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https://www.readbyqxmd.com/read/28093189/advancing-high-value-health-care-a-new-ajm-column-dedicated-to-cost-conscious-care-quality-improvement
#1
EDITORIAL
Pamela T Johnson, Amit Pahwa, Leonard Feldman, Roy Ziegelstein, David Hellmann
No abstract text is available yet for this article.
January 13, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28076262/physician-cost-consciousness-and-use-of-low-value-clinical-services
#2
Michael Grover, Neena Abraham, Yu-Hui Chang, Jon Tilburt
PURPOSE: Choosing Wisely(TM) engaged medical specialties, creating "top 5 lists" of low-value services. We describe primary care physicians' (PCPs') self-reported use of these services and perceived barriers to guideline adherence. We quantify physician cost consciousness and determine associations with use. METHODS: PCP attendees of a continuing medical education conference completed a survey. For each Family Medicine Choosing Wisely behavior, participants reported clinical adherence...
November 2016: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28052170/differences-in-routine-laboratory-ordering-between-a-teaching-service-and-a-hospitalist-service-at-a-single-academic-medical-center
#3
Michael I Ellenbogen, Madeleine Ma, Nicholas P Christensen, Jungwha Lee, Kevin J O'Leary
OBJECTIVES: Studies have shown that the overutilization of laboratory tests ("labs") for hospitalized patients is common and can cause adverse health outcomes. Our objective was to compare the ordering tendencies for routine complete blood counts (CBC) and chemistry panels by internal medicine residents and hospitalists. METHODS: This observational study included a survey of medicine residents and hospitalists and a retrospective analysis of labs ordering data. The retrospective data analysis comprised patients admitted to either the teaching service or nonteaching hospitalist service at a single hospital during 2014...
January 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/27974370/should-all-anticoagulated-patients-with-head-injury-receive-a-ct-scan-decision-analysis-modelling-of-an-observational-cohort
#4
Maxine Kuczawski, Matt Stevenson, Steve Goodacre, M Dawn Teare, Shammi Ramlakhan, Francis Morris, Suzanne Mason
OBJECTIVES: It is not currently clear whether all anticoagulated patients with a head injury should receive CT scanning or only those with evidence of traumatic brain injury (eg, loss of consciousness or amnesia). We aimed to determine the cost-effectiveness of CT for all compared with selective CT use for anticoagulated patients with a head injury. DESIGN: Decision-analysis modelling of data from a multicentre observational study. SETTING: 33 emergency departments in England and Scotland...
December 13, 2016: BMJ Open
https://www.readbyqxmd.com/read/27936845/dealing-with-prospective-memory-demands-while-performing-an-ongoing-task-shared-processing-increased-on-task-focus-or-both
#5
Jan Rummel, Bridget A Smeekens, Michael J Kane
Prospective memory (PM) is the cognitive ability to remember to fulfill intended action plans at the appropriate future moment. Current theories assume that PM fulfillment draws on attentional processes. Accordingly, pending PM intentions interfere with other ongoing tasks to the extent to which both tasks rely on the same processes. How do people manage the competition between PM and ongoing-task demands? Based on research relating mind wandering and attentional control (Kane & McVay, 2012), we argue that people may not only change the way they process ongoing-task stimuli when given a PM intention, but they may also engage in less off-task thinking than they otherwise would...
December 12, 2016: Journal of Experimental Psychology. Learning, Memory, and Cognition
https://www.readbyqxmd.com/read/27918894/perception-of-ensemble-statistics-requires-attention
#6
Molly Jackson-Nielsen, Michael A Cohen, Michael A Pitts
To overcome inherent limitations in perceptual bandwidth, many aspects of the visual world are represented as summary statistics (e.g., average size, orientation, or density of objects). Here, we investigated the relationship between summary (ensemble) statistics and visual attention. Recently, it was claimed that one ensemble statistic in particular, color diversity, can be perceived without focal attention. However, a broader debate exists over the attentional requirements of conscious perception, and it is possible that some form of attention is necessary for ensemble perception...
December 2, 2016: Consciousness and Cognition
https://www.readbyqxmd.com/read/27917076/the-cost-effectiveness-of-vedolizumab-for-inflammatory-bowel-disease-a-review-of-the-current-literature
#7
Yecheskel Schneider, Monica Saumoy, Shirley Cohen-Mekelburg, Adam F Steinlauf, Ellen J Scherl
The United States spends a greater share per gross domestic product on health care than any other developed country in the world. Cost-conscious, high-value care has an important role in the practice of medicine. Inflammatory bowel disease (IBD) affects 1.6 million people in the United States and is responsible for significant health care costs, with estimates as high as $31.6 billion annually, a large portion of which is attributable to the use of biologic therapies. As the number of therapeutic targets for IBD expands, gastroenterologists can anticipate the arrival of novel therapeutic agents on the market, and these may carry significant costs...
October 2016: Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/27894929/ultra-thin-disposable-gastroscope-for-screening-and-surveillance-of-gastroesophageal-varices-in-patients-with-liver-cirrhosis-a-prospective-comparative-study
#8
Dep K Huynh, Leanne Toscano, Vinh-An Phan, Tsai-Wing Ow, Mark Schoeman, Nam Q Nguyen
BACKGROUND AND AIMS: The study aims to evaluate the role of an unsedated, ultra-thin disposable gastroscopy (TDG) against conventional gastroscopy (CG) in screening and surveillance of gastroesophageal varices (GOVs) in patients with liver cirrhosis. METHOD: 48 patients (56.4±1.3 years; 38M:10F) with liver cirrhosis referred for screening (n=12) or surveillance (n=36) of GOVs were prospectively enrolled. Unsedated gastroscopy was initially performed with TDG (E...
November 25, 2016: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/27891474/an-evaluation-of-use-of-botulinum-toxin-type-a-in-the-management-of-dynamic-forehead-wrinkles-a-clinical-study
#9
Avvaru Susmita, Naga Neelima Devi Kolli, Sridhar Meka, Srinivas Pandi Chakravarthi, Vivekanand Sabanna Kattimani, Krishna Prasad Lingamaneni, Latheef Saheb Shaik
INTRODUCTION: The pursuit of youth and beauty has undergone a resurgence of interest which is evidenced by increasing cosmetic procedures. Botulinum Toxin Type A (Botox) is one among the many procedures invented for facial rejuvenation which denervates certain muscles of facial expression responsible for facial wrinkles. It has been applied in the forehead, glabella, lateral canthal area and neck. In maxillofacial area hyperactive forehead wrinkles show sagging. AIM: This study was aimed to clinically evaluate the efficacy of Botox injection in the elimination of hyperdynamic forehead wrinkles and the objectives were to compare pre-operative and post-operative improvement in the number of wrinkles, photographic grading and patient satisfaction responses after 1(st) week, 4(th) week and 16(th) week...
October 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27866120/evidence-based-guidelines-on-the-therapeutic-use-of-transcranial-direct-current-stimulation-tdcs
#10
REVIEW
Jean-Pascal Lefaucheur, Andrea Antal, Samar S Ayache, David H Benninger, Jérôme Brunelin, Filippo Cogiamanian, Maria Cotelli, Dirk De Ridder, Roberta Ferrucci, Berthold Langguth, Paola Marangolo, Veit Mylius, Michael A Nitsche, Frank Padberg, Ulrich Palm, Emmanuel Poulet, Alberto Priori, Simone Rossi, Martin Schecklmann, Sven Vanneste, Ulf Ziemann, Luis Garcia-Larrea, Walter Paulus
A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction...
January 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/27845490/cognitive-disability-in-alzheimer-s-disease-and-its-management
#11
M Corsi, T Di Raimo, C Di Lorenzo, M Rapp-Ricciardi, T Archer, S Ricci, R Businaro
Cognitive disability linked to neurodegenerative diseases and in particular to Alzheimer's disease, remains an increasing cause for concern through a dramatic prevalence increment and associated socio-economic burdens. Initially Alzheimer's disease develops asymptomatically with primary clinical signs, such as memory impairment, decline of spatial and perceptual abilities, occurring at a later stage. This delay implies the possibility of promoting early interventions during the pre-symptomatic stage of the disease...
September 2016: La Clinica Terapeutica
https://www.readbyqxmd.com/read/27825020/are-participants-reports-of-their-own-reaction-times-reliable-re-examining-introspective-limitations-in-active-and-passive-dual-task-paradigms
#12
Donna Bryce, Daniel Bratzke
There is a known introspective limitation in the Psychological Refractory Period (PRP) paradigm - people underestimate the dual-task costs on their second reaction time. The prevailing explanation for this is that conscious awareness of the second stimulus is delayed in time until the first task has been centrally processed. Here, we examined this effect in more detail, by comparing reaction time estimates after processing a PRP task, and after passively experiencing 'replays' of PRP trials. Even when participants had no dual-task processing demands, they did not accurately report the reaction time intervals using a visual analogue scale (the original reporting method of most introspective PRP experiments), but they did when placing markers that represent each event on a timeline...
January 2017: Acta Psychologica
https://www.readbyqxmd.com/read/27824937/gazing-into-thin-air-the-dual-task-costs-of-movement-planning-and-execution-during-adaptive-gait
#13
Toby J Ellmers, Adam J Cocks, Michail Doumas, A Mark Williams, William R Young
We examined the effect of increased cognitive load on visual search behavior and measures of gait performance during locomotion. Also, we investigated how personality traits, specifically the propensity to consciously control or monitor movements (trait movement 'reinvestment'), impacted the ability to maintain effective gaze under conditions of cognitive load. Healthy young adults traversed a novel adaptive walking path while performing a secondary serial subtraction task. Performance was assessed using correct responses to the cognitive task, gaze behavior, stepping accuracy, and time to complete the walking task...
2016: PloS One
https://www.readbyqxmd.com/read/27798067/radiolucent-triangle-as-a-positioning-tool-to-simplify-prone-ankle-fracture-surgery-technical-tip
#14
Kamran S Hamid, Travis J Dekker, Peter W White, Samuel B Adams
: Prone positioning affords significant benefits for the fixation of trimalleolar ankle fractures and has been the long-time standard for treatment of these injuries. However, 2 primary disadvantages hamper its utility. First, access to the medial ankle is impeded by the contralateral limb and inability to rotate the operative leg to the extent that is possible in other positions. Second, lateral fluoroscopic imaging of the ankle can be cumbersome and often necessitates physically elevating the ankle for a radiograph then placing it back on the operative table...
October 25, 2016: Foot & Ankle Specialist
https://www.readbyqxmd.com/read/27795820/cost-of-illness-among-patients-with-diabetic-foot-ulcer-in-turkey
#15
Ergun Oksuz, Simten Malhan, Bilge Sonmez, Rukiye Numanoglu Tekin
AIM: To evaluate the annual cost of patients with Wagner grade 3-4-5 diabetic foot ulcer (DFU) from the public payer's perspective in Turkey. METHODS: This study was conducted focused on a time frame of one year from the public payer's perspective. Cost-of-illness (COI) methodology, which was developed by the World Health Organization, was used in the generation of cost data. By following a clinical path with the COI method, the main total expenses were reached by multiplying the number of uses of each expense item, the percentage of cases that used them and unit costs...
October 15, 2016: World Journal of Diabetes
https://www.readbyqxmd.com/read/27788632/can-behavioural-observations-made-during-the-smart-assessment-detect-the-potential-for-later-emergence-from-vegetative-state
#16
Liliana da Conceição Teixeira, Helen Gill-Thwaites, Frances Reynolds, Sophie Duport
The management of prolonged disorders of consciousness (PDOC) such as vegetative state (VS) is a major clinical challenge. Presently there are no validated prognostic markers for emergence from VS apart from age, aetiology and time spent in VS. This study explores whether or not the behavioural observation component of the SMART assessment can detect the potential for later emergence from VS. For this retrospective study 14 patients were selected who were originally assessed by the SMART as being in VS. Clinical records showed that seven of these patients have since emerged from VS (Group 1) and the other half have remained in VS (Group 2)...
October 27, 2016: Neuropsychological Rehabilitation
https://www.readbyqxmd.com/read/27765016/the-addition-of-s100b-to-guidelines-for-management-of-mild-head-injury-is-potentially-cost-saving
#17
Olga Calcagnile, Anders Anell, Johan Undén
BACKGROUND: Mild traumatic brain injury (TBI) is associated with substantial costs due to over-triage of patients to computed tomography (CT) scanning, despite validated decision rules. Serum biomarker S100B has shown promise for safely omitting CT scans but the economic impact from clinical use has never been reported. In 2007, S100B was adapted into the existing Scandinavian management guidelines in Halmstad, Sweden, in an attempt to reduce CT scans and save costs. METHODS: Consecutive adult patients with mild TBI (GCS 14-15, loss of consciousness and/or amnesia), managed with the aid of S100B, were prospectively included in this study...
October 20, 2016: BMC Neurology
https://www.readbyqxmd.com/read/27746156/cost-analysis-of-iliac-stenting-performed-in-the-operating-room-and-the-catheterization-lab-a-case-control-study
#18
Sooyeon Kim, Sage P Kramer, Adam J Dugan, David J Minion, John C Gurley, Daniel L Davenport, Victor A Ferraris, Sibu P Saha
BACKGROUND: Iliac arterial stenting is performed both in the operating room (OR) and the catheterization lab (CL). To date, no analysis has compared resource utilization between these locations. METHODS: Consecutive patients (n = 105) treated at a single center were retrospectively analyzed. Patients included adults with chronic, symptomatic iliac artery stenosis with a minimum Rutherford classification (RC) of 3, treated with stents. Exclusion criteria were prior stenting, acute ischemia, or major concomitant procedures...
December 2016: International Journal of Surgery
https://www.readbyqxmd.com/read/27737654/effectiveness-and-cost-effectiveness-of-routine-third-trimester-ultrasound-screening-for-intrauterine-growth-restriction-study-protocol-of-a-nationwide-stepped-wedge-cluster-randomized-trial-in-the-netherlands-the-iris-study
#19
Jens Henrichs, Viki Verfaille, Laura Viester, Myrte Westerneng, Bert Molewijk, Arie Franx, Henriette van der Horst, Judith E Bosmans, Ank de Jonge, Petra Jellema
BACKGROUND: Intrauterine growth retardation (IUGR) is a major risk factor for perinatal mortality and morbidity. Thus, there is a compelling need to introduce sensitive measures to detect IUGR fetuses. Routine third trimester ultrasonography is increasingly used to detect IUGR. However, we lack evidence for its clinical effectiveness and cost-effectiveness and information on ethical considerations of additional third trimester ultrasonography. This nationwide stepped wedge cluster-randomized trial examines the (cost-)effectiveness of routine third trimester ultrasonography in reducing severe adverse perinatal outcome through subsequent protocolized management...
October 13, 2016: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/27733640/is-telemonitoring-useful-for-supporting-persons-with-consciousness-disorders-and-caregivers-a-preliminary-observational-study-in-a-real-life-population
#20
Chiara Zucchella, Massimo Di Santis, Biagio Ciccone, Massimiliano Pelella, Marina Scappaticci, Giovanna Badalassi, Susanna Lavezzi, Michelangelo Bartolo
INTRODUCTION: Preliminary evidences showed that telemedicine may allow a reduction of costs and an enhancement of patients' satisfaction and quality of life (QoL), with the same effectiveness of conventional methods of healthcare delivery. Literature is quite absent in relation to the use of telemedicine for patients with disorders of consciousness (DoC) whose management is delegated almost entirely to the family. In order to promote an alternative setting to manage persons affected by DoC, also supporting their families, a pilot project was designed to test the feasibility of home-care assistance based on a system of telemonitoring...
October 12, 2016: Journal of Telemedicine and Telecare
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