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https://www.readbyqxmd.com/read/28343174/mirna-analysis-in-pancreatic-cancer-the-dartmouth-experience
#1
Francine B de Abreu, Xiaoying Liu, Gregory J Tsongalis
Pancreatic cancer is considered one of the most lethal cancers being the fourth leading cause of cancer deaths in adults in the United States because of the lack of early signs and symptoms and the lack of early detection. Pancreatic ductal adenocarcinoma (PDAC) is the most common histological type among pancreatic cancers, representing 80%-90% of all solid tumors of the pancreas. The majority of PDAC develops from three precursor lesions: pancreatic intraepithelial neoplasia, intraductual papillary mucinous neoplasm and mucinous cystic neoplasm...
March 27, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28338572/the-drivers-of-medicare-reimbursement-for-thoracolumbar-fusion-an-analysis-of-data-from-the-centers-for-medicare-and-medicaid-services
#2
Krishn Khanna, Eric M Padegimas, Benjamin Zmistowski, Michael Howley, Kushagra Vema
STUDY DESIGN: Retrospective observational OBJECTIVE.: The purpose of this study is to examine the variation in Thoracolumbar Fusion (TLF) payment and determine the drivers of this variation. SUMMARY OF BACKGROUND DATA: As healthcare spending continues to increase, variation in surgical procedures reimbursements has come under more scrutiny. TLF is an example of a high-cost, proven-benefit procedure that is often the focus of Centers for Medicare and Medicaid Services (CMS) administrators...
March 23, 2017: Spine
https://www.readbyqxmd.com/read/28328708/long-term-outcomes-of-melanoma-in-situ-treated-with-topical-5-imiquimod-cream-a-retrospective-review
#3
Andrew J Park, Joan Paul, M Shane Chapman, Faramarz H Samie
BACKGROUND: Melanoma in situ (MIS) is a noninvasive form of melanoma for which nonsurgical therapeutic options continue to be explored. The off-label use of topical 5% imiquimod cream in the management of MIS has shown potential but reported recurrence rates vary considerably between 0% and 40%. Furthermore, the long-term efficacy of imiquimod is not well established. OBJECTIVE: To determine the recurrence rate of MIS among patients treated with topical 5% imiquimod cream at Dartmouth-Hitchcock Medical Center with at least 1 year of follow-up...
March 21, 2017: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.]
https://www.readbyqxmd.com/read/28289113/the-effects-of-training-institution-practice-costs-quality-and-other-characteristics-on-future-practice
#4
Robert L Phillips, Stephen M Petterson, Andrew W Bazemore, Peter Wingrove, James C Puffer
PURPOSE: Medicare beneficiary spending patterns reflect those of the 306 Hospital Referral Regions where physicians train, but whether this holds true for smaller areas or for quality is uncertain. This study assesses whether cost and quality imprinting can be detected within the 3,436 Hospital Service Areas (HSAs), 82.4 percent of which have only 1 teaching hospital, and whether sponsoring institution characteristics are associated. METHODS: We conducted a secondary, multi-level, multivariable analysis of 2011 Medicare claims and American Medical Association Masterfile data for a random, nationally representative sample of family physicians and general internists who completed residency between 1992 and 2010 and had more than 40 Medicare patients (3,075 physicians providing care to 503,109 beneficiaries)...
March 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/28192086/variant-call-concordance-between-two-laboratory-developed-solid-tumor-targeted-genomic-profiling-assays-using-distinct-workflows-and-sequencing-instruments
#5
Ken J Hampel, Francine B de Abreu, Nikoletta Sidiropoulos, Jason D Peterson, Gregory J Tsongalis
Targeted genomic profiling (TGP) using massively parallel DNA sequencing is becoming the standard methodology in clinical laboratories for detecting somatic variants in solid tumors. The variety of methodologies and sequencing platforms in the marketplace for TGP has resulted in a variety of clinical TGP laboratory developed tests (LDT). The variability of LDTs is a challenge for test-to-test and laboratory-to-laboratory reliability. At the University of Vermont Medical Center (UVMMC), we validated a TGP assay for solid tumors which utilizes DNA hybridization capture and complete exon and selected intron sequencing of 29 clinically actionable genes...
February 10, 2017: Experimental and Molecular Pathology
https://www.readbyqxmd.com/read/28159820/healthcare-resource-availability-quality-of-care-and-acute-ischemic-stroke-outcomes
#6
Emily C O'Brien, Jingjing Wu, Xin Zhao, Phillip J Schulte, Gregg C Fonarow, Adrian F Hernandez, Lee H Schwamm, Eric D Peterson, Deepak L Bhatt, Eric E Smith
BACKGROUND: Healthcare resources vary geographically, but associations between hospital-based resources and acute stroke quality and outcomes remain unclear. METHODS AND RESULTS: Using Get With The Guidelines-Stroke and Dartmouth Atlas of Health Care data, we examined associations between healthcare resource availability, stroke care, and outcomes. We categorized hospital referral regions with high-, medium-, or low-resource levels based on the 2006 national per-capita availability median of 6 relevant acute stroke care resources...
February 3, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28116996/digging-into-debt-the-financial-burden-associated-with-the-otolaryngology-match
#7
Marc A Polacco, Jack Lally, Andrew Walls, Linnea R Harrold, Sonya Malekzadeh, Eunice Y Chen
Objective To quantify the cost incurred during the match process for otolaryngology applicants, determine sources of expenditures, and highlight potential methods to alleviate financial burden of the match process. Study Design Cross-sectional. Study Setting Online survey. Subjects and Methods An electronic survey was sent via email to those who applied to the otolaryngology residency programs at Dartmouth-Hitchcock Medical Center and MedStar Georgetown University Hospital during the 2016 application cycle...
January 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28087244/practice-makes-perfect-correlations-between-prior-experience-in-high-level-athletics-and-robotic-surgical-performance-do-not-persist-after-task-repetition
#8
Kevin Shee, Fady M Ghali, Elias S Hyams
OBJECTIVE: Robotic surgical skill development is central to training in urology as well as in other surgical disciplines. Here, we describe a pilot study assessing the relationships between robotic surgery simulator performance and 3 categories of activities, namely, videogames, musical instruments, and athletics. DESIGN: A questionnaire was administered to preclinical medical students for general demographic information and prior experiences in surgery, videogames, musical instruments, and athletics...
January 10, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28065558/the-availability-of-community-health-center-services-and-access-to-medical-care
#9
James B Kirby, Ravi Sharma
BACKGROUND: Community Health Centers (CHCs) funded by Section 330 of the Public Health Service Act are an essential part of the health care safety net in the US. The Patient Protection and Affordable Care Act expanded the program significantly, but the extent to which the availability of CHCs improve access to care in general is not clear. In this paper, we examine the associations between the availability of CHC services in communities and two key measures of ambulatory care access - having a usual source of care and having any office-based medical visits over a one year period...
January 5, 2017: Healthcare
https://www.readbyqxmd.com/read/28062822/improving-health-care-for-spanish-speaking-rural-dairy-farm-workers
#10
Caledonia Buckheit, Dwan Pineros, Ardis Olson, Deborah Johnson, Stephen Genereaux
BACKGROUND: Dartmouth Geisel Migrant Health (DGMH) is a medical student group that provides on-site health services for Spanish-speaking dairy workers in rural Vermont and New Hampshire in conjunction with a federally qualified health center (FQHC). STUDY OBJECTIVE: This project was undertaken to evaluate and improve the services provided by DGMH and the FQHC and to refine understanding of the target population. METHODS: We surveyed 25 workers at 6 collaborating dairy farms to identify health priorities and concerns and perceived barriers and facilitators to health care for these workers...
January 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28035028/sexy-a-tool-for-sex-inference-from-genotype-arrays
#11
David C Qian, Jonathan A Busam, Xiangjun Xiao, Tracy A O'Mara, Rosalind A Eeles, Frederick R Schumacher, Catherine M Phelan, Christopher I Amos
MOTIVATION: Checking concordance between reported sex and genotype-inferred sex is a crucial quality control measure in genome-wide association studies (GWAS). However, limited insights exist regarding the true accuracy of software that infer sex from genotype array data. RESULTS: We present seXY, a logistic regression model trained on both X chromosome heterozygosity and Y chromosome missingness, that consistently demonstrated >99.5% sex inference accuracy in cross-validation for 889 males and 5,361 females enrolled in prostate cancer and ovarian cancer GWAS...
December 28, 2016: Bioinformatics
https://www.readbyqxmd.com/read/27998335/jos%C3%A3-pinto-de-azeredo%C3%A2-essays-on-some-maladies-of-angola-stewart-lloyd-jones-trans-timothy-d-walker-ed-with-contributions-by-adelino-cardoso-ant%C3%A3-nio-braz-de-oliveira-and-manuel-silv%C3%A3-rio-marques%C3%A2-dartmouth-ma-tagus-press-2016-pp-x-151-24-95-paperback-isbn
#12
https://www.readbyqxmd.com/read/27922948/fluoroscopic-guidance-increases-the-incidence-of-thoracic-epidural-catheter-placement-within-the-epidural-space-a-randomized-trial
#13
Michelle C Parra, Kristin Washburn, Jeremiah R Brown, Michael L Beach, Mark P Yeager, Patricia Barr, Kathy Bonham, Kathryn Lamb, Randy W Loftus
BACKGROUND AND OBJECTIVES: Thoracic epidural analgesia can reduce postoperative pain and cardiopulmonary morbidity, but it is associated with a high rate of clinical failure. Up to 50% of clinical failure is thought to be related to technical insertion. In this study, patients undergoing thoracic surgery were randomized to one of two catheter insertion techniques: fluoroscopically guided or conventional loss of resistance with saline/air. Our primary aim was to examine whether fluoroscopic guidance could increase the incidence of correct catheter placement and improve postoperative analgesia...
January 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27917479/hospital-postacute-care-referral-networks-is-referral-concentration-associated-with-medicare-style-bundled-payments
#14
Ramandeep Kaur, Jennifer N Perloff, Christopher Tompkins, Christine E Bishop
OBJECTIVE: To evaluate whether Medicare-style bundled payments are lower or higher for beneficiaries discharged from hospitals with postacute care (PAC) referrals concentrated among fewer PAC providers. DATA SOURCE: Medicare Part A and Part B claim (2008-2012) for all beneficiaries residing in any of 17 market areas: the Provider of Service file, the Healthcare Cost Report Information System, and the Dartmouth Atlas. STUDY DESIGN: An observational study in which hospitals were distinguished according to PAC referral concentration, which is the tendency to utilize fewer rather than more PAC providers...
December 5, 2016: Health Services Research
https://www.readbyqxmd.com/read/27893952/acceptability-and-impact-of-a-required-palliative-care-rotation-with-prerotation-and-postrotation-observed-simulated-clinical-experience-during-internal-medicine-residency-training-on-primary-palliative-communication-skills
#15
Maxwell T Vergo, Sharona Sachs, Meredith A MacMartin, Kathryn B Kirkland, Amelia M Cullinan, Lisa A Stephens
BACKGROUND: Improving communication training for primary palliative care using a required palliative care rotation for internal medicine (IM) residents has not been assessed. OBJECTIVE: To assess skills acquisition and acceptability for IM residents not selecting an elective. DESIGN: A consecutive, single-arm cohort underwent preobjective structured clinical examination (OSCE) with learner-centric feedback, two weeks of clinical experience, and finally a post-OSCE to crystallize learner-centric take home points...
November 28, 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27881699/multicenter-experience-of-surgical-explantation-of-carotid-stents-for-recurrent-stenosis
#16
MULTICENTER STUDY
Jesse A Columbo, John C McCallum, Philip P Goodney, Thomas C Bower, Marc L Schermerhorn, Richard J Powell, Randall R DeMartino
OBJECTIVE: A significant cohort of patients who have undergone carotid artery stenting (CAS) will have in-stent restenosis (ISR). The optimal management of symptomatic or severe ISR remains poorly defined. The purpose of this study was to describe the indications, treatment, and mid- to long-term outcomes of patients undergoing CAS explantation for ISR. METHODS: All patients undergoing internal carotid artery stent explantation with carotid artery reconstruction at Mayo Clinic Rochester, Dartmouth-Hitchcock Medical Center, and Beth-Israel Deaconess Medical Center from 2003 to 2013 were retrospectively reviewed...
November 2016: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/27861822/automated-delineation-of-hospital-service-areas-and-hospital-referral-regions-by-modularity-optimization
#17
Yujie Hu, Fahui Wang, Imam M Xierali
OBJECTIVE: To develop an automated, data-driven, and scale-flexible method to delineate hospital service areas (HSAs) and hospital referral regions (HRRs) that are up-to-date, representative of all patients, and have the optimal localization of hospital visits. DATA SOURCES: The 2011 state inpatient database in Florida from the Healthcare Cost and Utilization Project. STUDY DESIGN: A network optimization method was used to redefine HSAs and HRRs by maximizing patient-to-hospital flows within each HSA/HRR while minimizing flows between them...
November 16, 2016: Health Services Research
https://www.readbyqxmd.com/read/27794547/national-and-northern-new-england-opioid-prescribing-patterns-2013-2014
#18
Adam R Toth, Carl J Possidente, Linda M Sawyer, Mark A DiParlo, Gilbert J Fanciullo
OBJECTIVE : To evaluate current opioid prescribing patterns nationally and regionally across several northern New England states and compare with prescription data on an institutional level over a two-year period, between 2013 and 2014. DESIGN, SETTING, AND SUBJECTS:  The IMS Health National Prescription Audit (NPA) database was used to obtain prescription data from US retail pharmacies between 2013 and 2014. METHODS:  Our study compared noninjectable opioid dispensing between two time periods: January-June 2013 and July-December 2014...
October 29, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/27777668/clinical-and-educational-outcomes-of-an-integrated-inpatient-quality-improvement-curriculum-for-internal-medicine-residents
#19
Greg Ogrinc, Emily S Cohen, Robertus van Aalst, Beth Harwood, Ellyn Ercolano, Karyn D Baum, Adam J Pattison, Anne C Jones, Louise Davies, Al West
BACKGROUND : Integrating teaching and hands-on experience in quality improvement (QI) may increase the learning and the impact of resident QI work. OBJECTIVE : We sought to determine the clinical and educational impact of an integrated QI curriculum. METHODS : This clustered, randomized trial with early and late intervention groups used mixed methods evaluation. For almost 2 years, internal medicine residents from Dartmouth-Hitchcock Medical Center on the inpatient teams at the White River Junction VA participated in the QI curriculum...
October 2016: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/27763790/improving-adequacy-of-small-biopsy-and-fine-needle-aspiration-specimens-for-molecular-testing-by-next-generation-sequencing-in-patients-with-lung-cancer-a-quality-improvement-study-at-dartmouth-hitchcock-medical-center
#20
Vijayalakshmi Padmanabhan, Heather B Steinmetz, Elizabeth J Rizzo, Amber J Erskine, Tamara L Fairbank, Francine B de Abreu, Gregory J Tsongalis, Laura J Tafe
CONTEXT: - At our medical center, cytopathologists perform rapid on-site evaluation for specimen adequacy of fine-needle aspiration and touch imprint of needle core biopsy lung cancer samples. Two years ago the molecular diagnostics laboratory at our institution changed to next-generation sequencing using the Ion Torrent PGM and the 50-gene AmpliSeq Cancer Hotspot Panel v2 for analyzing mutations in a 50-gene cancer hot spot panel. This was associated with a dramatic fall in adequacy rate (68%)...
March 2017: Archives of Pathology & Laboratory Medicine
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