likes to analyze these posts using third party apps and I know shes gonna read this so mom just know mom, I don't hate you, I miss you, I would be very willing to see you again and talk but you need to get help, you need to be healthy, you need to take your meds, your unhealthiness makes me depressed, and your delusion does even more so. Also that last post wasn't about you. "Its not a phase mom" is a phrase I use to explain to people that I know I dress like i'm stuck in a world of alternative music marketed to teenagers, haha. It was really just a joke. Also my forehead is fine. Im not being targeted. Im healthier than I have ever been but I still have some normal life trauma that I have to deal with. I will delete this post later because its so embarrassing, but if you want me to not block you, you have to get help. Im sorry. I love you. Don't analyze this. This is me please believe me.” His other social media account, FB, was hacked as well. This is the MO of criminal sociopaths behind all this cybernetic non-consentual human & social engineering, MK-ULTRA, covert weapons torture, trafficking & terrorism; this was certainly the MO of Murder Inc., its PEDOPHILE LOBBY, its human trafficking lobby run by suspect IDIOT politicos & their corporations like SRI/SAIC, DynCorp & their ethnic terrorist (foreign & domestic) cohorts. “Weeping Angel” is one of the identities of hacker Chris Lissa Simmons, KKK Simmons daughter & Cheney niece, who was obsessed with killing witnesses & “getting over on them” as was Beason’s niece, infamous Carol/Christine & other members of Murder Inc. They hack accounts regularly between people trying to communicate - especially kidnapped children & their kidnapped mothers, legitimate military and other witnesses & whistle-blowers. For the record, I worked more than 17+yrs Clinical/Managerial in Psychiatric/MH often running facilities. When I worked at 4-Winds Psychiatric in Katonah, NY, I RAN a UNIT for Borderline Personality Disordered patients. I passed rigorous FBI & Interpol background checks, and have been evaluated innumerous times as a function of application for employment and continued employment. The ONLY meds I take are several cardiac meds, arthritis meds, osteoporosis meds and OTC and supplements for pain (from exposure to extreme levels of radiation from directed energy weapons). I’d be happy to jam thousands of milligrams in the arses of anyone who dared tried to say I was “mentally ill,” but alas all of my clinical licenses have expired. I personally prefer enhanced interrogation techniques for criminal psychopaths who so egregiously defame me & my family name, who harmed my son, me, harmed and/or murdered our friends, family, colleagues, witnesses, good government employs, whistle-blowers & anyone else innocent.

Some suspect people are using all this diabolical & sadistic torture, kidnapping, defamation & slander, theft & corruption done to me & my son just to get away with what they’ve done to us and others (on a grand scale), BUT some OTHER people are not only committing these crimes, but using all these other crimes done to me & my son to drum up as much hatred as possible for the West, particularly America, as their big chance to mass-murder Americans, especially white Americans - particularly WHITE AMERICAN MALES. I strongly suggest & insist that all these criminals harming me & my still kidnapped son are dealt with swiftly and fiercely - with as much force as is necessary to preserve not only the Republic, but its rapidly dwindling people. Top journalists, many foreign nations, UN HRCs, IHRC HQs, DSK, etc not only came running to me shortly after 911, but spoke up vigorously for me & my son. They also spoke out about all my wealth & works being stolen. Former CIA Director, George Tenet - who did do his job on 911 - said about me, “She’s the only one, the ONLY one who did real National & International security.” Bin Laden & others spoke well of me, too - you see, I got them to stop their planned hokey hijackings for 1999 or 2000 all of which I had reported to the FBI, I had others report it as well. I didn’t know about plans for 2001 either. My son & I are considered the “worst cases of human & civil rights abuses in this country’s (US) history.” We are not some plebeian nobodies. I suggest you not only go after the idiotic hacking rodent (violently), but after those who set up DNI Clapper, former CIA Directors John Brennan & George Tenet, Arnold Schwarzenneger, Rudy Giuliani, former NYS Governor Eliot Spitzer & a myriad of other good civil & public servants who tried to help me & my son. You probably should forcibly go after my convicted mother’s cousins: NYS Sen-R Joseph Bruno & their distant ditzy cousin, Ms. Pizzagate Pelosi.

You’ll find out that I have a “fake” birth certificate & contend with a nefarious DOD InfoWar Platform SAP on me that’s part highly classified & the other part is above top-secret; the very unconstitutional Patriot Act (passed on my birthday, btw); the Pedophile Lobby HQ’d in California, a myriad of Operation & Project Paperclips playing Star Wars & a quite dastardly agenda of Empires of Old.

[kristinsimmons]

A Health Tech’s Secret Weapon: The People Under The Hood

By DAVID SHAYWITZ, MD

The recently-announced acquisition of the oncology data company Flatiron Health by Roche for $2.1B represents a robust validation of the much-discussed but infrequently-realized hypothesis that technology entrepreneurs who can turn health data into actionable insights can capture significant value for this accomplishment.

Four questions underlying this deal (a transaction first reported, as usual, by Chrissy Farr) are: (1) What is the Flatiron business model? (2) What makes Flatiron different from other health data companies? (3) Why did Roche pay so much for this asset? (4) What are the lessons other health tech companies might learn?

The Flatiron Business Model

To a first approximation, Flatiron has a model that can be seen as similar to tech platforms like Google and Facebook – delight (or at least offer a useful service to) front-end users, and then sell the data generated to other businesses. For Flatiron, the front-end users are oncologists (mostly community, some academic), and the data customers are pharma companies. In contrast to Google (and also in contrast to the less successful Practice Fusion, recently acquired at a loss), Flatiron doesn’t sell access to front-end users themselves (e.g. through targeted ads), but rather access to de-identified, aggregated clinical information.

Success of this model requires that the Flatiron platform is attractive to oncology practices, who must feel that they’re getting distinct value from it and believe that it helps them fulfill their primary mission of taking care of cancer patients. If this is true, then the Flatiron platform will enjoy continued traction from its current base, and may more easily win over new users (including practices that use a different EMR system, like Epic, but still want access to the Flatiron network and analytics).

By all accounts, the oncologist-facing Flatiron platform (originally a mediocre oncology EHR that Flatiron acquired and serially refined) remains a work in progress; the company appears determined to continue to improve the quality of this application, even (especially) post-acquisition, as oncologists are foundational to this model, and the more delighted oncologists are with it, the more traction it stands to achieve.

On the back end, Flatiron has created a dataset thats seems largely distinct in the industry – a meticulously assembled oncology dataset that pulls information from the electronic health records and organizes it in a fashion that approaches the quality of clinical research, enabling investigators (and regulators) to ask questions of the data that might normally require a dedicated, stand-alone study to resolve.

What Makes Flatiron Different?

Flatiron’s key insight wasn’t so much recognizing the foundational need for a robust, clinical research-grade dataset, but rather, realizing that creating this required meticulous, artisanal data curation – largely done by hand, Mechanical Turk style.

The Mechanical Turk was a fake chess-playing machine from the late 18th century, presented as an intelligent device, but actually powered by hidden human players. Amazon (and indeed, many other tech companies) use a version of this approach to solve problems, generally problems that seem like they should be addressable by a computer but which in fact may be most efficiently or economically addressed by actual people.

Flatiron recognized that, at least in cancer, half or more of the most important data in health records isn’t in structured data fields, but rather in unstructured data, the free text fields of pathology reports and clinical notes. While technology can in theory “read” these fields, actually pulling out the most useful aspects, at least today, requires people, and Flatiron has hired and trained an army of them, generally health professionals who painstakingly read through unstructured data and extract the relevant aspects. Technology tools assist in this process (hence “technology-enabled”), and the quality of the extraction is closely and systematically monitored, but the essential work is still done by human beings.

A. Abernethy

Amy Abernethy, MD, PhD, Chief Medical Officer, Chief Scientific Officer, and Senior Vice President, Flatiron Health

The key driver of this approach was Dr. Amy Abernethy, a physician-scientist who spent her career at Duke focused on the question of how to upgrade the quality of EHR data so that it could be more useful for both clinicians and researchers.

When my co-host Lisa Suennen and I interviewed Abernethy on our Tech Tonics podcast last year, she told us that when she was first introduced to the young Flatiron founders Nat Turner and Zach Weinberg, and explained to them the need to painfully extract data from unstructured fields, “they listened and weren’t scared off by fact that it was a really hard problem to solve.” In the interview prep, Abernethy also told me, “what Flatiron did was not be scared off by doing the hard stuff – everyone else says ‘That is someone else’s problem to solve.’”

On the podcast, Abernethy explained,

“As we imagine the data in electronic health records, it’s easy to think about structured data and how we might make use of it. For example, using glucose or HbA1c values to monitor what’s going on in diabetes. But in cancer, many of the critical data points reside in documents that are not structured at all. For example, histology. If a cancer is an adenocarcinoma or a squamous cell cancer is something that’s in a pathology report, and sometimes it’s really distinct, and it’s pretty easy to pull that information out. But a lot of the times, it’s contextual, and includes a lot of the other information that a pathologist is seeing. And this is not just histology, but information like biomarkers, and what’s in the radiology report, and what’s in the clinical case notes . We estimate that 50% or more the critical data points you need for research live in these PDF representations of data.” [Comments lightly edited for clarity.]

Indeed, a fascinating publication from Flatiron and Pfizer compared the composition of two theoretical cancer research cohorts, one identified by using just structured data from an EHR, and a second identified by using the combination of structured and unstructured data. The profound conclusions were how different the composition of these cohorts were, how much larger the second cohort was, and how surprisingly little overlap there was between the two cohorts. In other words, if you’re trying to draw conclusions on the basis of extracting data from structured fields alone, you’re going to make a lot of mistakes, and you may miss a lot of patients.

In some ways, the vast quantities of data in hospital EHR systems has tempted and frustrated researchers for ages. On the one hand, it’s tantalizing – with so much data in these systems, surely this information can be mined for clinical and scientific insight? While there have been discrete examples of success, the process has proved maddeningly frustrating, and it seems, stubbornly resistant to automation – especially since both pharma researchers and practicing clinicians are exquisitely sensitive to data utility, not data volume. Moreover, even some examples of apparent automation success – such as the genotype/phenotype data integration that underlies the Regeneron drug discovery engine – owe much to artisanal curation of phenotype, the so-called “phenotype whispering” capability I’ve discussed at a number of conferences (in a previous role).

Why Did Roche Pay So Much For Flatiron?

The $2.1B total acquisition price caught the attention of investors and entrepreneurs alike, begging the inevitable question, why? A thoughtful discussion of this transaction has been written by Andrew Matzkin of the consultancy Health Advances – see here.

From what I’ve been able to piece together, it appears the answer is that Roche, through Flatiron, is embracing an evolving vision of clinical trial validation, a world in which real world data, extractable in nearly-real time from a network of oncology practices, can be used to provide a trusted, clinical-research grade readout of drug efficacy and utility. This would offer the possibility of obtaining regulator-worthy data with unprecedented ease, potentially saving significant money both from clinical study costs and by delivering the relevant data with the speed of a database query, which (if accepted by regulators) could lead to quicker decisions, and a faster time-to-market. Given Roche’s commitment to oncology at a global level, it’s not difficult to imagine how reduced trial costs and more rapid time to market could quickly translate into billions of dollars of value for the pharmaceutical giant.

An indication of this can be found in Pfizer and Flatiron poster presented at a breast cancer conference last year, in which the authors argue that data obtained from a cohort of Flatiron patients match data from the active control arm (representing existing standard of care) of a formal phase 3 study. The implication is that if active control arm data can be obtained reliably from a trustworthy database, then soon one might ask whether (and under what circumstances) it’s ethical to randomize patients to standard of care.

(As an aside, while some have suggested the Roche acquisition was motivated, at least in part, by the pharma company’s desire to directly access the Flatiron provider network, there is every indication by the way the transaction has been structured that this is explicitly not the case, and that Roche intends to maintain Flatiron as an independent subsidiary. For Roche, the value is likely in the clinical research-grade quality real world data generated by the Flatiron network, and they’re likely to keep their hands off, and do everything they can to keep the data flywheel spinning.)

Lessons Learned

Perhaps the most significant takeaway from the Flatiron story – what Flatiron figured out and what so many other health tech companies miss – is the importance of viscerally understanding what your customers want. In the case of Flatiron, it means truly understanding what practicing oncologist actually view as meaningful, and what oncology researchers actually view as meaningful. Flatiron didn’t say “here’s our amazing technology, let’s hire a sales team and see where we can jam it,” but instead, aligned around “here’s the goal, we’re recognize it’s hard, let’s own this challenge and see what it takes to get us there.”

As former FDA Commission Robert Califf pointed out on Twitter last week, “People should pay attention to the [Flatiron] strategy–relentless curation of data–an army of “data janitors” transforming EHR data into analyzable, actionable information. Congrats to the Flatiron team–this was hard work paying off–not slogans and glitz.”

Notably, Flatiron seems to have achieved a level of physician-engineer collaboration that most health tech companies fail to approach. From the outset, it seems clear that Flatiron didn’t just want to be a software vendor, delivering tech services to providers and pharma researchers, but wanted to be an empathetic partner, wanted to, on the deepest level, grok healthcare and the problems faced by those in the trenches. This aspect of the Flatiron culture was nicely captured by this Fast Company article from last year, which noted, correctly, “this is an entirely different style of work for the engineering talent.”

Flatiron also strategically and intelligently partnered closely with regulators, providing FDA with complimentary access to data, and publishing together the results of such analyses. As Abernethy discussed on Tech Tonics, this helped Flatiron refine their platform, better understanding the questions they should be addressing, while also providing referenceability for pharma companies: if Flatiron data is good enough to be used by the FDA, perhaps it’s worthy of pharma attention as well. Moreover, to the extent that the value proposition to pharma is that regulators accept Flatiron data (in some contexts) as equivalent to dedicated study data, regulator comfort with and buy-in to the platform is absolutely essential.

Finally, as some wags on twitter and elsewhere have been pointing to the Flatiron exit as confirming the value of health tech startups targeting pharma customers, I worry it may be easy to draw the wrong conclusion here. First, most resources within pharma companies aren’t just sloshing around, but tend to be exceptionally loculated, assigned to specific business initiatives and aligned with articulated corporate goals. Second, pharma drug developers are generally highly-trained scientists conducting research that must meet strict regulatory evidentiary standards. A cutesy app, a minimally-validated technology, or access to messy data probably isn’t going to cut it, no matter how valuable you insist it is. Conversely, a rigorously-vetted approach that offers the credible possibility of moving the needle – especially in the incredibly expensive area of clinical trials – is likely to be enthusiastically received.

Parting Thought: The People

How ironic, yet also so brilliant and telling, that the key technology behind “health tech” startup Flatiron is basically human-mediated extraction of data describing human illness, to achieve a level of utility required and explicitly demanded by the human physicians caring for patients, by the human researchers developing new medicines, and by the human regulators evaluating their efforts.

It’s a lesson many other health-focused tech startups might do well to heed.

A Health Tech’s Secret Weapon: The People Under The Hood published first on https://wittooth.tumblr.com/