e-HealthExpert.org - Primum non nocere

Everyone knows that if you hold and spin an object at the end of a string fast enough, the string will break, setting the object on a free trajectory. Switch the object for a baby in the womb and the string for the umbilical cord, and you've got yourself an idea for a patent. Oh, you must also go back in time to 1965 and have the mind of George and Charlotte Blonsky, the inventors of "Apparatus for Facilitating the Birth of a Child by Centrifugal Force". Now, "centrifugal force" is a bit of a misnomer, since the object at the end of the string just wants to fly in a straight line but can't due to the real centripetal force the string is exerting on it. Not having seen one of these in our local maternity ward, this editor suspects there might have been some negative effects associated with putting something like this into practice. Perhaps it was the side effects of spinning a child as its first worldly experience (though we certainly wouldn't have a shortage of astronauts), or maybe it was obstetricians that weren't into experiencing high G forces on a daily basis that shot down the project. Regardless, the march of progress is never ending yet does not follow a straight line. Maybe the inventors themselves climbed into their prototype and discovered that you might need something faster than a gentle playground spin for this to actually be remotely practical. United States Patent US3216423... (hat tip: Gizmodo)... Michael

Three-dimensional structures of proteins are determined by their amino acid sequences, but protein structure prediction remains a complex problem that requires massive amounts of computing power. For years, people from all over the world have been donating their computers' free processing time to Rosetta@home, which provides a screensaver that uses spare processor time to predict protein folding patterns. A group of researchers, however, thought that human intelligence might be better at solving these complex problems, so they developed a multiplayer online game, Foldit, in which accurate protein structure models are produced through gameplay. The game has an extensive motivation and reward structure with a score system, player statuses, ranks and forums. It turned out that humans were often very good at solving problems where computer algorithms would become stuck. Conversely, the computer performed better when starting from a simple linear chain of amino acids. Different players have different strengths, and by having team competitions, those strengths were combined to get the best results. For the article published in Nature, more than 57,000 players contributed through gameplay and feedback. The authors foresee this strategy being used in other scientific domains as well where human three-dimensional structural problem solving can be used. There is a video after the break. More from Ars Technica: Gamers beat algorithms at finding protein structures... Article abstract: Predicting protein structures with a multiplayer online game... Project website: Foldit: Solve Puzzles for Science...... Wouter Stomp

Background: Men considering the prostate specific antigen (PSA) test for prostate cancer, an increasingly common male cancer, are encouraged to make informed decisions, as the test is limited in its accuracy and the natural history of the condition is poorly understood. The Web-based PSA decision aid, Prosdex, was developed as part of the UK Prostate Cancer Risk Management Programme in order to help men make such informed decisions. Objectives: The aim of this study was to evaluate the effect of the Web-based PSA decision aid, Prosdex, on informed decision making. Methods: A Web-based randomized controlled trial was conducted in South Wales, United Kingdom. Men aged 50 to 75 who had not previously had a PSA test were randomly allocated to two intervention and two control groups. Participants in the intervention groups either viewed Prosdex or were given a paper version of the text. The main outcome measures were the three components of informed decision making: (1) knowledge of prostate cancer and PSA, (2) attitude toward PSA testing, (3) behavior using a proxy measure, intention to undergo PSA testing. Decisional conflict and anxiety were also measured as was uptake of the PSA test. Outcomes were measured by means of an online questionnaire for the Prosdex group, the paper version group, and one of two control groups. Six months later, PSA test uptake was ascertained from general practitioners’ records, and the online questionnaire was repeated. Results are reported in terms of the Mann-Whitney U-statistic divided by the product of the two sample sizes (U/mm), line of no effect 0.50. Results: Participants were 514 men. Compared with the control group that completed the initial online questionnaire, men in the Prosdex group had increased knowledge about the PSA test and prostate cancer (U/mn 0.70; 95% CI 0.62 - 0.76); less favourable attitudes to PSA testing (U/mn 0.39, 95% CI 0.31 - 0.47); were less likely to undergo PSA testing (U/mn 0.40, 95% CI 0.32 - 0.48); and had less decisional conflict (U/mn 0.32, 95% CI 0.25 - 0.40); while anxiety level did not differ (U/mn 0.50, 95% CI 0.42 - 0.58). For these outcomes there were no significant differences between men in the Prosdex group and the paper version group. However, in the Prosdex group, increased knowledge was associated with a less favourable attitude toward testing (Spearman rank correlation [ρ] = -0.49, P < .001) and lower intention to undergo testing (ρ = -0.27, P = .02). After six months, PSA test uptake was lower in the Prosdex group than in the paper version and the questionnaire control group (P = .014). Test uptake was also lower in the control group that did not complete a questionnaire than in the control group that did, suggesting a possible Hawthorne effect of the questionnaire in favour of PSA testing. Conclusions: Exposure to Prosdex was associated with improved knowledge about the PSA test and prostate cancer. Men who had a high level of knowledge had a less favourable attitude toward and were less likely to undergo PSA testing. Prosdex appears to promote informed decision making regarding the PSA test. Trial Registration: ISRCTN48473735; http://www.controlled-trials.com/ISRCTN48473735 (Archived by WebCite at http://www.webcitation.org/5r1TLQ5nK)

Thanks to Jeff, author of  the book Whaddaya Mean I Gotta Be Lean? for posting a 5-question Q&A with me on his blog. Check it out:

Featured Lean Thinker: Mark Graban

I don’t think you can post comments there, but feel free to come back and post a comment if you like.

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I've written several posts about the need for civility, good karma, and a thoughtful process for every issue.
I have to react to negativity several times each day. As I review my email, I read numerous reports of challenges, frustration, and dissatisfaction. It's an expected part of being a senior leader in large, complex organizations and being a CIO.
Some of these emails have a controversial he said/she said character.
Responding to them requires tact and diplomacy. I want to support and protect my staff but also want to ensure we improve our processes in the interest of continuous quality improvement.
Recently, I read an article about the Shirley Sherrod case by Steve Adubato, who speaks and coaches on leadership and communication. His observations mirror many of the lessons I've learned when reacting to controversy.
*Don’t be so quick to judge if you haven’t heard the entire story.
*Due diligence is critical when it comes to communication.
*Realize how dangerous it is to assume.
*Get the whole message.
As my due diligence progresses, I find that many emails have the quality of Roseanne Roseannadanna (for you 1978-1980 Saturday Night Live Fans).
People misrepresent the facts, distort the truth to suit their own ends, and highlight events that are in their self interest and not the greater good.
It's really important to check out the facts from multiple stakeholders before drawing a conclusion.
It's really important to pick up the phone and talk through the issues, listening and taking an active interest in all sides of the story.
It's really important to suggest next steps, assign accountability, and deliver on your promises.
Understanding the facts, having a dialog, and meeting expectations for followup resolves most conflicts.
As with the Sherrod case, once you know the whole story, most controversies are not what they seem.

There are lots of places online where people can ask questions about Lean, such as the LEI forums and numerous LinkedIn groups. I saw one question in a LinkedIn group that really gave me pause… I won’t use her name or company name since the LinkedIn groups are somewhat private.

She wrote:

Hello! I’ve been tasked to lead a Lean Implementation in a division here at [company]. I would like to ‘benchmark’ with other manufacturers in North America who have also done a Lean Implementation.

I have training (from 6 years ago) and book reading, but haven’t had the opportunity for Lean application until now. I also have a long road to ‘sell’ this to upper management. I would love input on how others have successfully implemented Lean, and what roadblocks to avoid.

Your advice would be? Mine is….

My first thought is maybe she should just quit. Is this at all a fair situation to put somebody in. What are the strikes against her here?

• She is, at a staff level, responsible for Lean implementation
• She has no experience with Lean, just some old training and books
• She is expected to sell upper management on Lean
• She has been told to go benchmark, I’m guessing to find a cookbook approach or simple things to copy

OMG. Is this a challenge she should really take on? It seems like a path toward burnout and gray hair. I can see her profile and I don’t see any management experience, just individual contributor work.

Clearly, I think she has an uphill battle. There’s honor in uphill battles, but at some point you have to wonder if it will be worth the effort to her.

Over the years, I’ve received many emails from frustrated Lean people who are expected to do miraculous things by just implementing tools when leadership doesn’t want to change, nobody has interest in changing the management system, and this lone wolf (or wolf-ette) isn’t allowed to get the front line staff involved (gotta keep making parts, you know).

I know one frustrated woman from a hospital who was brought it from a very world-class manufacturing company to “make the hospital Lean” but it sounds like senior leadership doesn’t have the first clue about what’s really needed and they aren’t listening to her recommendations based on her experience. So she’s wondering how long she should be loyal and try and at what point she should just quit and leave.

I have personally been a frustrated “lone wolf” – caught in the middle of a manufacturing company that said they wanted to get Lean, but I was supposed to do it myself, constantly fighting to engage the focused factory manager and the front-line manager… very little was happening, but the CEO was bragging about how Lean we were supposedly getting. I learned a lot and it was a huge personal and professional challenge… but we accomplished very little. I know I’ve helped accomplish quite a lot in a different setting, with better leadership and a better climate. It’s not all on the shoulders of the internal “lone wolf” or the lone external consultant who is expected to be some miracle worker.

I’m trying to remember exactly which Podcast it was, but this question came up with Dr. Jeff Liker and he was pretty dry and blunt that a person in a similar situation like this should just quit and go to a company that really wants to make the Lean transformation.

Yes, the woman who asked the question on LinkedIn will learn a ton in this uphill battle, but is it worth it, the amount of stress and effort that’s required? What would your advice be? Am I being too discouraging or am I just being realistic?

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• Right Method, Wrong Culture

The Radiology Assistant has just released an iPhone/iPod/iPad app bringing the website's content to your mobile device. The Radiology Assistant is the educational web site of the Radiological Society of the Netherlands, focusing on common radiological issues in a problem oriented way for radiology residents and radiologists. It provides some excellent information on a large variety of topics, making it a great resource for radiology residents. The app optimizes content for small-screen viewing and makes it all available offline. For now the app is not optimized for viewing on the iPad yet, but the makers promise an update is on the way. iTunes link: The Radiology Assistant... Main website: The Radiology Assistant...... Wouter Stomp