Objectives: Statistical significance does not equal clinical significance. This study looked at how frequently statistically significant results in the nuclear medicine literature are clinically relevant. Methods: A medline search was performed with results limited to clinical trials or randomized controlled trials, published in one of the major nuclear medicine journals. Articles analyzed were limited to those reporting continuous variables where a mean (X) and standard deviation (SD) were reported and determined to be statistically significant (p < 0.05). A total of 32 test results were evaluated. Clinical relevance was determined in a two-step fashion. First, the crossover point between group 1 (normal) and group 2 (abnormal) was determined. This is the the point at which a variable is just as likely to fall in the normal distrubution as the abnormal distribution. Jacobson's test for clinically significant change was used: crossover point = (SD1 * X2 + SD2 * X1) / (SD1 + SD2). It was then determined how many SD's from the mean this crossover point fell. For example, 13.9 +/- 4.5 compared to 9.2 +/- 2.1 was reported as statistically significant (p < 0.05). The crossover point is 10.7, which equals 0.71 std from the mean: 13.9 - (0.71*4.5) = 9.2 + (0.71*2.1). Results: The average crossover point was 0.66 SD's from the mean. The crossover point was within 1 SD from the mean in 26/32 cases, and in these cases averaged 0.45 SD. Thus, for 4 out of 5 statistically significant results, when applied to an individual patient, the cut-off between normal and abnormal was 0.45 SD from the mean. This results in a third of normal patients falling into an abnormal category. Conclusions: Statistically significant results frequently are not clinically significant. Statistical significance alone does not ensure clinical relevance.
Blockchain technology has great potential to revolutionize healthcare data management. The technology is sufficiently complex, however, making it essential that a large number of people with a broad range of skills will be required to implement the technology. Innovation clusters will be the primary means of producing blockchain breakthroughs in healthcare by bringing together computer scientists, medical experts, and business people in the pursuit of a common goal. Healthcare innovation clusters are most likely to be centered around medical universities, but will also include in close geographic proximity technology, business, and medical insurance organizations.
Healthcare complexity and costs can be decreased through the application of blockchain technology to medical records and insurance companies. Estonia has taken a leadership role in blockchain based services both in the commercial sector and in government. The Estonian government’s innovation strategy was to create GovTech partnerships to implement blockchain based technologies throughout the country, and become a global leader in the technology. Starting in 2011, just 3 years after Satoshi Nakamoto published the first description of distributed ledgers and blockchain technology, the Estonian Government started partnering with the private technology startup company Guardtime to use blockchains to secure public and internal records. Then in 2016, Estonia once again reinforced its global leadership in blockchain technology when it announced it would use blockchain technology to secure the health records of over a million citizens. Estonia’s systematic method of applying blockchain technologies through GovTech partnerships demnostrates how innovation is a process. Estonia also identified early the value of the blockchain as a disruptive platform innovation. The application of blockchain technology to healthcare is a radical innovation given that nearly all previous applications have been in the financial and legal sectors.
Blockchain technology can be utilized to improve gun control without changing existing laws. Firearm related mortality is at epidemic levels in the United States and not only has a significant impact upon public health, it also creates a large financial burden. Suicide is the most common way guns kill. Through better gun tracking and improved screening of high risk individuals, this technological advance in distributed ledger technology will improve background checks on individuals and tracing of guns used in crimes.
Blockchain technology enables the creation of immutable, publicly available data. Initial applications have been primarily in the fields of finance (Bitcoin) and law (smart contracts), yet it can also help advance science by reducing human bias. The blockchain can ensure that hypotheses are not altered; that methods of data collection are transparent; that results are publicly available for independent analyses; and that conclusions are less biased. Our current system of medical research suffers from too much bias. Blockchain technologies, by creating immutable data, will lead to an increased confidence in evidence based medicine.
Blockchain technology is a system of creating an immutable, secure, distributed database of transactions. Blockchains were initially created to provide a distributed ledger of financial transactions that did not rely upon a central bank, credit company, or other financial institution. The technological breakthrough, however, has been extended to transactions involving legal matters, medical records, insurance billing, and smart contracts. One primary way that blockchain technology is important to healthcare professionals in that it can revolutionize medical database interoperability. This greater interoperability can help improve access to medical records, imaging archives, prescription databases. Given that a patient’s medical history is a primary cornerstone of good medicine, blockchain technology has the potential to dramatically improve medical care.