The recipe includes: trust, incentives, visible early adopters, and leadership.

Innovation only starts at invention. Adoption is the next main component.

How many clever solutions do you know that need a push towards adoption?

Here is the JAMA article again: pubmed.ncbi.nlm.nih.gov/12697800/

The lesson? Discovery is only half the battle.

Without systems that support diffusion, life-saving interventions stay stuck in labs and journals instead of reaching patients.

In healthcare today, effective interventions (drugs, vaccines, care models) take DECADES to become routine.

Innovation diffuses slowly even when the benefits seem obvious.

"To introduce any new article of food among seamen... requires both the EXAMPLES and the authority of a Commander."
- Captain James Cook.

LEADERSHIP DRIVES DIFFUSION!

EVIDENCE ALONE IS NOT ENOUGH!

Adoption required authority, leadership, and culture change.

Cook saw this and he benefited from the immediate application for himself and his crews.

However, it wasn't until 1865 - 264 yrs after Lancaster, that the British Board of Trade required merchant ships to follow suit.

Two and a half centuries from proof to policy!!! So why so slow?? 😵‍💫

It took 48 more years for the British Navy to officially issue citrus rations.

Scurvy nearly disappeared from its fleets.

Year: 1747 (146 years later!)

James Lind repeated the test aboard HMS Salisbury.

Again, citrus worked!! Now, there should be immediate adoption, right? Again, not even close!!😢

Year: 1601. Nobody knows about vitamin C at that time.

Captain James Lancaster tested lemon juice at sea.
👉 His sailors remained healthy. 🎉💪
👉 All while almost HALF the crews on other ships died of scurvy.💀

You'd expect immediate adoption? Not even close. The Navy ignored it.

a good biomarker of what? 😊

Diet? Inflammation? Liver disease? Kidney disease? (Example etiologies)

High risk patients for mortality or other poor outcomes? (outcomes)

Not good as in non specific: yes.
But good as gold as risk marker.

*screaming

I once witnessed a cardiothoracic surgeon (aka God) SCREENING in ICU: “I WANT DIALYSIS”

for a patient after he was told nephrology suggested a different plan. 😬😟

There are gaps in the evidence, particularly for whether interventions to increase alb directly lower the risk of adverse outcomes.

Treatment should target underlying causes of low alb rather than the lab values alone. Eg protein-energy wasting (PEW), chronic inflammation, poor dietary intake, and comorbidities (including infections and chronic inflammatory conditions).

+ nutritional interventions and tailored dietary plans.

A suggestion that the relationship is mediated through inflammation in this CKD5 pts study

The Higher Mortality Associated With Low Serum Albumin Is Dependent on Systemic Inflammation in End-Stage Kidney Disease.

pubmed.ncbi.nlm.nih.gov/29298330/

Nephrology world: KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update.

doi:10.1053/j.ajkd.2020.05.006.

pubmed.ncbi.nlm.nih.gov/32829751/