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Atul Gawande

Trevor E Angell, Chirag M Vyas, Justine A Barletta, Edmund S Cibas, Nancy L Cho, Gerard M Doherty, Atul A Gawande, Brooke E Howitt, Jeffrey F Krane, Ellen Marqusee, Kyle C Strickland, Erik K Alexander, Francis D Moore, Matthew A Nehs
BACKGROUND: Diagnostic hemithyroidectomy (HT) is the most widely recommended surgical procedure for a nodule with indeterminate cytology; however, additional details may make initial total thyroidectomy (TT) preferable. We sought to identify patient-specific factors (PSFs) associated with initial TT in patients with indeterminate thyroid nodules. METHODS: Retrospective analysis of all patients with a thyroid nodule ≥ 1 cm and initial cytology of atypia of undetermined significance or suspicious for follicular neoplasm between 2012 and 2015 who underwent thyroidectomy...
March 8, 2018: Annals of Surgical Oncology
Moska Hamidi, Michael Sullivan, George Hunter, Leena Hamberg, Nancy L Cho, Atul A Gawande, Gerard M Doherty, Francis D Moore, Matthew A Nehs
BACKGROUND: Recurrent primary hyperparathyroidism (PHPT) presents a diagnostic challenge in localizing a hyperfunctioning gland. Although several imaging modalities are available for preoperative localization, 4D-CT is increasingly utilized for its ability to locate both smaller and previously unlocalized lesions. Currently, there is a paucity of data evaluating the utility of 4D-CT in the reoperative setting compared with ultrasound (US) and sestamibi. We aimed to determine the sensitivity of 4D-CT in localizing parathyroid adenomas in recurrent or persistent PHPT...
February 26, 2018: Annals of Surgical Oncology
Benjamin D Sommers, Atul A Gawande, Katherine Baicker
No abstract text is available yet for this article.
November 16, 2017: New England Journal of Medicine
Katherine E A Semrau, Lisa R Hirschhorn, Megan Marx Delaney, Vinay P Singh, Rajiv Saurastri, Narender Sharma, Danielle E Tuller, Rebecca Firestone, Stuart Lipsitz, Neelam Dhingra-Kumar, Bhalachandra S Kodkany, Vishwajeet Kumar, Atul A Gawande
BACKGROUND: The prevalence of facility-based childbirth in low-resource settings has increased dramatically during the past two decades, yet gaps in the quality of care persist and mortality remains high. The World Health Organization (WHO) Safe Childbirth Checklist, a quality-improvement tool, promotes systematic adherence to practices that have been associated with improved childbirth outcomes. METHODS: We conducted a matched-pair, cluster-randomized, controlled trial in 60 pairs of facilities across 24 districts of Uttar Pradesh, India, testing the effect of the BetterBirth program, an 8-month coaching-based implementation of the Safe Childbirth Checklist, on a composite outcome of perinatal death, maternal death, or maternal severe complications within 7 days after delivery...
December 14, 2017: New England Journal of Medicine
Dean T Jamison, Ala Alwan, Charles N Mock, Rachel Nugent, David Watkins, Olusoji Adeyi, Shuchi Anand, Rifat Atun, Stefano Bertozzi, Zulfiqar Bhutta, Agnes Binagwaho, Robert Black, Mark Blecher, Barry R Bloom, Elizabeth Brouwer, Donald A P Bundy, Dan Chisholm, Alarcos Cieza, Mark Cullen, Kristen Danforth, Nilanthi de Silva, Haile T Debas, Peter Donkor, Tarun Dua, Kenneth A Fleming, Mark Gallivan, Patricia J Garcia, Atul Gawande, Thomas Gaziano, Hellen Gelband, Roger Glass, Amanda Glassman, Glenda Gray, Demissie Habte, King K Holmes, Susan Horton, Guy Hutton, Prabhat Jha, Felicia M Knaul, Olive Kobusingye, Eric L Krakauer, Margaret E Kruk, Peter Lachmann, Ramanan Laxminarayan, Carol Levin, Lai Meng Looi, Nita Madhav, Adel Mahmoud, Jean Claude Mbanya, Anthony Measham, María Elena Medina-Mora, Carol Medlin, Anne Mills, Jody-Anne Mills, Jaime Montoya, Ole Norheim, Zachary Olson, Folashade Omokhodion, Ben Oppenheim, Toby Ord, Vikram Patel, George C Patton, John Peabody, Dorairaj Prabhakaran, Jinyuan Qi, Teri Reynolds, Sevket Ruacan, Rengaswamy Sankaranarayanan, Jaime Sepúlveda, Richard Skolnik, Kirk R Smith, Marleen Temmerman, Stephen Tollman, Stéphane Verguet, Damian G Walker, Neff Walker, Yangfeng Wu, Kun Zhao
The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions...
November 24, 2017: Lancet
Alex B Haynes, Lizabeth Edmondson, Stuart R Lipsitz, George Molina, Bridget A Neville, Sara J Singer, Aunyika T Moonan, Ashley Kay Childers, Richard Foster, Lorri R Gibbons, Atul A Gawande, William R Berry
OBJECTIVE: To determine whether completion of a voluntary, checklist-based surgical quality improvement program is associated with reduced 30-day postoperative mortality. BACKGROUND: Despite evidence of efficacy of team-based surgical safety checklists in improving perioperative outcomes in research trials, effective methods of population-based implementation have been lacking. The Safe Surgery 2015 South Carolina program was designed to foster state-wide engagement of hospitals in a voluntary, collaborative implementation of a checklist program...
December 2017: Annals of Surgery
Trevor E Angell, Chirag M Vyas, Marco Medici, Zhihong Wang, Justine A Barletta, Carol B Benson, Edmund S Cibas, Nancy L Cho, Gerard M Doherty, Peter M Doubilet, Mary C Frates, Atul A Gawande, Howard T Heller, Matthew I Kim, Jeffrey F Krane, Ellen Marqusee, Francis D Moore, Matt A Nehs, Ann Marie Zavacki, P Reed Larsen, Erik K Alexander
Context: Thyroid nodule growth was once considered concerning for malignancy, but data showing that benign nodules grow questioned the use of this paradigm. To date, however, no studies have adequately evaluated whether growth rates differ in malignant vs. benign nodules. Objective: To sonographically evaluate growth rates in benign and malignant thyroid nodules ≥1 cm. Design: Prospective, cohort study of patients with tissue diagnosis of benign or malignant disease, with repeated ultrasound evaluation six or more months apart...
December 1, 2017: Journal of Clinical Endocrinology and Metabolism
Jonathon D Gass, Anamika Misra, Mahendra Nath Singh Yadav, Fatima Sana, Chetna Singh, Anup Mankar, Brandon J Neal, Jennifer Fisher-Bowman, Jenny Maisonneuve, Megan Marx Delaney, Krishan Kumar, Vinay Pratap Singh, Narender Sharma, Atul Gawande, Katherine Semrau, Lisa R Hirschhorn
BACKGROUND: There are few published standards or methodological guidelines for integrating Data Quality Assurance (DQA) protocols into large-scale health systems research trials, especially in resource-limited settings. The BetterBirth Trial is a matched-pair, cluster-randomized controlled trial (RCT) of the BetterBirth Program, which seeks to improve quality of facility-based deliveries and reduce 7-day maternal and neonatal mortality and maternal morbidity in Uttar Pradesh, India. In the trial, over 6300 deliveries were observed and over 153,000 mother-baby pairs across 120 study sites were followed to assess health outcomes...
September 7, 2017: Trials
Elliot Wakeam, George Molina, Neel Shah, Stuart R Lipsitz, David C Chang, Atul A Gawande, Alex B Haynes
BACKGROUND: Health care costs are an important policy focus in the United States. The magnitude and drivers of variation in the costs of common operative procedures are not well understood. We sought to characterize variation in costs across hospitals. METHODS: We used data from the Nationwide Inpatient Sample from 2001-2011 for 5 elective operations: colectomy, coronary artery bypass graft, total knee arthroplasty, cesarean section, and lung resection. Hospitals were benchmarked for each using hierarchical risk- and reliability-adjustment methods to generate an observed-to-expected cost ratio, which was adjusted for patient demographics, comorbidity, wage index, and procedure complexity...
September 2017: Surgery
Avery C Plough, Grace Galvin, Zhonghe Li, Stuart R Lipsitz, Shehnaz Alidina, Natalie J Henrich, Lisa R Hirschhorn, William R Berry, Atul A Gawande, Doris Peter, Rory McDonald, Donna L Caldwell, Janet H Muri, Debra Bingham, Aaron B Caughey, Eugene R Declercq, Neel T Shah
OBJECTIVE: To define, measure, and characterize key competencies of managing labor and delivery units in the United States and assess the associations between unit management and maternal outcomes. METHODS: We developed and administered a management measurement instrument using structured telephone interviews with both the primary nurse and physician managers at 53 diverse hospitals across the United States. A trained interviewer scored the managers' interview responses based on management practices that ranged from most reactive (lowest scores) to most proactive (highest scores)...
August 2017: Obstetrics and Gynecology
Joshua R Lakin, Luca A Koritsanszky, Rebecca Cunningham, Francine L Maloney, Brandon J Neal, Joanna Paladino, Marissa C Palmor, Christine Vogeli, Timothy G Ferris, Susan D Block, Atul A Gawande, Rachelle E Bernacki
Improving communication about goals and values for patients with advancing serious illness nearing the end of life is a key opportunity to improve the value of care. The Serious Illness Care Program, implemented at primary care clinics affiliated with Brigham and Women's Hospital in Boston, Massachusetts, is a multicomponent intervention designed to support best practices in communication by clinicians to increase conversations with patients with serious illness about their goals and values. We conducted a study of the program in fourteen primary care clinics participating in a high-risk care management program based in an accountable care organization...
July 1, 2017: Health Affairs
George Molina, William R Berry, Stuart R Lipsitz, Lizabeth Edmondson, Zhonghe Li, Bridget A Neville, Aunyika T Moonan, Lorri R Gibbons, Atul A Gawande, Sara J Singer, Alex B Haynes
OBJECTIVE: To evaluate whether the perception of safety of surgical practice among operating room (OR) personnel is associated with hospital-level 30-day postoperative death. BACKGROUND: The relationship between improvements in the safety of surgical practice and benefits to postoperative outcomes has not been demonstrated empirically. METHODS: As part of the Safe Surgery 2015: South Carolina initiative, a baseline survey measuring the perception of safety of surgical practice among OR personnel was completed...
October 2017: Annals of Surgery
Nabihah Kara, Rebecca Firestone, Tapan Kalita, Atul A Gawande, Vishwajeet Kumar, Bhala Kodkany, Rajiv Saurastri, Vinay Pratap Singh, Pinki Maji, Ami Karlage, Lisa R Hirschhorn, Katherine Ea Semrau
Shifting childbirth into facilities has not improved health outcomes for mothers and newborns as significantly as hoped. Improving the quality and safety of care provided during facility-based childbirth requires helping providers to adhere to essential birth practices-evidence-based behaviors that reduce harm to and save lives of mothers and newborns. To achieve this goal, we developed the BetterBirth Program, which we tested in a matched-pair, cluster-randomized controlled trial in Uttar Pradesh, India. The goal of this intervention was to improve adoption and sustained use of the World Health Organization Safe Childbirth Checklist (SCC), an organized collection of 28 essential birth practices that are known to improve the quality of facility-based childbirth care...
June 27, 2017: Global Health, Science and Practice
Megan Marx Delaney, Pinki Maji, Tapan Kalita, Nabihah Kara, Darpan Rana, Krishan Kumar, Jenny Masoinneuve, Simon Cousens, Atul A Gawande, Vishwajeet Kumar, Bhala Kodkany, Narender Sharma, Rajiv Saurastri, Vinay Pratap Singh, Lisa R Hirschhorn, Katherine Ea Semrau, Rebecca Firestone
BACKGROUND: Adherence to evidence-based essential birth practices is critical for improving health outcomes for mothers and newborns. The WHO Safe Childbirth Checklist (SCC) incorporates these practices, which occur during 4 critical pause points: on admission, before pushing (or cesarean delivery), soon after birth, and before discharge. A peer-coaching strategy to support consistent use of the SCC may be an effective approach to increase birth attendants' adherence to these practices...
June 27, 2017: Global Health, Science and Practice
Benjamin D Sommers, Atul A Gawande, Katherine Baicker
The national debate over the Affordable Care Act (ACA) has involved substantial discussion about what effects — if any — insurance coverage has on health and mortality. The prospect that the law’s replacement might lead to millions of Americans losing coverage has brought this empirical question..
August 10, 2017: New England Journal of Medicine
Amy E Caruso Brown, Rebecca Garden
Physicians' narratives of their own experiences of illness can be a kind of empathic bridge across the divide between a professional healer and a sick patient. This essay considers ways in which physicians' narratives of their own and family members' experiences of cancer shape encounters with patients and patients' experiences of illness. It analyzes ethical dimensions of physicians' narratives (such as those by Atul Gawande, Siddhartha Mukherjee, and Paul Kalanithi) and of reflective writing in medical education...
May 1, 2017: AMA Journal of Ethics
Madeline Pesec, Hannah L Ratcliffe, Ami Karlage, Lisa R Hirschhorn, Atul Gawande, Asaf Bitton
Long considered a paragon among low- and middle-income countries in its provision of primary health care, Costa Rica reformed its primary health care system in 1994 using a model that, despite its success, has been generally understudied: basic integrated health care teams. This case study provides a detailed description of Costa Rica's innovative implementation of four critical service delivery reforms and explains how those reforms supported the provision of the four essential functions of primary health care: first-contact access, coordination, continuity, and comprehensiveness...
March 1, 2017: Health Affairs
Atul A Gawande
No abstract text is available yet for this article.
April 2017: Annals of Surgery
Michael C Sullivan, Paul H Graham, Erik K Alexander, Daniel T Ruan, Matthew A Nehs, Atul A Gawande, Francis D Moore, Brooke E Howitt, Kyle C Strickland, Jeffrey F Krane, Justine A Barletta, Nancy L Cho
BACKGROUND: Thyroid lobectomy alone is being performed increasingly for patients with encapsulated follicular variant of papillary thyroid carcinoma (fvPTC). However, the prevalence of contralateral disease in these patients is unknown. We investigated the presence of synchronous disease in fvPTC to improve decision making about the extent of surgical resection and need for surveillance. STUDY DESIGN: We performed a retrospective review of patients who underwent thyroid surgery from October 2009 to February 2013 with a diagnosis of fvPTC as their primary lesion...
June 2017: Journal of the American College of Surgeons
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