As someone who has studied healthcare handoffs for a while, I can’t stop thinking about the Presidential one coming up. I see I’m not the only one. But this is not like any handoff. My nerdy 🧵 #MedTwitter #Inauguration2021

Handoffs come in many flavors in medicine. In general, the highest risk handoffs are when the patient is really sick and the handoff is permanent and not temporary. So in some ways, yes has elements of a risky handoff. America is definitely sick and the handoff is permanent.
Ideal handoffs are a transfer of content and a transfer of professional responsibility. The goal of content transfer: to achieve a shared mental model or shared vision of the patient. Professional responsibility usu= does receiver accept? Now it’s been will sender relinquish?
While both parts key, the transfer of professional responsibility is a must. The transfer of content also rests on the quality and accuracy of information transferred, the sender investment to transfer the information, and the receivers ability to understand & act on it.
In this case, there is concern no or sparse content is transferred. Even with a checklist, there may reason to question the content. In fact, too much dependency on content during any handoff could actually harm decision making of the person taking over due to an anchoring bias.
The clinical assumptions we make typically are the outgoing team is trying to do their best and that their vision is accurate. many assume the new team is a risk because continuity of care is important. That is true a lot when the team is invested and care is going well.
But when the care is not going well, a new team can bring lots to the table: fresh eyes, a new perspective, better expertise, higher morale as they may not be burned out and will be more invested in doing better.
The other thing about continuity is sometimes it’s provided in other ways. The team may change but maybe not everyone leaves at the same time preserving some continuity. E.g. there are many career public servants, like Dr Fauci, across agencies who can help with filling gaps.
We can’t also forget the importance of empowering patients and caregivers during healthcare handoffs —in that way an activated engaged democracy is important too. We are and can be the helpers. Fitting to think about before #MLKDay and the importance of service.
So while handoffs are certainly vulnerable and we should be on the lookout for risks, I always say the handoff is also a learning opportunity and could even improve care. In this case, many typical assumptions don’t even apply and a new approach maybe what we need most.
I’m actually writing this as my husband is picking up a service and Wednesday is our resident switch day so here’s to anyone starting a new rotation this week! H/t @ETSshow @aoglasser @WrayCharles @ShikhaJainMD for forwarding many handoff tweets prompting this.
tagging some great thinkers on this or related #ptsafety topics. @leorahorwitzmd @jdensonMD @LekshmiMD @jeannemfarnan @nvhstewart @DrStephMueller @kathlynsafedoc @sumantranji @ChrisMoriates @ReshmaGuptaMD @subhaairan @karynbaum @_plyons @JulieJKJohnson @Bob_Wachter @kgshojania
h/t those who support the geekiness @alikhan28 @MDaware @krupali @gradydoctor @AmmahStarr @arghavan_salles @drjessigold @nvhstewart @neel_shah @choo_ek @darakass @meganranney @ErinSandersNP @thehowie @JosephSakran @HelenBurstin @DrSimpsonHSR @dr_msharma @yejnes @BobDohertyACP

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I applaud the #EUCancerPlan *BUT* caution: putting #meat 🥩 (a nourishing, evolutionary food) in the same box as 🚬 to solve a contemporary health challenge, would be basing policy on assumptions rather than robust data.

#FollowTheScience yes, but not just part of it!
THREAD👇


1/ Granted, some studies have pointed to ASSOCIATIONS of HIGH intake of red & processed meats with (slightly!) increased colorectal cancer incidence. Also, @WHO/IARC is often mentioned in support (usually hyperbolically so).

But, let’s have a closer look at all this! 🔍


2/ First, meat being “associated” with cancer is very different from stating that meat CAUSES cancer.

Unwarranted use of causal language is widespread in nutritional sciences, posing a systemic problem & undermining credibility.

3/ That’s because observational data are CONFOUNDED (even after statistical adjustment).

Healthy user bias is a major problem. Healthy middle classes are TOLD to eat less red meat (due to historical rather than rational reasons, cf link). So, they

4/ What’s captured here is sociology, not physiology.

Health-focused Westerners eat less red meat, whereas those who don’t adhere to dietary advice tend to have unhealthier lifestyles.

That tells us very little about meat AS SUCH being responsible for disease.
No-regret #hydrogen:
Charting early steps for H₂ infrastructure in Europe.

👉Summary of conclusions of a new study by @AgoraEW @AFRY_global @Ma_Deutsch @gnievchenko (1/17)
https://t.co/YA50FA57Em


The idea behind this study is that future hydrogen demand is highly uncertain and we don’t want to spend tens of billions of euros to repurpose a network which won’t be needed. For instance, hydrogen in ground transport is a hotly debated topic
https://t.co/RlnqDYVzpr (2/17)

Similar things can be said about heat. 40% of today’s industrial natural gas use in the EU goes to heat below 100°C and therefore is within range of electric heat pumps – whose performance factors far exceed 100%. (3/17)


Even for higher temperatures, a range of power-to-heat (PtH) options can be more energy-efficient than hydrogen and should be considered first. Available PtH technologies can cover all temperature levels needed in industrial production (e.g. electric arc furnace: 3500°C). (4/17)


In our view, hydrogen use for feedstock and chemical reactions is the only inescapable source of industrial hydrogen demand in Europe that does not lend itself to electrification. Examples include ammonia, steel, and petrochemical industries. (5/17)

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