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15 papers 0 to 25 followers Papers reflecting cool ideas, disruptive thinking, and digitalhealth advances - cool stuff in anesthesia and perioperative medicine
By Ron George Anesthesiologist with special interests in Obstetrics, Pain, and Global Health
https://www.readbyqxmd.com/read/28427805/confounding-causality-and-confusion-the-role-of-intermediate-variables-in-interpreting-observational-studies-in-obstetrics
#1
Cande V Ananth, Enrique F Schisterman
Both prospective and retrospective cohort, and case-control studies are some of the most important study designs in epidemiology because, under certain assumptions, they can mimic a randomized trial when done well. These assumptions include but not limited to properly accounting for two important sources of bias: confounding and selection bias. While not adjusting the causal association for an intermediate variable will yield an unbiased estimate of the exposure-outcome's total causal effect, it is often that obstetricians will want to adjust for an intermediate variable to assess if the intermediate is the underlying driver of the association...
April 17, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28410247/ce-original-research-creating-an-evidence-based-progression-for-clinical-advancement-programs
#2
Kathleen G Burke, Tonya Johnson, Christine Sites, Jane Barnsteiner
: Background: The Institute of Medicine (IOM) and the Quality and Safety Education for Nurses (QSEN) project have identified six nursing competencies and supported their integration into undergraduate and graduate nursing curricula nationwide. But integration of those competencies into clinical practice has been limited, and evidence for the progression of competency proficiency within clinical advancement programs is scant. Using an evidence-based approach and building on the competencies identified by the IOM and QSEN, a team of experts at an academic health system developed eight competency domains and 186 related knowledge, skills, and attitudes (KSAs) for professional nursing practice...
May 2017: American Journal of Nursing
https://www.readbyqxmd.com/read/28399145/a-systematic-identification-and-analysis-of-scientists-on-twitter
#3
Qing Ke, Yong-Yeol Ahn, Cassidy R Sugimoto
Metrics derived from Twitter and other social media-often referred to as altmetrics-are increasingly used to estimate the broader social impacts of scholarship. Such efforts, however, may produce highly misleading results, as the entities that participate in conversations about science on these platforms are largely unknown. For instance, if altmetric activities are generated mainly by scientists, does it really capture broader social impacts of science? Here we present a systematic approach to identifying and analyzing scientists on Twitter...
2017: PloS One
https://www.readbyqxmd.com/read/28405531/will-the-meikirch-model-a-new-framework-for-health-induce-a-paradigm-shift-in-healthcare
#4
REVIEW
Johannes Bircher, Eckhart G Hahn
Over the past decades, scientific medicine has realized tremendous advances. Yet, it is felt that the quality, costs, and equity of medicine and public health have not improved correspondingly and, both inside and outside the USA, may even have changed for the worse. An initiative for improving this situation is value-based healthcare, in which value is defined as health outcomes relative to the cost of achieving them. Value-based healthcare was advocated in order to stimulate competition among healthcare providers and thereby reduce costs...
March 6, 2017: Curēus
https://www.readbyqxmd.com/read/28288254/variation-in-physician-spending-and-association-with-patient-outcomes
#5
Yusuke Tsugawa, Ashish K Jha, Joseph P Newhouse, Alan M Zaslavsky, Anupam B Jena
Importance: While the substantial variation in health care spending across regions and hospitals is well known, key clinical decisions are ultimately made by physicians. However, the degree to which spending varies across physicians and the clinical consequences of that variation are unknown. Objective: To investigate variation in spending across physicians and its association with patient outcomes. Design, Setting, and Participants: For this retrospective data analysis, we analyzed a 20% random sample of Medicare fee-for-service beneficiaries 65 years and older who were hospitalized with a nonelective medical condition and treated by a general internist between January 1, 2011, and December 31, 2014...
May 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28279297/the-academic-medical-system-reinvention-to-survive-the-revolution-in-health-care
#6
REVIEW
Marvin A Konstam, Joseph A Hill, Richard J Kovacs, Robert A Harrington, James A Arrighi, Amit Khera
Academic medical centers (AMCs) are presently facing enormous challenges arising from a prospective decline in government funding for research and education, shifting payment models emphasizing efficiency and value, and increasing competition. Left unabated, these challenges will drive many AMCs to de-emphasize or forsake their core missions in an effort to survive. Stemming from a symposium held at the 2015 Scientific Sessions of the American College of Cardiology titled, "The Academic Medical Center of the Future," we propose a series of changes, including internal restructuring, system-wide partnership, and novel approaches to support research and education, that are designed to better position AMCs to compete and face their growing challenges in a manner that preserves their essential missions...
March 14, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28284877/midwifery-continuity-of-carer-in-an-area-of-high-socio-economic-disadvantage-in-london-a-retrospective-analysis-of-albany-midwifery-practice-outcomes-using-routine-data-1997-2009
#7
Caroline Se Homer, Nicky Leap, Nadine Edwards, Jane Sandall
OBJECTIVE: in 1997, The Albany Midwifery Practice was established within King's College Hospital NHS Trust in a South East London area of high social disadvantage. The Albany midwives provided continuity of care to around 216 women per year, including those with obstetric, medical or social risk factors. In 2009, the Albany Midwifery Practice was closed in response to concerns about safety, amidst much publicity and controversy. The aim of this evaluation was to examine trends and outcomes for all mothers and babies who received care from the practice from 1997-2009...
February 27, 2017: Midwifery
https://www.readbyqxmd.com/read/28219376/cooperate-a-paradigm-shift-for-health-equity
#8
REVIEW
Wei-Ching Chang, Joy H Fraser
The role of competition and cooperation in relation to the goal of health equity is examined in this paper. The authors explain why the win-lose mentality associated with avoidable competition is ethically questionable and less effective than cooperation in achieving positive outcomes, particularly as it relates to health and health equity. Competition, which differentiates winners from losers, often with the winner-takes-all reward system, inevitably leads to a few winners and many losers, resulting in social inequality, which, in turn, engenders and perpetuates health inequity...
February 21, 2017: International Journal for Equity in Health
https://www.readbyqxmd.com/read/28110382/economic-evaluations-alongside-efficient-study-designs-using-large-observational-datasets-the-pleasant-trial-case-study
#9
Matthew Franklin, Sarah Davis, Michelle Horspool, Wei Sun Kua, Steven Julious
BACKGROUND: Large observational datasets such as Clinical Practice Research Datalink (CPRD) provide opportunities to conduct clinical studies and economic evaluations with efficient designs. OBJECTIVES: Our objectives were to report the economic evaluation methodology for a cluster randomised controlled trial (RCT) of a UK NHS-delivered public health intervention for children with asthma that was evaluated using CPRD and describe the impact of this methodology on results...
May 2017: PharmacoEconomics
https://www.readbyqxmd.com/read/28077235/drivers-of-poor-medical-care
#10
REVIEW
Vikas Saini, Sandra Garcia-Armesto, David Klemperer, Valerie Paris, Adam G Elshaug, Shannon Brownlee, John P A Ioannidis, Elliott S Fisher
The global ubiquity of overuse and underuse of health-care resources and the gravity of resulting harms necessitate an investigation of drivers to inform potential solutions. We describe the network of influences that contribute to poor care and suggest that it is driven by factors that fall into three domains: money and finance; knowledge, bias, and uncertainty; and power and human relationships. In each domain the drivers operate at the global, national, regional, and individual level, and are modulated by the specific contexts within which they act...
January 6, 2017: Lancet
https://www.readbyqxmd.com/read/27603038/a-model-for-the-departmental-quality-management-infrastructure-within-an-academic-health-system
#11
Simon C Mathews, Renee Demski, Jody E Hooper, Lee Daugherty Biddison, Stephen A Berry, Brent G Petty, Allen R Chen, Peter M Hill, Marlene R Miller, Frank R Witter, Lisa Allen, Elizabeth C Wick, Tracey S Stierer, Lori Paine, Hans A Puttgen, Rafael J Tamargo, Peter J Pronovost
As quality improvement and patient safety come to play a larger role in health care, academic medical centers and health systems are poised to take a leadership role in addressing these issues. Academic medical centers can leverage their large integrated footprint and have the ability to innovate in this field. However, a robust quality management infrastructure is needed to support these efforts. In this context, quality and safety are often described at the executive level and at the unit level. Yet, the role of individual departments, which are often the dominant functional unit within a hospital, in realizing health system quality and safety goals has not been addressed...
May 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/27440636/surgicric-2-a-comparative-bench-study-with-two-established-emergency-cricothyroidotomy-techniques-in-a-porcine-model
#12
L Chrisman, W King, K Wimble, S Cartwright, K B Mohammed, B Patel
BACKGROUND: 'Can't Intubate, Can't Oxygenate' is a rare but life threatening event. Anaesthetists must be trained and have appropriate equipment available for this. The ideal equipment is a topic of ongoing debate. To date cricothyroidotomy training for anaesthetists has concentrated on cannula techniques. However cases reported to the NAP4 audit illustrated that they were associated with a high failure rate. A recent editorial by Kristensen and colleagues suggested all anaesthetists must master a surgical technique...
August 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/18257379/a-move-to-universal-or-start-times-a-case-study-of-leading-change-in-an-academic-anesthesia-department
#13
Kathleen Donahue, Berend Mets
Learn how leaders at Penn State Milton S. Hershey Medical Center successfully implemented universal operating room start times and the impact it had on patient flow.
January 2008: Physician Executive
https://www.readbyqxmd.com/read/27524393/addition-of-a-non-immersive-virtual-reality-component-to-treadmill-training-to-reduce-fall-risk-in-older-adults-v-time-a-randomised-controlled-trial
#14
RANDOMIZED CONTROLLED TRIAL
Anat Mirelman, Lynn Rochester, Inbal Maidan, Silvia Del Din, Lisa Alcock, Freek Nieuwhof, Marcel Olde Rikkert, Bastiaan R Bloem, Elisa Pelosin, Laura Avanzino, Giovanni Abbruzzese, Kim Dockx, Esther Bekkers, Nir Giladi, Alice Nieuwboer, Jeffrey M Hausdorff
BACKGROUND: Age-associated motor and cognitive deficits increase the risk of falls, a major cause of morbidity and mortality. Because of the significant ramifications of falls, many interventions have been proposed, but few have aimed to prevent falls via an integrated approach targeting both motor and cognitive function. We aimed to test the hypothesis that an intervention combining treadmill training with non-immersive virtual reality (VR) to target both cognitive aspects of safe ambulation and mobility would lead to fewer falls than would treadmill training alone...
September 17, 2016: Lancet
https://www.readbyqxmd.com/read/27524394/virtual-reality-and-the-prevention-of-falls-in-the-real-world
#15
COMMENT
Stephen R Lord
No abstract text is available yet for this article.
September 17, 2016: Lancet
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