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What is quality in medical care?

H G Schnürch, S Ackermann, C D Alt, J Barinoff, C Böing, C Dannecker, F Gieseking, A Günthert, P Hantschmann, L C Horn, R Kürzl, P Mallmann, S Marnitz, G Mehlhorn, C C Hack, M C Koch, U Torsten, W Weikel, L Wölber, M Hampl
Purpose: This is an official guideline, published and coordinated by the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO, Study Group for Gynecologic Oncology) of the Deutsche Krebsgesellschaft (DKG, German Cancer Society) and the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG, German Society for Gynecology and Obstetrics). The number of cases with vulvar cancer is on the rise, but because of the former rarity of this condition and the resulting lack of literature with a high level of evidence, in many areas knowledge of the optimal clinical management still lags behind what would be required...
October 2016: Geburtshilfe und Frauenheilkunde
Thomas Weber
Validation of a medical device measuring a biomarker is a complex process, involving technical aspects (What is actually measured by the device, and how is this done ? Is the measurement reproducible ? Is there a gold standard for measurement of the particular biomarker ? If yes, how accurate and how precise are the measurements by the device, compared to the gold standard ?) and clinical aspects (Do the measurements predict outcome ? If yes, is there added value, when standard clinical parameters are considered ? Is there a treatment strategy, based on the mesurements of the novel device ? Is this strategy cost-effective ?)...
September 2016: Journal of Hypertension
Jean Christophe Rusatira, Brian Tomaszewski, Vincent Dusabejambo, Vincent Ndayiragije, Snedden Gonsalves, Aishwarya Sawant, Angeline Mumararungu, George Gasana, Etienne Amendezo, Anne Haake, Leon Mutesa
BACKGROUND: Lack of access to health and medical education resources for doctors in the developing world is a serious global health problem. In Rwanda, with a population of 11 million, there is only one medical school, hence a shortage in well-trained medical staff. The growth of interactive health technologies has played a role in the improvement of health care in developed countries and has offered alternative ways to offer continuous medical education while improving patient's care...
June 1, 2016: JMIR Med Educ
Nicholas Waldron, Claire E Johnson, Peter Saul, Heidi Waldron, Jeffrey C Chong, Anne-Marie Hill, Barbara Hayes
BACKGROUND: Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. METHODS: Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature...
October 6, 2016: BMC Health Services Research
Kirstin Borgerson
The volume of clinical research is increasing exponentially-far beyond our ability to process and absorb the results. Given this situation, it may be beneficial to consider reducing the flow at its source. In what follows, I will motivate and critically evaluate the following proposal: researchers should conduct fewer clinical trials. More specifically, I consider whether researchers should be permitted to conduct only clinical research of very high quality and, in turn, whether research ethics committees (RECs) should prohibit all other, lower-quality research, even when it might appear to meet some minimal ethical standard...
October 6, 2016: Hastings Center Report
Lane Koenig, Qian Zhang, Matthew S Austin, Berna Demiralp, Thomas K Fehring, Chaoling Feng, Richard C Mather, Jennifer T Nguyen, Asha Saavoss, Bryan D Springer, Adolph J Yates
BACKGROUND: Demand for total hip arthroplasty (THA) is high and expected to continue to grow during the next decade. Although much of this growth includes working-aged patients, cost-effectiveness studies on THA have not fully incorporated the productivity effects from surgery. QUESTIONS/PURPOSES: We asked: (1) What is the expected effect of THA on patients' employment and earnings? (2) How does accounting for these effects influence the cost-effectiveness of THA relative to nonsurgical treatment? METHODS: Taking a societal perspective, we used a Markov model to assess the overall cost-effectiveness of THA compared with nonsurgical treatment...
October 3, 2016: Clinical Orthopaedics and related Research
Marta Rzadkiewicz, Ola Bråtas, Geir Arild Espnes
The present paper is a narrative review focusing on the psychological impact, identification of protective factors, and interventions minimizing the psychological burdens of chronic obstructive pulmonary disease (COPD). The research reviews studies on neurocognitive functions, personality, emotional problems, and health-related quality of life. This is done with regard to resources as well as activities enabling or enhancing a patient's adaptation. PubMed and PsychArticles databases were searched for relevant medical (eg, CODP, emphysema), psychopathology (eg, depression), and psychological (eg, personality) keywords, followed by hand search...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Kathleen T Unroe, Susan E Hickman, Alexia M Torke
A basic tenet of palliative care is discerning patient treatment preferences and then honoring these preferences, reflected by the inclusion of "Care Consistency with Documented Care Preferences" as one of ten Measuring What Matters (MWM) quality indicators. MWM indicators are intended to serve as a foundation for quality measurement in health care settings. However, there are a number of logistic and practical issues to be considered in the application of this quality indicator to clinical practice. In this brief methodologic report, we describe how care consistency with documented care preferences has been measured in research on patients near the end of life...
September 24, 2016: Journal of Pain and Symptom Management
Media Esser
Diaper dermatitis is a major issue among hospitalized infants, leading to increased medical costs, pain, risk for infection, and distress among patients and caregivers. An evidence-based algorithm for prevention and treatment of diaper dermatitis was developed and introduced in a level IV neonatal intensive care unit (NICU). Two cases are discussed as examples of severe diaper dermatitis. The first case demonstrates the final case of severe diaper dermatitis since the introduction of the algorithm. The second case demonstrates a less severe, but equally frustrating, case of diaper dermatitis that occurred after the practice of using the algorithm was established...
October 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
John Shiguang Loy, Eskinder Eshetu Ali, Kevin Yi-Lwern Yap
BACKGROUND: The advent of smartphones has enabled a plethora of medical apps for disease management. As of 2012, there are 40,000 health care-related mobile apps available in the market. Since most of these medical apps do not go through any stringent quality assessment, there is a risk of consumers being misinformed or misled by unreliable information. In this regard, apps that target medication-related problems (MRPs) are not an exception. There is little information on what constitutes quality in apps that target MRPs and how good the existing apps are...
October 2016: Journal of Managed Care & Specialty Pharmacy
Maya Kumar, Sheila Gahagan, Bretten Pickering, Jeffrey Gold, Martin T Stein
Jennifer is a 16-year-old Latina girl who is new to your practice. During her first well visit, she mentions that she has had daily headaches for 2 years. They began after sustaining a concussion in a car accident. Typically, her headaches are bilateral and "squeezing"; they occur in the afternoons and last for a few hours. Her concussion also resulted in depressed mood, which has improved over time.When you ask if her headaches have changed recently, she says that they have been worse for the last few days...
September 20, 2016: Journal of Developmental and Behavioral Pediatrics: JDBP
Dominique Tremblay, Jean Latreille, Karine Bilodeau, Arnaud Samson, Linda Roy, Marie-France L'Italien, Christine Mimeault
This article discusses the case of a 47-year-old woman who underwent primary therapy with curative intent for breast cancer. The case illustrates a number of failure events in transferring information and responsibility from oncology to primary care teams. The article emphasizes the importance of shared leadership, as multiple team members, dispersed in time and space, pursue their own objectives while achieving the common goal of coordinating care for survivors of cancer transitioning across settings. Shared leadership is defined as a team property comprising shared responsibility and mutual influence between the patient and the patient's family, primary care providers, and oncology teams, whereby they lead each other toward quality and safety of care...
September 20, 2016: Journal of Oncology Practice
Kayleigh M Kew, Marina Nashed, Valdeep Dulay, Janelle Yorke
BACKGROUND: People with asthma have a higher prevalence of anxiety and depression than the general population. This is associated with poorer asthma control, medication adherence, and health outcomes. Cognitive behavioural therapy (CBT) may be a way to improve the quality of life of people with asthma by addressing associated psychological issues, which may lead to a lower risk of exacerbations and better asthma control. OBJECTIVES: To assess the efficacy of CBT for asthma compared with usual care...
September 21, 2016: Cochrane Database of Systematic Reviews
Thomas B Birdwell, Sadiah M Hoque, Mara C Kennedy, Jane H Sim, Tracey C Vlahovic
INTRODUCTION AND OBJECTIVES: Psoriasis is a systemic condition with several dermatological manifestations that affect many individuals on a daily basis. According to Langley et al in a study titled "Psoriasis: epidemiology, clinical features, and quality of life," psoriasis affects 2% of the American population, which is approximately 6 million people. Out of these 6 million people, approximately 2-3% are affected by palmoplantar psoriasis (Farber et al). Plantar psoriasis in particular can cause significant functional and social disabilities...
September 2016: Journal of the American Podiatric Medical Association
M J Schuuring, A P Backx, R Zwart, A H Veelenturf, D Robbers-Visser, M Groenink, A Abu-Hanna, N Bruining, M P Schijven, B J Mulder, B J Bouma
OBJECTIVE: Many adults with congenital heart disease (CHD) are affected lifelong by cardiac events, particularly arrhythmias and heart failure. Despite the care provided, the cardiac event rate remains high. Mobile health (mHealth) brings opportunities to enhance daily monitoring and hence timely response in an attempt to improve outcome. However, it is not known if adults with CHD are currently using mHealth and what type of mHealth they may need in the near future. METHODS: Consecutive adult patients with CHD who visited the outpatient clinic at the Academic Medical Center in Amsterdam were asked to fill out questionnaires...
November 2016: Netherlands Heart Journal
Thomas Weber
Validation of a medical device measuring a biomarker is a complex process, involving technical aspects (What is actually measured by the device, and how is this done ? Is the measurement reproducible ? Is there a gold standard for measurement of the particular biomarker ? If yes, how accurate and how precise are the measurements by the device, compared to the gold standard ?) and clinical aspects (Do the measurements predict outcome ? If yes, is there added value, when standard clinical parameters are considered ? Is there a treatment strategy, based on the mesurements of the novel device ? Is this strategy cost-effective ?)...
September 2016: Journal of Hypertension
Ann Scheck McAlearney, Daniel M Walker, Jennifer Livaudais-Toman, Michael Parides, Nina A Bickell
OBJECTIVES: Implementation of interventions designed to improve the quality of medical care often proceeds differently from what is planned. Improving existing conceptual models to better understand the sources of these differences can help future projects avoid these pitfalls and achieve desired effectiveness. To inform an adaptation of an existing theoretical model, we examined unanticipated changes that occurred in an intervention designed to improve reporting of adjuvant therapies for breast cancer patients at a large, urban academic medical center...
2016: SAGE Open Medicine
Ann Hagensen, Amy E London, Jennifer J Phillips, W Scott Helton, Vincent J Picozzi, C Craig Blackmore
PURPOSE: Despite the importance of the patient care experience to quality and outcome, the literature detailing the care experience in patients with pancreatic cancer is limited. METHODS: To elicit the experience of patients with pancreatic cancer for care redesign, we deployed experience-based design, an emerging methodology based on identification of events of high emotional content, known as touch points, to delineate qualitatively what matters most to patients and families...
September 13, 2016: Journal of Oncology Practice
A A De Graaff, J Van Lankveld, L J Smits, J J Van Beek, G A J Dunselman
STUDY QUESTION: To what extent are endometriosis and its related physical and mental symptoms associated with the perceived level of sexual functioning in women and their male partners? SUMMARY ANSWER: Dyspareunia and depressive symptoms are associated with impaired sexual functioning in women with endometriosis, whereas sexual functioning in their male partners is not affected. WHAT IS KNOWN ALREADY: Women with endometriosis suffer from more dyspareunia, lower sexual functioning, and lower quality of life...
September 12, 2016: Human Reproduction
Thomas H Gallagher, Michael L Farrell, Hannah Karson, Sarah J Armstrong, John T Maldon, Michelle M Mello, Bruce F Cullen
OBJECTIVE: Communication and resolution programs (CRPs) involve institutions responding to adverse events using transparency with patients, event analysis, recurrence prevention, and compensation. Collaboration with regulators around CRPs could enhance health care quality. SETTING AND PARTICIPANTS: Health care institutions, liability insurers, and the Medical Quality Assurance Commission (MQAC, board of medicine) in Washington State. STUDY DESIGN: MQAC has collaborated with the Foundation for Health Care Quality (FHCQ) on the CRP Certification pilot...
September 7, 2016: Health Services Research
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