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https://www.readbyqxmd.com/read/29452560/health-care-efficiencies-consolidation-and-alternative-models-vs-health-care-and-antitrust-regulation-irreconcilable-differences
#1
Michael W King
Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation...
November 2017: American Journal of Law & Medicine
https://www.readbyqxmd.com/read/29451497/automated-skeletal-tissue-quantification-in-the-lower-leg-using-pqct
#2
Sokratis Makrogiannis, Fatima Boukari, Luigi Ferrucci
In this paper we introduce a methodology for hard and soft tissue quantification at proximal, intermediate and distal tibia sites using peripheral Quantitative Computed Tomography (pQCT) scans. Quantification of bone properties is crucial for estimating bone structure resistance to mechanical stress and adaptations to loading. Soft tissue variables can be computed to investigate muscle volume and density, muscle-bone relationship, and fat infiltration.
 Approach: We employed implicit active contour models and clustering techniques for automated segmentation and identification of bone, muscle and fat at 4%, 38%, and 66% tibia length...
February 15, 2018: Physiological Measurement
https://www.readbyqxmd.com/read/29449367/load-independent-systolic-and-diastolic-right-ventricular-function-in-heart-failure-with-preserved-ejection-fraction-as-assessed-by-resting-and-handgrip-exercise-pressure-volume-loops
#3
Karl-Philipp Rommel, Maximilian von Roeder, Christian Oberueck, Konrad Latuscynski, Christian Besler, Stephan Blazek, Thomas Stiermaier, Karl Fengler, Volker Adams, Marcus Sandri, Axel Linke, Gerhard Schuler, Holger Thiele, Philipp Lurz
BACKGROUND: Although systolic right ventricular (RV) dysfunction has been shown to be a potent predictor for adverse outcomes in patients with heart failure with preserved ejection fraction (HFpEF), RV functional abnormalities in the course of the syndrome are not well characterized. We, therefore, sought to assess load-independent and load-dependent systolic and diastolic characteristics of RV function in stable outpatients with HFpEF. METHODS AND RESULTS: We invasively obtained RV and left ventricular pressure-volume loops in 24 HFpEF patients and 9 patients without heart failure symptoms with a conductance catheter during basal conditions and handgrip exercise...
February 2018: Circulation. Heart Failure
https://www.readbyqxmd.com/read/29441100/dose-volume-analysis-of-target-volume-and-critical-structures-in-computed-tomography-image-based-multicatheter-high-dose-rate-interstitial-brachytherapy-for-head-and-neck-cancer
#4
Hironori Akiyama, Tibor Major, Csaba Polgár, Zoltán Takácsi-Nagy
Purpose: To evaluate dose-volume relationships of target volume and critical structures in computed tomography (CT) image-based brachytherapy for head and neck cancer. Material and methods: Thirty-seven patients with mobile tongue, floor of mouth, and base of tongue cancer treated with brachytherapy (post-operative alone and as a boost after external beam radiotherapy [EBRT], or definitive alone or as a boost after EBRT) were selected. Treatment plans were made using post-implant CT images...
December 2017: Journal of Contemporary Brachytherapy
https://www.readbyqxmd.com/read/29440285/nutrient-intake-in-the-first-two-weeks-of-life-and-brain-growth-in-preterm-neonates
#5
Juliane Schneider, Céline J Fischer Fumeaux, Emma G Duerden, Ting Guo, Justin Foong, Myriam Bickle Graz, Patric Hagmann, M Mallar Chakravarty, Petra S Hüppi, Lydie Beauport, Anita C Truttmann, Steven P Miller
BACKGROUND: Optimizing early nutritional intake in preterm neonates may promote brain health and neurodevelopment through enhanced brain maturation. Our objectives were (1) to determine the association of energy and macronutrient intake in the first 2 weeks of life with regional and total brain growth and white matter (WM) maturation, assessed by 3 serial MRI scans in preterm neonates; (2) to examine how critical illness modifies this association; and (3) to investigate the relationship with neurodevelopmental outcomes...
February 13, 2018: Pediatrics
https://www.readbyqxmd.com/read/29434810/relationship-of-renal-morphology-on-3-dimensional-ultrasonography-with-renal-pathologic-findings-and-outcome-in-biopsy-proven-nephropathy
#6
Jianwei Xu, Sung Il Hwang, Hak Jong Lee, Ho Jun Chin
Kidney morphology has been used to estimate renal functions. The present study investigated the usefulness of kidney length and renal parenchymal volume (RPV) measured using three-dimensional ultrasonography (3-D USG) in estimating renal pathological findings, and the outcome in patients with nephropathy who underwent renal biopsy. In this study, 94 adult patients who had native kidney biopsy with 3-D USG results were included. The mean kidney length and RPV were independent factors of, and positively correlated to the estimated glomerular filtration rate (eGFR)...
February 2018: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29429789/a-purely-functional-imaging-based-approach-for-transcortical-resection-of-lesion-involving-the-dominant-atrium-towards-safer-imaging-guided-tailored-cortico-leucotomies
#7
Alessandro Frati, Alessandro Pesce, Giancarlo D'Andrea, Flavia Fraschetti, Maurizio Salvati, Marco Cimatti, Vincenzo Esposito, Antonino Raco
BACKGROUND AND STUDY OBJECT: The Dominant Atrium (DA) is a crossroad of eloquent white matter bundles difficult to preserve with a standard "anatomical" approach. The aim of this work is to evaluate the results of a cohort of patients who underwent surgery with the aid of a purely functional MRI and DTI-based approach. MATERIALS AND METHODS: 43 patients suffering from lesions involving the DA have been included in the final cohort and studied in regards to quality of life (KPS); a special attention was lent on the incidence of new or worsening of preexisting neurological deficits, with a focus on motor, visual and speech disturbances after the surgical treatment...
February 8, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29426688/variation-in-adolescent-idiopathic-scoliosis-surgery-implications-for-improving-healthcare-value
#8
Jennifer K Workman, Jacob Wilkes, Angela P Presson, Yizhe Xu, John A Heflin, John T Smith
OBJECTIVES: To investigate the variation in care and cost of spinal fusion for adolescent idiopathic scoliosis (AIS), and to identify opportunities for improving healthcare value. STUDY DESIGN: Retrospective cohort study from the Pediatric Health Information Systems database, including children 11-18 years of age with AIS who underwent spinal fusion surgery between 2004 and 2015. Multivariable regression was used to evaluate the relationships between hospital cost, patient outcomes, and resource use...
February 6, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29426264/comparison-between-maternal-and-neonatal-outcome-of-pprom-in-the-cases-of-amniotic-fluid-index-afi-of-more-and-less-than-5-cm
#9
Ashraf Sadat Mousavi, Neda Hashemi, Maryam Kashanian, Narges Sheikhansari, Arash Bordbar, Shayesteh Parashi
The study was performed on pregnant women with a gestational age of 26-32 weeks of pregnancy, who had been admitted to the hospital with a confirmed diagnosis of premature rupture of membranes. In all eligible women, ultrasounds were performed for the evaluation of amniotic fluid index. Then, the women were divided into two groups according to amniotic fluid index of ≥5 cm and <5 cm. These women were followed and monitored up to delivery. The women of the two groups did not have significant difference between them according to age, gestational age at the time of ruptured membrane, body mass index, gravidity, parity, gestational age at delivery and route of delivery...
February 9, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/29425548/ejection-fraction-as-related-to-basic-components-in-the-left-and-right-ventricular-volume-domains
#10
Peter L M Kerkhof, Peter M van de Ven, Byungwon Yoo, Richard A Peace, Guy R Heyndrickx, Neal Handly
BACKGROUND: Ejection fraction (EF) is commonly applied as a clinically relevant metric to assess ventricular function. The numerical value of EF depends on the interplay between end-systolic volume (ESV) and end-diastolic volume (EDV). Remarkably, the relative impact of the two constitutive components on EF received little attention. METHODS: Three patient groups not using beta-blockers were analyzed for a robust investigation into the relative contribution of ESV and EDV when assessing EF: cardiac patients (N=155) with left ventricular (LV) data obtained by biplane ventriculography, near-normals (N=276) by gated SPECT investigation, and an MRI-based post Fallot repair study including right ventricular (RV) data (N=124), besides LV...
March 15, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29417641/role-of-computed-tomography-calculated-intraparenchymal-tumor-volume-in-assessment-of-patients-undergoing-partial-nephrectomy
#11
Raj Vikesh Tiwari, Chia Ming Ho, Hong Hong Huang, Henry Sun Sien Ho, Allen Soon Phang Sim
OBJECTIVES: To determine the complexity of renal masses by using an objective novel imaging parameter (intraparenchymal tumor volume) based on computed tomography scans, to correlate this parameter to perioperative outcomes and to the RENAL nephrometry score. METHODS: After institutional review board approval, 87 patients who underwent partial nephrectomy between 2012 and 2016 at Singapore General Hospital, Singapore, were retrospectively analyzed. Preoperative computed tomography intravenous pyelogram scans were reviewed by a single senior radiologist who calculated the intraparenchymal tumor volume...
February 8, 2018: International Journal of Urology: Official Journal of the Japanese Urological Association
https://www.readbyqxmd.com/read/29413738/evidence-based-thresholds-for-the-volume-value-relationship-in-adolescent-idiopathic-scoliosis-outcomes-and-economies-of-scale
#12
Sergio M Navarro, Prem N Ramkumar, Anthony C Egger, Ryan C Goodwin
OBJECTIVES: Increased surgeon and hospital volume has been associated with improved patient outcomes and cost effectiveness for adolescent idiopathic scoliosis (AIS). However, no evidence-based thresholds that clarify the volume at which these strata occur exist. The objective of this study was to establish statistically meaningful thresholds that define high-volume surgeons and hospitals performing spinal fusion for AIS from those that are low volume with respect to length of stay (LOS) and cost...
March 2018: Spine Deformity
https://www.readbyqxmd.com/read/29411336/central-sleep-apnea-with-cheyne-stokes-breathing-in-heart-failure-from-research-to-clinical-practice-and-beyond
#13
K Terziyski, A Draganova
Characterized by periodic crescendo-decrescendo pattern of breathing alternating with central apneas, Central sleep apnea (CSA) with Cheyne-Stokes Breathing represents a highly prevalent, yet underdiagnosed comorbidity in chronic heart failure (CHF). A diverse body of evidence demonstrates increased morbidity and mortality in the presence of CSB. CSB has been described in both CHF patients with preserved and reduced ejection fraction, regardless of drug treatment. Risk factors for CSB are older age, male gender, high BMI, atrial fibrillation and hypocapnia...
February 7, 2018: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29411303/combination-of-intra-hematomal-hypodensity-on-ct-and-brain-scoring-improves-prediction-of-hemorrhage-expansion-in-ich
#14
Joshua VanDerWerf, Donna Kurowski, James Siegler, Taneeta Ganguly, Brett Cucchiara
BACKGROUND: Hematoma expansion (HE) occurs in 1/3 of ICH patients and is associated with poor outcome. Intra-hematomal hypodensity (IHH) on CT has been reported to predict HE, as has the "BRAIN" score. We sought to assess the predictive value of these markers alone and in combination. METHODS: We performed a retrospective single-center study of ICH patients with CT < 6 h from onset. Two blinded neurologists assessed IHH on initial CT. Two HE definitions were examined: > 6 ml and > 6 ml or > 33%...
February 6, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29411224/association-of-generic-health-related-quality-of-life-eq-5d-dimensions-and-inactivity-with-lung-function-in-lung-healthy-german-adults-results-from-the-kora-studies-f4l-and-age
#15
Agnes Luzak, Stefan Karrasch, Margarethe Wacker, Barbara Thorand, Dennis Nowak, Annette Peters, Holger Schulz
PURPOSE: Among patients with lung disease, decreased lung function is associated with lower health-related quality of life. However, whether this association is detectable within the physiological variability of respiratory function in lung-healthy populations is unknown. We analyzed the association of each EQ-5D-3L dimension (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) and self-reported physical inactivity with spirometric indices in lung-healthy adults...
February 6, 2018: Quality of Life Research
https://www.readbyqxmd.com/read/29408506/higher-donor-apheresis-blood-volumes-are-associated-with-a-reduction-in-relapse-risk-and-improved-survival-in-reduced-intensity-allogeneic-transplants-with-unrelated-donors
#16
Lisa M Crisalli, Joanne T Hinkle, Christopher C Walling, Mary Sell, Noelle V Frey, Elizabeth O Hexner, Alison W Loren, Selina M Luger, Edward A Stadtmauer, David L Porter, Ran Reshef
Allogeneic hematopoietic stem cell transplantation (HSCT) with reduced intensity conditioning (RIC) offers a curative option for patients with hematologic malignancies who are unable to undergo myeloablative conditioning, but its success is limited by high rates of relapse. Several studies have suggested a role for T-cell doses in peripheral blood stem-cell grafts in RIC HSCT. Since T-cell dose is typically not known until after the collection, and apheresis blood volume is easily modifiable, we hypothesized that higher donor apheresis blood volumes would improve transplant outcomes through an effect on graft composition...
February 2, 2018: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/29406837/optimization-of-medication-use-at-accountable-care-organizations
#17
Chrisanne Wilks, Erik Krisle, Kimberly Westrich, Kristina Lunner, David Muhlestein, Robert Dubois
BACKGROUND: Optimized medication use involves the effective use of medications for better outcomes, improved patient experience, and lower costs. Few studies systematically gather data on the actions accountable care organizations (ACOs) have taken to optimize medication use. OBJECTIVES: To (a) assess how ACOs optimize medication use; (b) establish an association between efforts to optimize medication use and achievement on financial and quality metrics; (c) identify organizational factors that correlate with optimized medication use; and (d) identify barriers to optimized medication use...
May 30, 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29405275/surgeon-volume-and-prognosis-of-patients-with-advanced-papillary-thyroid-cancer-and-lateral-nodal-metastasis
#18
H I Kim, T H Kim, J-H Choe, J-H Kim, J S Kim, Y N Kim, H Kim, S W Kim, J H Chung
BACKGROUND: Surgery is the most important treatment modality for papillary thyroid cancer (PTC). However, the relationship between surgeon volume and long-term oncological outcomes has not been explored. METHODS: Patients diagnosed with N1b PTC after initial thyroid surgery between 1 July 1994 and 31 December 2011 were eligible for inclusion in the study. Surgeons were categorized into high (at least 100 operations per year) and low (fewer than 100 operations per year) volume groups...
February 2018: British Journal of Surgery
https://www.readbyqxmd.com/read/29402170/residual-limb-fluid-volume-change-and-volume-accommodation-relationships-to-activity-and-self-report-outcomes-in-people-with-trans-tibial-amputation
#19
Joan E Sanders, Robert T Youngblood, Brian J Hafner, Marcia A Ciol, Katheryn J Allyn, David Gardner, John C Cagle, Christian B Redd, Colin R Dietrich
BACKGROUND: Fluctuations in limb volume degrade prosthesis fit and require users to accommodate changes using management strategies, such as donning and doffing prosthetic socks. OBJECTIVES: To examine how activities and self-report outcomes relate to daily changes in residual limb fluid volume and volume accommodation. STUDY DESIGN: Standardized, two-part laboratory protocol with an interim observational period. METHODS: Participants were classified as "accommodators" or "non-accommodators," based on self-report prosthetic sock use...
February 1, 2018: Prosthetics and Orthotics International
https://www.readbyqxmd.com/read/29397658/the-effect-of-hospital-case-volume-on-clinical-outcomes-in-patients-with-nasopharyngeal-carcinoma-a-multi-institutional-retrospective-analysis-krog-1106
#20
Boram Ha, Kwan Ho Cho, Sung Ho Moon, Chang-Geol Lee, Ki Chang Keum, Yeon-Sil Kim, Hong-Gyun Wu, Jin Ho Kim, Yong Chan Ahn, Dongryul Oh, Jae Myoung Noh, Jong Hoon Lee, Sung Hwan Kim, Won Taek Kim, Young-Taek Oh, Min Kyu Kang, Jin Hee Kim, Ji-Yoon Kim, Moon-June Cho, Chul Seoung Kay, Jin Hwa Choi
Purpose: The purpose of this study was to investigate the effect of hospital case volume (HCV) on clinical outcomes in patients with nasopharyngeal carcinoma (NPC). Materials and Methods: Data on 1,073 patients with cT1-4N0-3M0 NPC were collected from a multi-institutional retrospective database (KROG 11-06). All patients received definitive radiotherapy (RT) either with three-dimensional-conformal RT (3D-CRT) (n=576) or intensity-modulated RT (IMRT) (n=497). The patients were divided into two groups treated at high volume institution (HVI) (n=750) and low volume institution (LVI) (n=323), defined as patient volume ≥10 (median, 13; range, 10 to 18) and < 10 patients per year (median, 3; range, 2 to 6), respectively...
February 5, 2018: Cancer Research and Treatment: Official Journal of Korean Cancer Association
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