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Caro JJ, Möller J, Santhirapala V, Gill H, Johnston J, El-Boghdadly K, Santhirapala R, Kelly P, McGuire A. Predicting Hospital Resource Use During COVID-19 Surges: A Simple but Flexible Discretely Integrated Condition Event Simulation of Individual Patient-Hospital Trajectories. Value Health 2021; 24:1570-1577. [PMID: 34711356 PMCID: PMC8339677 DOI: 10.1016/j.jval.2021.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/22/2021] [Accepted: 05/26/2021] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assist with planning hospital resources, including critical care (CC) beds, for managing patients with COVID-19. METHODS An individual simulation was implemented in Microsoft Excel using a discretely integrated condition event simulation. Expected daily cases presented to the emergency department were modeled in terms of transitions to and from ward and CC and to discharge or death. The duration of stay in each location was selected from trajectory-specific distributions. Daily ward and CC bed occupancy and the number of discharges according to care needs were forecast for the period of interest. Face validity was ascertained by local experts and, for the case study, by comparing forecasts with actual data. RESULTS To illustrate the use of the model, a case study was developed for Guy's and St Thomas' Trust. They provided inputs for January 2020 to early April 2020, and local observed case numbers were fit to provide estimates of emergency department arrivals. A peak demand of 467 ward and 135 CC beds was forecast, with diminishing numbers through July. The model tended to predict higher occupancy in Level 1 than what was eventually observed, but the timing of peaks was quite close, especially for CC, where the model predicted at least 120 beds would be occupied from April 9, 2020, to April 17, 2020, compared with April 7, 2020, to April 19, 2020, in reality. The care needs on discharge varied greatly from day to day. CONCLUSIONS The DICE simulation of hospital trajectories of patients with COVID-19 provides forecasts of resources needed with only a few local inputs. This should help planners understand their expected resource needs.
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Affiliation(s)
- J Jaime Caro
- Department of Health Policy, London School of Economics and Political Science, London, England, UK; Evidera, London, England, UK.
| | | | - Vatshalan Santhirapala
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Harpreet Gill
- Department of Health Policy, London School of Economics and Political Science, London, England, UK; Department of Theatres, Anaesthesia, and Perioperative Care, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Jessica Johnston
- Department of Theatres, Anaesthesia, and Perioperative Care, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Kariem El-Boghdadly
- Department of Theatres, Anaesthesia, and Perioperative Care, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Ramai Santhirapala
- Department of Theatres, Anaesthesia, and Perioperative Care, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Paul Kelly
- Department of Theatres, Anaesthesia, and Perioperative Care, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Alistair McGuire
- Department of Health Policy, London School of Economics and Political Science, London, England, UK
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Lin GS, Tseng PL, Chang CC, Yiang GT, Yen ZS, Jian JW, Tung CY. Adequate emergency department resource usage: Applying simulation-based workshop to improve teaching competence among elementary and junior high school teachers in Taiwan. Medicine (Baltimore) 2021; 100:e27258. [PMID: 34664876 PMCID: PMC8448039 DOI: 10.1097/md.0000000000027258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION More than 80% of patients who visited Emergency Department (ED) was not urgent in Taiwan in 2019. It causes insufficient medical services and a latent fiscal threat to the Nation Health Insurance (NHI). This study adopted simulation-based educating modules to explore the effect in teaching competence among primary and middle school teachers for efficient AEDRU (adequate emergency department resource usage) education in the future. METHOD The subjects were 414 elementary and junior high school teachers in Taiwan. 214 participants attended the simulation-based workshop as the simulation-based group, whereas 200 participants took an online self-learning module as the self-learning group. The workshop was created by an expert panel for decreasing the unnecessary usage amount of ED medial resources. The materials are lecture, board games, miniature ED modules, and simulation-based scenarios. A teaching competence questionnaire including ED knowledge, teaching attitude, teaching skills, and teaching self-efficacy was conducted among participants before and after the intervention. Data were analyzed via McNemar, paired t test and the generalized estimating equations (GEE). RESULTS The study showed that teachers who participated in the simulation-based workshop had improved more in teaching competence than those who received the online self-learning module. In addition, there were significant differences between the pre-test and post-test among the two groups in teaching competence. CONCLUSION The simulation-based workshop is effective and it should be spread out. When students know how to use ED medical resources properly, they could affect their families. It can help the ED service to be used properly and benefits the finance of the NHI. The health care cost will be managed while also improving health.
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Affiliation(s)
- Geng-Shiau Lin
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
- Emergency Medicine Department, Taipei City Hospital, Taipei, Taiwan
| | - Pei-Ling Tseng
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Chia-Chen Chang
- Department of Senior Citizen Service Business, College of Human Ecology and Design, St. John's University, New Taipei, Taiwan
| | - Giou-Teng Yiang
- Emergency Medicine Department, Buddhist Tzu Chi General Hospital, New Taipei, Taiwan
| | - Zui-Shen Yen
- Emergency Medicine Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Jang-Wei Jian
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Chen-Yin Tung
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
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Zhang X, Shen H, Lv Z. Deployment optimization of multi-stage investment portfolio service and hybrid intelligent algorithm under edge computing. PLoS One 2021; 16:e0252244. [PMID: 34086735 PMCID: PMC8177502 DOI: 10.1371/journal.pone.0252244] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/28/2021] [Indexed: 11/19/2022] Open
Abstract
The purposes are to improve the server deployment capability under Mobile Edge Computing (MEC), reduce the time delay and energy consumption of terminals during task execution, and improve user service quality. After the server deployment problems under traditional edge computing are analyzed and researched, a task resource allocation model based on multi-stage is proposed to solve the communication problem between different supporting devices. This model establishes a combined task resource allocation and task offloading method and optimizes server execution by utilizing the time delay and energy consumption required for task execution and comprehensively considering the restriction processes of task offloading, partition, and transmission. For the MEC process that supports dense networks, a multi-hybrid intelligent algorithm based on energy consumption optimization is proposed. The algorithm converts the original problem into a power allocation problem via a heuristic model. Simultaneously, it determines the appropriate allocation strategy through distributed planning, duality, and upper bound replacement. Results demonstrate that the proposed multi-stage combination-based service deployment optimization model can solve the problem of minimizing the maximum task execution energy consumption combined with task offloading and resource allocation effectively. The algorithm has good performance in handling user fairness and the worst-case task execution energy consumption. The proposed hybrid intelligent algorithm can partition tasks into task offloading sub-problems and resource allocation sub-problems, meeting the user's task execution needs. A comparison with the latest algorithm also verifies the model's performance and effectiveness. The above results can provide a theoretical basis and some practical ideas for server deployment and applications under MEC.
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Affiliation(s)
- Xuecong Zhang
- College of Information Science and Technology, Jinan University, Guangzhou, China
| | - Haolang Shen
- Jinan University- University of Birmingham Joint Institute, Jinan University, Guangzhou, China
| | - Zhihan Lv
- School of Data Science and Software Engineering, Qingdao University, Qingdao, China
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Upadhyay U, Sikka G. MRS-DP: Improving Performance and Resource Utilization of Big Data Applications with Deadlines and Priorities. Big Data 2020; 8:323-331. [PMID: 32820950 DOI: 10.1089/big.2020.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article proposes the MapReduce scheduler with deadline and priorities (MRS-DP) scheduler capable of handling jobs with deadlines and priorities. Big data have emerged as a key concept and revolutionized data analytics in the present era. Big data are characterized by multiple dimensions or Vs, namely volume, velocity, variety, veracity, and valence. Recently, a new and important dimension (another V) is added, known as value. Value has emerged as an important characteristic and it can be understood in terms of delay in acquiring information, leading to late decisions that may result in missed opportunities. To gain optimal benefits, this article introduces a scheduler based on jobs with deadlines and priorities intending to improve resource utilization, with efficient job progress monitoring and backup launching mechanism. The proposed scheduler is capable of accommodating multiple jobs to maximize the number of jobs processed successfully and avoid starvation of lower priority jobs while improving the resource utilization and ensuring the assured quality of service (QoS). To evaluate our proposed scheduler, we ran multiple workloads consisting of the WordCount jobs and DataSort jobs. The performance of the proposed MRS-DP scheduler is compared with minimal earliest deadline first-work conserving scheduler and MapReduce Constraint Programming based Resource Management algorithm in terms of the percentage of successful jobs, priority-wise jobs, and resource utilization of the cluster. The result of the proposed scheduler depicts an improvement of around 10%-20% in terms of the percentage of successful jobs, 20%-25% concerning effective resource utilization offered, and the ability to ensure the offered QoS.
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Affiliation(s)
- Utsav Upadhyay
- Department of Computer Science & Engineering, National Institute of Technology, Jalandhar, Punjab, India
| | - Geeta Sikka
- Department of Computer Science & Engineering, National Institute of Technology, Jalandhar, Punjab, India
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Wallace D, Robb M, Hughes W, Johnson R, Ploeg R, Neuberger J, Forsythe J, Cacciola R. Outcomes of Patients Suspended From the National Kidney Transplant Waiting List in the United Kingdom Between 2000 and 2010. Transplantation 2020; 104:1654-1661. [PMID: 32732844 DOI: 10.1097/tp.0000000000003033] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the United Kingdom, 1 in 3 patients on the National Kidney Transplant Waiting List (NKTWL) is suspended from the list at least once during their wait. The mortality of this large cohort of patients remains underreported and poorly described. METHODS We linked patient records from the UK transplant registry to mortality data from the Office of National Statistics and evaluated the impact of a clinically induced suspension event by estimating hazard ratios (HRs) that compared mortality and graft survival between those who had experienced a suspension event and those who had not. RESULTS Between January 1, 2000, and December 31, 2010, 16.7% (2221/13 322) of all patients registered on the NKTWL were suspended. Forty-eight percent (588/1225) of those who were suspended and who were never transplanted died, most often from cardiothoracic causes. A suspension event was associated with increased mortality from the time of listing (adjusted HR [aHR], 1.79; 1.64-1.95) and from the time of transplantation (aHR, 1.20; 1.06-1.37; P = 0.005). Graft survival was also poorer in those who had been suspended (aHR, 1.13; 1.01-1.28; P = 0.04). CONCLUSIONS Patients suspended on the NKTWL have a significantly higher rate of mortality both on the waiting list and following transplantation. Earlier prioritization of patients at risk of experiencing a suspension event may improve their outcomes.
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Affiliation(s)
- David Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew Robb
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Winter Hughes
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Rachel Johnson
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - Rutger Ploeg
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - James Neuberger
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
| | - John Forsythe
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
- Transplant Unit, University of Edinburgh, Edinburgh, United Kingdom
| | - Roberto Cacciola
- Department of Surgical Sciences, Transplant Unit, Tor Vergata University, Rome, Italy
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Mogul DB, Perito ER, Wood N, Mazariegos GV, VanDerwerken D, Ibrahim SH, Mohammad S, Valentino PL, Gentry S, Hsu E. Impact of Acuity Circles on Outcomes for Pediatric Liver Transplant Candidates. Transplantation 2020; 104:1627-1632. [PMID: 32732840 PMCID: PMC7319877 DOI: 10.1097/tp.0000000000003079] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND In December 2018, United Network for Organ Sharing approved an allocation scheme based on recipients' geographic distance from a deceased donor (acuity circles [ACs]). Previous analyses suggested that ACs would reduce waitlist mortality overall, but their impact on pediatric subgroups was not considered. METHODS We applied Scientific Registry of Transplant Recipients data from 2011 to 2016 toward the Liver Simulated Allocation Model to compare outcomes by age and illness severity for the United Network for Organ Sharing-approved AC and the existing donor service area-/region-based allocation schemes. Means from each allocation scheme were compared using matched-pairs t tests. RESULTS During a 3-year period, AC allocation is projected to decrease waitlist deaths in infants (39 versus 55; P < 0.001), children (32 versus 50; P < 0.001), and teenagers (15 versus 25; P < 0.001). AC allocation would increase the number of transplants in infants (707 versus 560; P < 0.001), children (677 versus 547; P < 0.001), and teenagers (404 versus 248; P < 0.001). AC allocation led to decreased median pediatric end-stage liver disease/model for end-stage liver disease at transplant for infants (29 versus 30; P = 0.01), children (26 versus 29; P < 0.001), and teenagers (26 versus 31; P < 0.001). Additionally, AC allocation would lead to fewer transplants in status 1B in children (97 versus 103; P = 0.006) but not infants or teenagers. With AC allocation, 77% of pediatric donor organs would be allocated to pediatric candidates, compared to only 46% in donor service area-/region-based allocation (P < 0.001). CONCLUSIONS AC allocation will likely address disparities for pediatric liver transplant candidates and recipients by increasing transplants and decreasing waitlist mortality. It is more consistent with federally mandated requirements for organ allocation.
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Affiliation(s)
- Douglas B Mogul
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Emily R Perito
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Nicholas Wood
- Department of Mathematics, United States Naval Academy, Annapolis, MD
| | - George V Mazariegos
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | | | - Samar H Ibrahim
- Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Saeed Mohammad
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Pamela L Valentino
- Section of Gastroenterology & Hepatology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Sommer Gentry
- Department of Mathematics, United States Naval Academy, Annapolis, MD
| | - Evelyn Hsu
- Department of Pediatrics, University of Washington, Seattle, WA
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O'Connell DA, Seikaly H, Isaac A, Pyne J, Hart RD, Goldstein D, Yoo J. Recommendations from the Canadian Association of Head and Neck Surgical Oncology for the Management of Head and Neck Cancers during the COVID-19 pandemic. J Otolaryngol Head Neck Surg 2020; 49:53. [PMID: 32727583 PMCID: PMC7387877 DOI: 10.1186/s40463-020-00448-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/06/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The SARS-CoV-2 virus (COVID19) pandemic has placed extreme pressures on the Canadian Healthcare system. Many health care regions in Canada have cancelled or limited surgical and non-surgical interventions on patients to preserve healthcare resources for a predicted increase in COVID19 related hospital admissions. Also reduced health interventions may limit the risk of possible transmission of COVID19 to other patients and health care workers during this pandemic. The majority of institutions in Canada have developed their own operational mandates regarding access to surgical resources for patients suffering from Head and Neck Cancers during this pandemic. There is a large degree of individual practitioner judgement in deciding access to care as well as resource allocation during these challenging times. The Canadian Association of Head and Neck Surgical Oncology (CAHNSO) convened a task force to develop a set of guidelines based on the best current available evidence to help Head and Neck Surgical Oncologists and all practitioners involved in the care of these patients to help guide individual practice decisions. MAIN BODY The majority of head and neck surgical oncology from initial diagnosis and work up to surgical treatment and then follow-up involves aerosol generating medical procedures (AGMPs) which inherently put head and neck surgeons and practitioners at high risk for transmission of COVID19. The aggressive nature of the majority of head and neck cancer negates the ability for deferring surgical treatment for a prolonged period of time. The included guidelines provide recommendations for resource allocation for patients, use of personal protective equipment for practitioners as well as recommendations for modification of practice during the current pandemic. CONCLUSION 1. Enhanced triaging should be used to identify patients with aggressive malignancies. These patients should be prioritized to reduce risk of significant disease progression in the reduced resource environment of COVID19 era. 2. Enhanced triaging including aggressive pre-treatment COVID19 testing should be used to identify patients with high risk of COVID19 transmission. 3. Enhanced personal protective equipment (PPE) including N95 masks and full eye protection should be used for any AGMPs performed even in asymptomatic patients. 4. Enhanced PPE including full eye protection, N95 masks and/or powered air purifying respirators (PAPRs) should be used for any AGMPs in symptomatic or presumptive positive COVID 19 patients.
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Affiliation(s)
- Daniel A O'Connell
- Canadian Association of Head and Neck Surgical Oncology (CAHNSO), 1E4 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
- Division of Otolaryngology - Head & Neck Surgery, University of Alberta, Edmonton, AB, Canada.
| | - Hadi Seikaly
- Canadian Association of Head and Neck Surgical Oncology (CAHNSO), 1E4 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
- Division of Otolaryngology - Head & Neck Surgery, University of Alberta, Edmonton, AB, Canada.
| | - Andre Isaac
- Division of Otolaryngology - Head & Neck Surgery, University of Alberta, Edmonton, AB, Canada
| | - Justin Pyne
- Division of Otolaryngology - Head & Neck Surgery, University of Alberta, Edmonton, AB, Canada
| | - Robert D Hart
- Canadian Association of Head and Neck Surgical Oncology (CAHNSO), 1E4 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
- Division of Otolaryngology, University of Calgary, Calgary, AB, Canada
| | - David Goldstein
- Canadian Association of Head and Neck Surgical Oncology (CAHNSO), 1E4 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - John Yoo
- Canadian Association of Head and Neck Surgical Oncology (CAHNSO), 1E4 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
- Department of Otolaryngology - Head & Neck Surgery, University of Western Ontario, London, ON, Canada
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Breathett K, Yee E, Pool N, Hebdon M, Crist JD, Yee RH, Knapp SM, Solola S, Luy L, Herrera-Theut K, Zabala L, Stone J, McEwen MM, Calhoun E, Sweitzer NK. Association of Gender and Race With Allocation of Advanced Heart Failure Therapies. JAMA Netw Open 2020; 3:e2011044. [PMID: 32692370 PMCID: PMC7412827 DOI: 10.1001/jamanetworkopen.2020.11044] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Importance Racial bias is associated with the allocation of advanced heart failure therapies, heart transplants, and ventricular assist devices. It is unknown whether gender and racial biases are associated with the allocation of advanced therapies among women. Objective To determine whether the intersection of patient gender and race is associated with the decision-making of clinicians during the allocation of advanced heart failure therapies. Design, Setting, and Participants In this qualitative study, 46 US clinicians attending a conference for an international heart transplant organization in April 2019 were interviewed on the allocation of advanced heart failure therapies. Participants were randomized to examine clinical vignettes that varied 1:1 by patient race (African American to white) and 20:3 by gender (women to men) to purposefully target vignettes of women patients to compare with a prior study of vignettes of men patients. Participants were interviewed about their decision-making process using the think-aloud technique and provided supplemental surveys. Interviews were analyzed using grounded theory methodology, and surveys were analyzed with Wilcoxon tests. Exposure Randomization to clinical vignettes. Main Outcomes and Measures Thematic differences in allocation of advanced therapies by patient race and gender. Results Among 46 participants (24 [52%] women, 20 [43%] racial minority), participants were randomized to the vignette of a white woman (20 participants [43%]), an African American woman (20 participants [43%]), a white man (3 participants [7%]), and an African American man (3 participants [7%]). Allocation differences centered on 5 themes. First, clinicians critiqued the appearance of the women more harshly than the men as part of their overall impressions. Second, the African American man was perceived as experiencing more severe illness than individuals from other racial and gender groups. Third, there was more concern regarding appropriateness of prior care of the African American woman compared with the white woman. Fourth, there were greater concerns about adequacy of social support for the women than for the men. Children were perceived as liabilities for women, particularly the African American woman. Family dynamics and finances were perceived to be greater concerns for the African American woman than for individuals in the other vignettes; spouses were deemed inadequate support for women. Last, participants recommended ventricular assist devices over transplantation for all racial and gender groups. Surveys revealed no statistically significant differences in allocation recommendations for African American and white women patients. Conclusions and Relevance This national study of health care professionals randomized to clinical vignettes that varied only by gender and race found evidence of gender and race bias in the decision-making process for offering advanced therapies for heart failure, particularly for African American women patients, who were judged more harshly by appearance and adequacy of social support. There was no associated between patient gender and race and final recommendations for allocation of advanced therapies. However, it is possible that bias may contribute to delayed allocation and ultimately inequity in the allocation of advanced therapies in a clinical setting.
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Affiliation(s)
- Khadijah Breathett
- Sarver Heart Center, Division of Cardiology, Department of Medicine, University of Arizona, Tucson
| | - Erika Yee
- Sarver Heart Center, Clinical Research Office, University of Arizona, Tucson
| | - Natalie Pool
- College of Nursing, University of Arizona, Tucson
| | - Megan Hebdon
- College of Nursing, University of Utah, Salt Lake City
| | | | - Ryan H Yee
- Sarver Heart Center, Clinical Research Office, University of Arizona, Tucson
| | - Shannon M Knapp
- Statistics Consulting Lab, Bio5 Institute, University of Arizona, Tucson
| | - Sade Solola
- Department of Medicine, University of Arizona, Tucson
| | - Luis Luy
- University of Rochester, New York
| | | | - Leanne Zabala
- Department of Medicine, University of California, Los Angeles
| | - Jeff Stone
- Department of Psychology, University of Arizona, Tucson
| | | | - Elizabeth Calhoun
- Center for Population Health Sciences, University of Arizona, Tucson
| | - Nancy K Sweitzer
- Sarver Heart Center, Division of Cardiology, Department of Medicine, University of Arizona, Tucson
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Souadka A, Benkabbou A, Majbar MA, Essangri H, Amrani L, Mohsine R, Ghannam A, El Ahmadi B, Belkhadir Z. Oncological Surgery During the COVID-19 Pandemic: The Need for Deep and Lasting Measures. Oncologist 2020; 25:e1424-e1425. [PMID: 32535974 PMCID: PMC7323022 DOI: 10.1634/theoncologist.2020-0360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/21/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Amine Souadka
- Department of Surgical Oncology, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Amine Benkabbou
- Department of Surgical Oncology, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Mohammed Anass Majbar
- Department of Surgical Oncology, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Hajar Essangri
- Department of Surgical Oncology, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Laila Amrani
- Department of Surgical Oncology, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Raouf Mohsine
- Department of Surgical Oncology, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Abdelilah Ghannam
- Department of Intensive Care, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Brahim El Ahmadi
- Department of Intensive Care, National Institute of Oncology, University Mohammed VRabatMorocco
| | - Zakaria Belkhadir
- Department of Intensive Care, National Institute of Oncology, University Mohammed VRabatMorocco
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Al‐Shamsi HO, Alhazzani W, Alhuraiji A, Coomes EA, Chemaly RF, Almuhanna M, Wolff RA, Ibrahim NK, Chua ML, Hotte SJ, Meyers BM, Elfiki T, Curigliano G, Eng C, Grothey A, Xie C. A Practical Approach to the Management of Cancer Patients During the Novel Coronavirus Disease 2019 (COVID-19) Pandemic: An International Collaborative Group. Oncologist 2020; 25:e936-e945. [PMID: 32243668 PMCID: PMC7288661 DOI: 10.1634/theoncologist.2020-0213] [Citation(s) in RCA: 431] [Impact Index Per Article: 107.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/26/2020] [Indexed: 01/08/2023] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread globally since being identified as a public health emergency of major international concern and has now been declared a pandemic by the World Health Organization (WHO). In December 2019, an outbreak of atypical pneumonia, known as COVID-19, was identified in Wuhan, China. The newly identified zoonotic coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is characterized by rapid human-to-human transmission. Many cancer patients frequently visit the hospital for treatment and disease surveillance. They may be immunocompromised due to the underlying malignancy or anticancer therapy and are at higher risk of developing infections. Several factors increase the risk of infection, and cancer patients commonly have multiple risk factors. Cancer patients appear to have an estimated twofold increased risk of contracting SARS-CoV-2 than the general population. With the WHO declaring the novel coronavirus outbreak a pandemic, there is an urgent need to address the impact of such a pandemic on cancer patients. This include changes to resource allocation, clinical care, and the consent process during a pandemic. Currently and due to limited data, there are no international guidelines to address the management of cancer patients in any infectious pandemic. In this review, the potential challenges associated with managing cancer patients during the COVID-19 infection pandemic will be addressed, with suggestions of some practical approaches. IMPLICATIONS FOR PRACTICE: The main management strategies for treating cancer patients during the COVID-19 epidemic include clear communication and education about hand hygiene, infection control measures, high-risk exposure, and the signs and symptoms of COVID-19. Consideration of risk and benefit for active intervention in the cancer population must be individualized. Postponing elective surgery or adjuvant chemotherapy for cancer patients with low risk of progression should be considered on a case-by-case basis. Minimizing outpatient visits can help to mitigate exposure and possible further transmission. Telemedicine may be used to support patients to minimize number of visits and risk of exposure. More research is needed to better understand SARS-CoV-2 virology and epidemiology.
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Affiliation(s)
- Humaid O. Al‐Shamsi
- Medical Oncology Department, Alzahra Hospital DubaiDubaiUnited Arab Emirates
- Department of Medicine, University of SharjahSharjahUnited Arab Emirates
- Emirates Oncology SocietyDubaiUnited Arab Emirates
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, Medicine, McMaster UniversityHamiltonOntarioCanada
- Medicine, McMaster UniversityHamiltonOntarioCanada
| | - Ahmad Alhuraiji
- Department of Hematology, Kuwait Cancer Control CenterKuwait
| | - Eric A. Coomes
- Division of Infectious Disease, Department of Medicine, University of TorontoTorontoOntarioCanada
| | - Roy F. Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Robert A. Wolff
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Nuhad K. Ibrahim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Melvin L.K. Chua
- Divisions of Radiation Oncology and Medical Sciences, National Cancer Center SingaporeSingapore
- Oncology Academic Program, Duke‐NUS Medical SchoolSingapore
- Cong Hua's InstituteSingapore
| | - Sebastien J. Hotte
- Department of Oncology, Juravinski Cancer Centre, McMaster UniversityHamiltonOntarioCanada
| | - Brandon M. Meyers
- Department of Oncology, Juravinski Cancer Centre, McMaster UniversityHamiltonOntarioCanada
| | - Tarek Elfiki
- Windsor Regional Cancer CenterWindsorOntarioCanada
- Department of Oncology, Schulich School of Medicine, University of Western OntarioLondonOntarioCanada
| | - Giuseppe Curigliano
- Department of Oncology and Hemato‐Oncology University of MilanMilanItaly
- Division of Early Drug Development for Innovative Therapy, University of MilanMilanItaly
- European Institute of OncologyMilanItaly
- IRCCS, University of MilanoMilanItaly
| | - Cathy Eng
- Vanderbilt‐Ingram Cancer CenterNashvilleTennesseeUSA
| | - Axel Grothey
- West Cancer Center, University of TennesseeMemphisTennesseeUSA
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan UniversityWuhanPeople's Republic of China
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11
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Rubio O, Estella A, Cabre L, Saralegui-Reta I, Martin MC, Zapata L, Esquerda M, Ferrer R, Castellanos A, Trenado J, Amblas J. [Ethical recommendations for a difficult decision-making in intensive care units due to the exceptional situation of crisis by the COVID-19 pandemia: A rapid review & consensus of experts]. Med Intensiva 2020; 44:439-445. [PMID: 32402532 PMCID: PMC7158790 DOI: 10.1016/j.medin.2020.04.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/10/2020] [Indexed: 01/10/2023]
Abstract
Ante la situación excepcional de salud pública provocada por la pandemia por COVID-19, desde el grupo de ética de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) se ha promovido un trabajo de consenso con el objetivo de encontrar algunas respuestas desde la ética a la encrucijada entre el incremento de personas con necesidades de atención intensiva y la disponibilidad efectiva de medios. En un periodo muy corto de tiempo se ha cambiado el marco de ejercicio de la medicina hacia un escenario de «medicina de catástrofe», con el consecuente cambio en los parámetros de toma de decisiones. En este contexto la asignación de recursos o la priorización de tratamiento pasan a ser elementos cruciales, y es importante contar con un marco de referencia ético para poder tomar las decisiones clínicas necesarias. Para ello, se ha realizado un proceso de revisión narrativa de la evidencia, seguida de un consenso de expertos no sistematizado, que ha tenido como resultado tanto la publicación de un documento de posicionamiento y recomendaciones de la propia SEMICYUC, como el consenso entre 18 sociedades científicas y 5 institutos/cátedras de bioética y cuidados paliativos de un documento marco de referencia de recomendaciones éticas generales en este contexto de crisis.
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Affiliation(s)
- O Rubio
- Cuidados Intensivos, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España.
| | - A Estella
- Cuidados Intensivos, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España
| | - L Cabre
- Cuidados Intensivos, Comité de Bioética de Cataluña, Catalunya, España
| | - I Saralegui-Reta
- Cuidados Intensivos, Hospital Universitario de Áraba, Osakidetza Araba, Vitoria-Gasteiz, España
| | - M C Martin
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
| | - L Zapata
- Cuidados Intensivos, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Esquerda
- Instituto Borja de Bioética, Esplugues de Llobregat, Barcelona, España
| | - R Ferrer
- Servicio de Medicina Intensiva, Hospital Universitario Vall de Hebron, Barcelona, España
| | - A Castellanos
- Área de Medicina Crítica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - J Trenado
- Servicio de Medicina Intensiva, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España
| | - J Amblas
- Geriatría y Cuidados paliativos, Hospital Universitario de la Santa Creu de Vic, Central Catalonia Chronicity Research Group (C3RG), Universitat de Vic-UCC, Vic, Barcelona, España
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12
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Mankowski MA, Kosztowski M, Raghavan S, Garonzik-Wang JM, Axelrod D, Segev DL, Gentry SE. Accelerating kidney allocation: Simultaneously expiring offers. Am J Transplant 2019; 19:3071-3078. [PMID: 31012528 PMCID: PMC6812592 DOI: 10.1111/ajt.15396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/17/2019] [Accepted: 04/03/2019] [Indexed: 01/25/2023]
Abstract
Using nonideal kidneys for transplant quickly might reduce the discard rate of kidney transplants. We studied changing kidney allocation to eliminate sequential offers, instead making offers to multiple centers for all nonlocally allocated kidneys, so that multiple centers must accept or decline within the same 1 hour. If more than 1 center accepted an offer, the kidney would go to the highest-priority accepting candidate. Using 2010 Kidney-Pancreas Simulated Allocation Model-Scientific Registry for Transplant Recipients data, we simulated the allocation of 12 933 kidneys, excluding locally allocated and zero-mismatch kidneys. We assumed that each hour of delay decreased the probability of acceptance by 5% and that kidneys would be discarded after 20 hours of offers beyond the local level. We simulated offering kidneys simultaneously to small, medium-size, and large batches of centers. Increasing the batch size increased the percentage of kidneys accepted and shortened allocation times. Going from small to large batches increased the number of kidneys accepted from 10 085 (92%) to 10 802 (98%) for low-Kidney Donor Risk Index kidneys and from 1257 (65%) to 1737 (89%) for high-Kidney Donor Risk Index kidneys. The average number of offers that a center received each week was 10.1 for small batches and 16.8 for large batches. Simultaneously expiring offers might allow faster allocation and decrease the number of discards, while still maintaining an acceptable screening burden.
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Affiliation(s)
- Michal A. Mankowski
- Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Martin Kosztowski
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Subramanian Raghavan
- Smith School of Business and Institute for Systems Research, University of Maryland, College Park, Maryland
| | | | - David Axelrod
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Sommer E. Gentry
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
- Department of Mathematics, United States Naval Academy, Annapolis, Maryland
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13
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Friesner D, McPherson MQ, Haugen K. Assessing the Impact of Medical Laboratory Resource Allocations on Hospital Finances. Hosp Top 2019; 97:119-132. [PMID: 31354085 DOI: 10.1080/00185868.2019.1631724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The relationship between resource allocation decisions within medical laboratory cost centers and overall hospital financial performance is empirically investigated using a panel of critical access hospitals in Washington State (2014-2016). In order to increase accessibility to hospital managers and health policy makers, a managerial finance perspective (defining performance using simple financial accounting ratios) is adopted. Results indicate that resource allocation decisions within the medical laboratory cost center have a significant impact on the financial performance of the hospital as a whole. However, the nature of the impact depends on the type of financial metric utilized. For instance, the proportion of the typical medical laboratory's budget that is allocated to rent is negatively and significantly related to the hospital's return on assets. Concomitantly, medical laboratory cost centers that have a larger footprint in the hospital (as measured by square footage) exhibit a significant, positive association with the hospital's current ratio. Thus, physically larger medical laboratories may allow the hospital to better manage its liquid assets.
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Affiliation(s)
- Dan Friesner
- College of Health Professions, North Dakota State University , Fargo , North Dakota , USA
| | - Matthew Q McPherson
- School of Business Administration, Gonzaga University , Spokane , Washington , USA
| | - Kelly Haugen
- College of Health Professions, North Dakota State University , Fargo , North Dakota , USA
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14
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Sim SY, Jit M, Constenla D, Peters DH, Hutubessy RCW. A Scoping Review of Investment Cases for Vaccines and Immunization Programs. Value Health 2019; 22:942-952. [PMID: 31426936 DOI: 10.1016/j.jval.2019.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Many investment cases have recently been published intending to show the value of new health investments, but without consistent methodological approaches. OBJECTIVES To conduct a scoping review of existing investment cases (using vaccines and immunization programs as an example), identify common characteristics that define these investment cases, and examine their role within the broader context of the vaccine development and introduction. METHODS A systematic search was conducted from January 1980 to November 2017 to identify investment cases in the area of vaccines and immunization programs from gray literature and electronic bibliographic databases. Investment case outcomes, objectives, key variables, target audiences, and funding sources were extracted and analyzed according to their reporting frequency. RESULTS We found 24 investment cases, and most of them aim to provide information for decisions (12 cases) or advocate for a specific agenda (9 cases). Outcomes presented fell into 4 broad categories-burden of disease, cost of investment, impact of investment, and other considerations for implementation. Number of deaths averted (70%), incremental cost-effectiveness ratios (67%), and reduction in health and socioeconomic inequalities (54%) were the most frequently reported outcome measures for impact of investment. Health system capacity (79%) and vaccine financing landscape (75%) were the most common considerations for implementation. A sizable proportion (41.4%) of investment cases did not reveal their funding sources. CONCLUSIONS This review describes information that is critical to decision making about resource mobilization and allocation concerning vaccines. Global efforts to harmonize investment cases more broadly will increase transparency and comparability.
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Affiliation(s)
- So Yoon Sim
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark Jit
- London School of Hygiene & Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK
| | - Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David H Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Raymond C W Hutubessy
- Initiative for Vaccine Research, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
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15
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Mehta N, Dodge JL, Hirose R, Roberts JP, Yao FY. Predictors of low risk for dropout from the liver transplant waiting list for hepatocellular carcinoma in long wait time regions: Implications for organ allocation. Am J Transplant 2019; 19:2210-2218. [PMID: 30861298 PMCID: PMC7072024 DOI: 10.1111/ajt.15353] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/24/2019] [Accepted: 02/28/2019] [Indexed: 01/25/2023]
Abstract
All patients with hepatocellular carcinoma meeting United Network for Organ Sharing T2 criteria currently receive the same listing priority for liver transplant (LT). A previous study from our center identified a subgroup with a very low risk of waitlist dropout who may not derive immediate LT benefit. To evaluate this issue at a national level, we analyzed within the United Network for Organ Sharing database 2052 patients with T2 hepatocellular carcinoma receiving priority listing from 2011 to 2014 in long wait time regions 1, 5, and 9. Probabilities of waitlist dropout were 18.3% at 1 year and 27% at 2 years. In multivariate analysis, factors associated with a lower risk of waitlist dropout included Model for End-Stage Liver Disease-Na < 15, Child's class A, single 2- to 3-cm lesion, and α-fetoprotein ≤20 ng/mL. The subgroup of 245 (11.9%) patients meeting these 4 criteria at LT listing had a 1-year probability of dropout of 5.5% vs 20% for all others (P < .001). On explant, the low dropout risk group was more likely to have complete tumor necrosis (35.5% vs 24.9%, P = .01) and less likely to exceed Milan criteria (9.9% vs 17.7%, P = .03). We identified a subgroup with a low risk of waitlist dropout who should not receive the same LT listing priority.
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Affiliation(s)
- Neil Mehta
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Jennifer L. Dodge
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Ryutaro Hirose
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California
| | - John P. Roberts
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Francis Y. Yao
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, California
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California
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16
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Öhler H, Negre M, Smets L, Massari R, Bogetić Ž. Putting your money where your mouth is: Geographic targeting of World Bank projects to the bottom 40 percent. PLoS One 2019; 14:e0218671. [PMID: 31226139 PMCID: PMC6588237 DOI: 10.1371/journal.pone.0218671] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/06/2019] [Indexed: 11/24/2022] Open
Abstract
The adoption of the shared prosperity goal by the World Bank in 2013 and Sustainable Development Goal 10, on inequality, by the United Nations in 2015 should strengthen the focus of development interventions and cooperation on the income growth of the bottom 40 percent of the income distribution. This paper contributes to the incipient literature on within-country allocations of development institutions and assesses the geographic targeting of World Bank projects to the bottom 40 percent. Bivariate correlations between the allocation of project funding approved over 2005–14 and the geographical distribution of the bottom 40 as measured by survey income or consumption data are complemented by regressions with population and other potential factors affecting the within-country allocations as controls. The correlation analysis shows that, of the 58 countries in the sample, 41 exhibit a positive correlation between the shares of the bottom 40 and World Bank funding, and, in almost half of these, the correlation is above 0.5. Slightly more than a quarter of the countries, mostly in Sub-Saharan Africa, exhibit a negative correlation. The regression analysis shows that, once one controls for population, the correlation between the bottom 40 and World Bank funding switches sign and becomes significant and negative on average. This is entirely driven by Sub-Saharan Africa and not observed in the other regions. Hence, the significant and positive correlation in the estimations without controlling for population suggests that World Bank project funding is concentrated in administrative areas in which more people live (including the bottom 40) rather than in poorer administrative areas. Furthermore, capital cities receive disproportionally high shares of World Bank funding on average.
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Affiliation(s)
- Hannes Öhler
- German Development Institute, Bonn, North Rhine-Westphalia, Germany
- * E-mail:
| | - Mario Negre
- German Development Institute, Bonn, North Rhine-Westphalia, Germany
- World Bank, Washington, D.C., United States of America
| | - Lodewijk Smets
- LICOS Centre for Institutions and Economic Performance, KU Leuven, Flemish Brabant, Belgium
| | - Renzo Massari
- Independent consultant, Washington, D.C., United States of America
| | - Željko Bogetić
- Independent Evaluation Group, World Bank, Washington, D.C., United States of America
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17
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Hackl C, Schmidt KM, Süsal C, Döhler B, Zidek M, Schlitt HJ. Split liver transplantation: Current developments. World J Gastroenterol 2018; 24:5312-5321. [PMID: 30598576 PMCID: PMC6305537 DOI: 10.3748/wjg.v24.i47.5312] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/09/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023] Open
Abstract
In 1988, Rudolf Pichlmayr pioneered split liver transplantation (SLT), enabling the transplantation of one donor liver into two recipients - one pediatric and one adult patient. In the same year, Henri Bismuth and colleagues performed the first full right/full left split procedure with two adult recipients. Both splitting techniques were rapidly adopted within the transplant community. However, a SLT is technically demanding, may cause increased perioperative complications, and may potentially transform an excellent deceased donor organ into two marginal quality grafts. Thus, crucial evaluation of donor organs suitable for splitting and careful screening of potential SLT recipients is warranted. Furthermore, the logistic background of the splitting procedure as well as the organ allocation policy must be adapted to further increase the number and the safety of SLT. Under defined circumstances, in selected patients and at experienced transplant centers, SLT outcomes can be similar to those obtained in full organ LT. Thus, SLT is an important tool to reduce the donor organ shortage and waitlist mortality, especially for pediatric patients and small adults. The present review gives an overview of technical aspects, current developments, and clinical outcomes of SLT.
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Affiliation(s)
- Christina Hackl
- Department of Surgery, University Hospital Regensburg, Regensburg 93053, Germany
| | - Katharina M Schmidt
- Department of Surgery, University Hospital Regensburg, Regensburg 93053, Germany
| | - Caner Süsal
- Collaborative Transplant Study (CTS), Institute of Immunology, Heidelberg University, Heidelberg 69120, Germany
| | - Bernd Döhler
- Collaborative Transplant Study (CTS), Institute of Immunology, Heidelberg University, Heidelberg 69120, Germany
| | - Martin Zidek
- Department of Surgery, University Hospital Regensburg, Regensburg 93053, Germany
| | - Hans J Schlitt
- Department of Surgery, University Hospital Regensburg, Regensburg 93053, Germany
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18
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Artzner T, Michard B, Besch C, Levesque E, Faitot F. Liver transplantation for critically ill cirrhotic patients: Overview and pragmatic proposals. World J Gastroenterol 2018; 24:5203-5214. [PMID: 30581269 PMCID: PMC6295835 DOI: 10.3748/wjg.v24.i46.5203] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation for critically ill cirrhotic patients with acute deterioration of liver function associated with extrahepatic organ failures is controversial. While transplantation has been shown to be beneficial on an individual basis, the potentially poorer post-transplant outcome of these patients taken as a group can be held as an argument against allocating livers to them. Although this issue concerns only a minority of liver transplants, it calls into question the very heart of the allocation paradigms in place. Indeed, most allocation algorithms have been centered on prioritizing the sickest patients by using the model for end-stage liver disease score. This has led to allocating increasing numbers of livers to increasingly critically ill patients without setting objective or consensual limits on how sick patients can be when they receive an organ. Today, finding robust criteria to deem certain cirrhotic patients too sick to be transplanted seems urgent in order to ensure the fairness of our organ allocation protocols. This review starts by fleshing out the argument that finding such criteria is essential. It examines five types of difficulties that have hindered the progress of recent literature on this issue and identifies various strategies that could be followed to move forward on this topic, taking into account the recent discussion on acute on chronic liver failure. We move on to review the literature along four axes that could guide clinicians in their decision-making process regarding transplantation of critically ill cirrhotic patients.
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Affiliation(s)
- Thierry Artzner
- Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg 67000, France
| | - Baptiste Michard
- Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg 67000, France
- Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg 67000, France
| | - Camille Besch
- Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg 67000, France
| | - Eric Levesque
- Service d’Anesthésie et Réanimation Chirurgicale, Hôpital Henri Mondor, Créteil 94000, France
| | - François Faitot
- Service de Chirurgie Hépatobiliaire et Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg 67000, France
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19
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By the Contributors to the C4 Article (Appendix 1). Current opinions in organ allocation. Am J Transplant 2018; 18:2625-34. [PMID: 30303603 DOI: 10.1111/ajt.15094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 02/06/2023]
Abstract
Existing methods of academic publication provide limited opportunity to obtain stakeholder input on issues of broad interest. This article reports the results of an experiment to produce a collaborative, crowdsourced article examining a current controversial issue in transplant medicine (hereby referred to as the "C4 Article"). The editorial team as a whole selected the topic of organ allocation, then divided into six sections, each supported by an individual editorial team. Widely promoted by the American Journal of Transplantation, the C4 Article was open for public comment for 1 month. The nonblinded editorial teams reviewed the contributions daily and interacted with contributors in near-real time to clarify and expand on the content received. Draft summaries of each section were posted and subsequently revised as new contributions were received. One hundred ninety-four individuals viewed the manuscript, and 107 individuals contributed to the manuscript during the submission period. The article engaged the international transplant community in producing a contemporary delineation of issues of agreement and controversy related to organ allocation and identified opportunities for new policy development. This initial experience successfully demonstrated the potential of a crowdsourced academic manuscript to advance a broad-based understanding of a complex issue.
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20
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Zhang X, Melanson TA, Plantinga LC, Basu M, Pastan SO, Mohan S, Howard DH, Hockenberry JM, Garber MD, Patzer RE. Racial/ethnic disparities in waitlisting for deceased donor kidney transplantation 1 year after implementation of the new national kidney allocation system. Am J Transplant 2018; 18:1936-1946. [PMID: 29603644 PMCID: PMC6105401 DOI: 10.1111/ajt.14748] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/26/2018] [Accepted: 03/20/2018] [Indexed: 01/25/2023]
Abstract
The impact of a new national kidney allocation system (KAS) on access to the national deceased-donor waiting list (waitlisting) and racial/ethnic disparities in waitlisting among US end-stage renal disease (ESRD) patients is unknown. We examined waitlisting pre- and post-KAS among incident (N = 1 253 100) and prevalent (N = 1 556 954) ESRD patients from the United States Renal Data System database (2005-2015) using multivariable time-dependent Cox and interrupted time-series models. The adjusted waitlisting rate among incident patients was 9% lower post-KAS (hazard ratio [HR]: 0.91; 95% confidence interval [CI], 0.90-0.93), although preemptive waitlisting increased from 30.2% to 35.1% (P < .0001). The waitlisting decrease is largely due to a decline in inactively waitlisted patients. Pre-KAS, blacks had a 19% lower waitlisting rate vs whites (HR: 0.81; 95% CI, 0.80-0.82); following KAS, disparity declined to 12% (HR: 0.88; 95% CI, 0.85-0.90). In adjusted time-series analyses of prevalent patients, waitlisting rates declined by 3.45/10 000 per month post-KAS (P < .001), resulting in ≈146 fewer waitlisting events/month. Shorter dialysis vintage was associated with greater decreases in waitlisting post-KAS (P < .001). Racial disparity reduction was due in part to a steeper decline in inactive waitlisting among minorities and a greater proportion of actively waitlisted minority patients. Waitlisting and racial disparity in waitlisting declined post-KAS; however, disparity remains.
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Affiliation(s)
- Xingyu Zhang
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA
| | - Taylor A. Melanson
- Department of Health Policy & Management, Rollins School of Public Health, Atlanta, GA
| | - Laura C. Plantinga
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA
- Department of Medicine, Renal Division, Emory University School of Medicine
| | - Mohua Basu
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA
| | - Stephen O. Pastan
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA
- Department of Medicine, Renal Division, Emory University School of Medicine
| | - Sumit Mohan
- Department of Medicine, Columbia University College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, New York
| | - David H. Howard
- Department of Health Policy & Management, Rollins School of Public Health, Atlanta, GA
| | - Jason M. Hockenberry
- Department of Health Policy & Management, Rollins School of Public Health, Atlanta, GA
| | - Michael D. Garber
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA
| | - Rachel E. Patzer
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA
- Department of Medicine, Renal Division, Emory University School of Medicine
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Affiliation(s)
- Chloe M. Barrera
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gayle Whatley
- Alabama Department of Public Health, Montgomery, AL, USA
| | - Amy Stratton
- Alabama Department of Public Health, Montgomery, AL, USA
| | - Sahra Kahin
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diane Roberts Ayers
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daurice Grossniklaus
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carol MacGowan
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Shah N, Abraham J, Goodwin W, Kahal H, Menon V, Lam FT, Barber TM. Effective Implementation of Peri-operative Local Guidelines for Metabolic Surgery in Patients with Diabetes Mellitus in a Tier 4 Setting Demonstrate Improved Work Efficiency and Resource Allocation. Obes Surg 2018; 28:3342-3347. [PMID: 30022426 DOI: 10.1007/s11695-018-3389-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Dynamic changes in glycaemia predominate peri-operatively in patients with type 2 diabetes mellitus (T2DM) undergoing metabolic surgery. There is a lack of consensus and clear guidance on effective glycaemic management of such patients. The aim of this study was to design, pilot, and implement a proforma to improve consistency of glycaemic management and clarity of communication with healthcare professionals following metabolic surgery in patients with T2DM, thereby reducing unnecessary diabetes specialist nurse (DSN) referrals. METHODS A proforma was designed and piloted for 12 months to guide healthcare professionals on managing glycaemic therapies for T2DM patients undergoing metabolic surgery. Glycaemic control (HbA1c) and glycaemic therapies were reviewed 3 weeks pre-operatively and a proforma was completed accordingly. RESULTS Of the patients with T2DM (n = 34) who underwent metabolic surgery prior to the new proforma being implemented, 71% (n = 24) had a DSN referral. Half of these referrals were deemed unnecessary by the DSNs. Of the patients with T2DM (n = 33) who underwent metabolic surgery following implementation of the proforma, 21% (n = 7) had a DSN referral. Only 10% of these were deemed unnecessary. Despite the reduced DSN input, no diabetes-related complications were reported. CONCLUSION Implementation of our proforma effectively halved the proportion of patients with T2DM requiring a DSN referral. Additionally, there was a 40% absolute reduction in the proportion of unnecessary DSN referrals. The proforma improved clarity of communication and guidance for healthcare professionals in the glycaemic management of patients. This also facilitated improved work efficiency and resource allocation.
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Affiliation(s)
- Neha Shah
- Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK.
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
| | - Jenny Abraham
- Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Wendy Goodwin
- Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Hassan Kahal
- Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Vinod Menon
- Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - F T Lam
- Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Thomas M Barber
- Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
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Abstract
In general, readers of Families, Systems, and Health (FSH) practice in high income countries and in settings that have adequate resources. Providers can usually count on being able to offer the material resources and skills that patients need to heal. This bounty of resources is in contrast to many clinics in low- and middle-income countries (LMICs). The need for mental health services in LMICs is significant and growing because of upheaval caused by war and other disasters. The topics in this issue talk about the obstacles to obtaining mental health services, trends in global mental health, and FSH in the global mental health movement. (PsycINFO Database Record
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Eltaki SM, Singh-Franco D, Leon DJ, Nguyen MO, Wolowich WR. Allocation of faculty and curricular time to the teaching of transitions of care concepts by colleges of pharmacy. Curr Pharm Teach Learn 2018; 10:701-711. [PMID: 30025769 DOI: 10.1016/j.cptl.2018.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 12/16/2017] [Accepted: 03/03/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION To determine the allocation of faculty and curricular time to the teaching of transitions of care (ToC) concepts by colleges of pharmacy (COPs) to equip students with the necessary skills for the provision of these services. METHODS A novel 15-question anonymous electronic survey was sent to 136 pharmacy practice chairpersons. RESULTS Response rate was 26.5% (n = 36). Of these, 47% employed ToC faculty while 44% are not actively recruiting for that position in the foreseeable future. Median total curriculum hours dedicated to teaching ToC was four (interquartile range two to 10 hours). Medication reconciliation skills were taught didactically and via interactive lab sessions by 53% of respondents. Only 11% offered an interdisciplinary ToC program. A significant association between not having ToC faculty and lack of implementation of ToC concepts within a pharmacy curriculum (p = 0.02, Fisher's Exact) and practice site (p = 0.045, Pearson's) was observed. Barriers to adopting ToC within the curriculum (e.g., uncertainty of placement within curriculum, resistance by faculty and administrators) and at a practice site (e.g., inadequate infrastructure to accommodate ToC delivery, ToC faculty unavailability and resistance by other health care providers) were reported. DISCUSSION AND CONCLUSIONS This study demonstrated that COPs devote curricular time to ToC activities and involve dedicated faculty in the provision of these services. Several barriers to employing ToC faculty and planning additional time in the curriculum for teaching these skills were identified. Future research should determine the best methods for training students to ensure competence in performing ToC tasks.
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Affiliation(s)
- Sara M Eltaki
- Memorial Regional Hospital, Clinical Pharmacy Coordinator-Transitions of Care, 3501 Johnson St., Hollywood, FL 33021, United States.
| | - Devada Singh-Franco
- Department of Pharmacy Practice, Nova Southeastern University-College of Pharmacy, 3200 South University Drive, Fort Lauderdale, FL 33328, United States.
| | - David J Leon
- Nova Southeastern University-College of Pharmacy, Fort Lauderdale, FL, United States.
| | - My-Oanh Nguyen
- Nova Southeastern University-College of Pharmacy, Fort Lauderdale, FL, United States.
| | - William R Wolowich
- Department of Pharmacy Practice, Nova Southeastern University-College of Pharmacy, 3200 South University Drive, Fort Lauderdale, FL 33328, United States.
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Nazarian S, Peng A, Duggirala B, Gupta M, Bittermann T, Amaral S, Levine M. The kidney allocation system does not appropriately stratify risk of pediatric donor kidneys: Implications for pediatric recipients. Am J Transplant 2018; 18:574-579. [PMID: 28805300 PMCID: PMC5812849 DOI: 10.1111/ajt.14462] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 08/04/2017] [Accepted: 08/06/2017] [Indexed: 01/25/2023]
Abstract
Kidney Allocation System (KAS) was enacted in 2014 to improve graft utility, while facilitating transplantation of highly-sensitized patients and preserving pediatric access to high-quality kidneys. Central to this system is the Kidney Donor Profile Index (KDPI), a metric intended to predict transplant outcomes based on donor characteristics but derived using only adult donors. We posited that KAS had inadvertently altered the profile and quantity of kidneys made available to pediatric recipients. This question arose from our observation that most pediatric donors carry a KDPI over 35 and have therefore been rendered relatively inaccessible to pediatric recipients under KAS. Here we explore early trends in pediatric transplantation following KAS, including: (i) use of pediatric donors, (ii) use of Public Health System (PHS) high infectious risk donors, (iii) wait time, and (iv) living donor transplantation. We note some concerning preliminary changes following KAS implementation, including the allocation of fewer deceased donor pediatric kidneys to children and stagnation in pediatric wait times. Moreover, the poor predictive power of the KDPI for adult donors appears to be even worse when applied to pediatric donors. These early trends warrant further observation and consideration of changes in pediatric kidney allocation if they persist.
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Affiliation(s)
- S.M. Nazarian
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - A.W. Peng
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - B. Duggirala
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - M. Gupta
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - T. Bittermann
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - S. Amaral
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
- The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - M.H. Levine
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- The Children’s Hospital of Philadelphia, Philadelphia, PA
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Xu S, Liang Z, Du Q, Li Z, Tan G, Nie C, Yang Y, Lv X, Zhang C, Luo X. A systematic study on the prevention and treatment of retinopathy of prematurity in China. BMC Ophthalmol 2018; 18:44. [PMID: 29444655 PMCID: PMC5813392 DOI: 10.1186/s12886-018-0708-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 02/06/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To identify the prevention situation, the main factors influencing prevention effects and to develop control measures over retinopathy of prematurity in China. METHODS Using stratified random sampling method, we randomly selected 23 provincial and ministerial hospitals (8 in Guangdong province, 5 in Hunan province and 10 in Shaanxi province), 81 municipal hospitals (38 in Guangdong province, 19 in Hunan province and 24 in Shaanxi province), 180 district and county hospitals (76 in Guangdong province, 57 in Hunan province and 47 in Shaanxi province) in China. A total of 284 hospitals were enrolled in the study, with questionnaires distributed investigating the status and constrain factors of ROP presentation. Significant outcomes were analyzed thereafter by SPSS 19.0. RESULTS The screening rate of ROP in medical institutions from eastern, central and western China were 84.6%, 35.0% and 56.7%, respectively. The screening rate of tertiary and secondary medical institutions were 84.6% and 25.7% in the eastern, 35.0% and 4.9% in the central, 56.7% and 5.9% in the western region. Screening was carried out better in the tertiary than that in the secondary and primary institutions. Treatment for ROP was available in 15.7% of all the tertiary hospitals surveyed. Lack of professionals, equipments and technologies were considered to be major restrain factors for screening. CONCLUSIONS The ROP screening and treatment status have demonstrated significant regional diversity due to uneven distribution of medical resources in China. Developed areas had established intraregional cooperation models, whereas less-developed areas should consider set up a large-scale, three-level ROP prevention network. It is of paramount importance that education and training towards ophthalmologists should be vigorously strengthened. It is strongly recommended that implement ROP telemedicine and integrated ROP prevention and management platforms through the Internet should be established.
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Affiliation(s)
- Shuman Xu
- Guangdong Women and Children Hospital, 521 Xingnan Road, Guangzhou, Guangdong 511442 People’s Republic of China
| | - Zhijiang Liang
- Guangdong Women and Children Hospital, 521 Xingnan Road, Guangzhou, Guangdong 511442 People’s Republic of China
| | - Qiyun Du
- Hunan Women and Children Hospital, Changsha, Hunan People’s Republic of China
| | - Zhankui Li
- Shaanxi Women and Children Hospital, Xi’an, Shaanxi People’s Republic of China
| | - Guangming Tan
- Guangdong Women and Children Hospital, 521 Xingnan Road, Guangzhou, Guangdong 511442 People’s Republic of China
| | - Chuan Nie
- Guangdong Women and Children Hospital, 521 Xingnan Road, Guangzhou, Guangdong 511442 People’s Republic of China
| | - Yang Yang
- Guangdong Women and Children Hospital, 521 Xingnan Road, Guangzhou, Guangdong 511442 People’s Republic of China
| | - Xuzai Lv
- Guangdong Women and Children Hospital, 521 Xingnan Road, Guangzhou, Guangdong 511442 People’s Republic of China
| | - Chunyi Zhang
- Guangdong Women and Children Hospital, 521 Xingnan Road, Guangzhou, Guangdong 511442 People’s Republic of China
| | - Xianqiong Luo
- Guangdong Women and Children Hospital, 521 Xingnan Road, Guangzhou, Guangdong 511442 People’s Republic of China
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Hasler B, Delabouglise A, Babo Martins S. Achieving an optimal allocation of resources for animal health surveillance, intervention and disease mitigation. REV SCI TECH OIE 2018; 36:57-66. [PMID: 28926028 DOI: 10.20506/rst.36.1.2609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The primary role of animal health economics is to inform decision-making by determining optimal investments for animal health. Animal health surveillance produces information to guide interventions. Consequently, investments in surveillance and intervention must be evaluated together. This article explores the different theoretical frameworks and methods developed to assess and optimise the spending of resources in surveillance and intervention and their technical interdependence. The authors present frameworks that define the relationship between health investment and losses due to disease, and the relationship between surveillance and intervention resources. Surveillance and intervention are usually considered as technical substitutes, since increased investments in surveillance reduce the level of intervention resources required to reach the same benefit. The authors also discuss approaches used to quantify externalities and non-monetary impacts. Finally, they describe common economic evaluation types, including optimisation, acceptability and least-cost studies.
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Abstract
Background: In the English National Health Service (NHS), Primary Care Trusts (PCTs) are responsible for commissioning health-care services on behalf of their populations. As resources are finite, decisions are required as to which services best fulfil population needs. Evidence on effectiveness varies in quality and availability. Nevertheless, decisions still have to be made. Methods: We report the development and pilot application of a multi-criteria prioritization mechanism in an English PCT, capable of accommodating a wide variety of evidence to rank six service developments. Results: The mechanism proved valuable in assisting prioritization decisions and feedback was positive. Two community-based interventions were expected to save money in the long term and were ranked at the top of the list. Based on weighted benefit score and cost, two preventive programmes were ranked third and fourth. Finally, two National Institute for Health and Clinical Excellence (NICE)-approved interventions were ranked fifth and sixth. Sensitivity analysis revealed overlap in benefit scores for some of the interventions, representing diversity of opinion among the scoring panel. Conclusion: The method appears to be a practical approach to prioritization for commissioners of health care, but the pilot also revealed interesting divergences in relative priority between nationally mandated service developments and local health-care priorities.
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Affiliation(s)
- Edward Wilson
- UEA/NHS Health Economics Support Programme, Health Economics Group, School of Medicine, Health Policy & Practice, University of East Anglia, Norwich, UK.
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Abstract
The management of water is a topic of great concern. Inadequate management may lead to water scarcity and ecological destruction, but also to an increase of catastrophic floods. With climate change, both water scarcity and the risk of flooding are likely to increase even further in the coming decades. This makes water management currently a highly dynamic field, in which experiments are made with new forms of policy making. In the current paper, a case study is presented in which different interest groups were invited for developing new water policy. The case was innovative in that stakeholders were invited to identify and frame the most urgent water issues, rather than asking them to reflect on possible solutions developed by the water authority itself. The case suggests that stakeholders can participate more effectively if their contribution is focused on underlying competing values rather than conflicting interests.
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Affiliation(s)
- Neelke Doorn
- Department of Technology, Policy and Management - Values, Technology and Innovation, Delft University of Technology, PO Box 5015, 2600 GA, Delft, The Netherlands.
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Shiroiwa T, Saito S, Shimozuma K, Kodama S, Noto S, Fukuda T. Societal Preferences for Interventions with the Same Efficiency: Assessment and Application to Decision Making. Appl Health Econ Health Policy 2016; 14:375-85. [PMID: 26940671 DOI: 10.1007/s40258-016-0236-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Although quality-adjusted life-years (QALYs) may not completely reflect the value of a healthcare technology, it remains unclear how to adjust the cost per QALY threshold. First, the present study compares two survey methods of measuring people's preferences for a specific healthcare technology when each choice has the same efficiency. The second objective was to consider how this information regarding preferences could be used in decision making. METHODS We conducted single-attribute (budget allocation) and multi-attribute (discrete-choice) experiments to survey public medical care preferences. Approximately 1000 respondents were sampled for each experiment. Six questions were prepared to address the attributes included in the study: (a) age; (b) objective of care; (c) disease severity; (d) prior medical care; (e) cause of disease; and (f) disease frequency. For the discrete-choice experiment (a) age, (b) objective of care, (c) disease severity, and (d) prior medical care were orthogonally combined. All assumed medical care had the same costs and incremental cost-effectiveness ratio (ICER; cost per life-year or QALY). We also calculated the preference-adjusted threshold (PAT) to reflect people's preferences in a threshold range. RESULTS The results of both experiments revealed similar preferences: intervention for younger patients was strongly preferred, followed by interventions for treatment and severe disease states being preferred, despite the same cost per life-year or QALY. The single-attribute experiment revealed that many people prefer an option in which resources are equally allocated between two interventions. Marginal PATs were calculated for age, objective of care, disease severity, and prior medical care. CONCLUSION The single- and multi-attribute experiments revealed similar preferences. PAT can reflect people's preferences within the decision-maker's threshold range in a numerical manner.
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Affiliation(s)
- Takeru Shiroiwa
- Department of Health and Welfare Service, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan.
| | - Shinya Saito
- Graduate School of Health Sciences, Okayama University, Okayama, Japan
| | - Kojiro Shimozuma
- Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University, Kusatsu, Japan
| | - Satoshi Kodama
- Department of Ethics, Graduate School of Letters, Kyoto University, Kyoto, Japan
| | - Shinichi Noto
- Department of Health Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Takashi Fukuda
- Department of Health and Welfare Service, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan
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Adler JT, Axelrod DA. Regulations' Impact on Donor and Recipient Selection for Liver Transplantation: How Should Outcomes be Measured and MELD Exception Scores be Considered? AMA J Ethics 2016; 18:133-142. [PMID: 26894809 DOI: 10.1001/journalofethics.2016.18.2.pfor1-1602] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - David A Axelrod
- Section chief of solid organ transplant surgery at Dartmouth-Hitchcock Medical Center and an associate professor of surgery at the Geisel School of Medicine at Dartmouth College in Hanover, New Hampshire, and a regional councilor for the United Network of Organ Sharing (UNOS) and a member of the Organ Procurement and Transplantation Network/UNOS Membership and Professional Standards Committee
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Prin M, Harrison D, Rowan K, Wunsch H. Epidemiology of admissions to 11 stand-alone high-dependency care units in the UK. Intensive Care Med 2015; 41:1903-10. [PMID: 26359162 DOI: 10.1007/s00134-015-4011-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/04/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE High-dependency care units (HDUs) are a focus of research to optimize critical care resource allocation. HDUs provide a level of care between the general ward and the intensive care unit (ICU). However, few data report on the case mix and outcomes of patients in these units. METHODS Retrospective observational cohort study of patients admitted to 11 stand-alone HDUs in the UK from 2008 to 2011. We stratified patients by location prior to HDU admission and location on discharge from HDU, and we summarized the case mix, transitions of care, and mortality. RESULTS Of 9008 patients admitted to 11 stand-alone HDUs, 56.5% were male and the mean age was 62.7 ± 17.9 years. The majority of patients admitted to HDUs were non-surgical (59.3%), with 22.4 and 20.1% admitted from the ICU and general ward, respectively; 41.3% were admitted from the operating room or recovery suite. The median length of stay in HDU was 1.8 days (IQR 0.9-3.5) and in-HDU mortality was 5.1%. Among HDU survivors (n = 8551), 8.5% were discharged to an ICU, 80.9% to a general ward, and 10.6% to other care areas. For patients admitted to HDU from an ICU, only 5.8% were readmitted to ICU. Hospital mortality for the HDU population was 14.8%; for patients discharged to an ICU, hospital mortality was 43.6%. CONCLUSIONS In a sample of 11 stand-alone HDUs in the UK, patients are from many different hospital locations. Hospital mortality for patients requiring HDU care is high, particularly for patients who require transfer to an ICU.
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Affiliation(s)
- Meghan Prin
- Department of Anesthesiology, Columbia University, New York, NY, USA
| | - David Harrison
- Intensive Care National Audit and Research Centre, London, UK
| | - Kathryn Rowan
- Intensive Care National Audit and Research Centre, London, UK
| | - Hannah Wunsch
- Department of Anesthesiology, Columbia University, New York, NY, USA.
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Avenue, Room D1.08, Toronto, ON, M4N 3M5, Canada.
- Department of Anesthesiology, University of Toronto, Toronto, ON, Canada.
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Fanourgiakis J, Kanoupakis E. Health technology assessment (HTA): a brief introduction of history and the current status in the field of cardiology under the economic crisis. J Evid Based Med 2015; 8:161-4. [PMID: 26291523 DOI: 10.1111/jebm.12171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/27/2014] [Indexed: 01/11/2023]
Abstract
In a time of economic recession health technology assessment is an established aid in decision making in many countries in order to identify cost-containment policy options. Moreover, as the volume, complexity, and cost of new medical technology increases, the need for evaluating benefits, risks and costs becomes increasingly important. In recent years there has been a proliferation of health technology assessment initiatives internationally, aimed in introducing rationality in the decision-making process, informing reimbursement, providing clinical guidance on the use of medical technologies across the world in an evidence-based decision-making environment and in pricing decisions.
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Affiliation(s)
- John Fanourgiakis
- Department of Accounting and Finance, School of Economics and Management, Technological Educational Institute, Crete, Greece
- Department of Business Administration, Technological Educational Institute, Crete, Greece
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Six-month report on new kidney allocation system due this month. Am J Transplant 2015; 15:1450. [PMID: 26185830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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38
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Reilly R. Getting the right asset mix. Healthc Financ Manage 2015; 69:72-76. [PMID: 26415485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
To accurately measure service costs associated with medical equipment, hospitals should undertake a four-step process: Form a core project team and define the project's scope. Collect data. Employ forensic accounting to ascertain the actual service costs for clinical equipment. Analyze key metrics to identify savings opportunities
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40
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Warnet S. [Second look at mental disorders and their management]. Rev Infirm 2014:8. [PMID: 26050392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Morton A. Aversion to health inequalities in healthcare prioritisation: a multicriteria optimisation perspective. J Health Econ 2014; 36:164-173. [PMID: 24831800 DOI: 10.1016/j.jhealeco.2014.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 03/26/2014] [Accepted: 04/02/2014] [Indexed: 06/03/2023]
Abstract
In this paper we discuss the prioritisation of healthcare projects where there is a concern about health inequalities, but the decision maker is reluctant to make explicit quantitative value judgements and the data systems only allow the measurement of health at an aggregate level. Our analysis begins with a standard welfare economic model of healthcare resource allocation. We show how - under the assumption that the healthcare projects under consideration have a small impact on individual health--the problem can be reformulated as one of finding a particular subset of the class of efficient solutions to an implied multicriteria optimisation problem. Algorithms for finding such solutions are readily available, and we demonstrate our approach through a worked example of treatment for clinical depression.
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Affiliation(s)
- Alec Morton
- Department of Management Science, Strathclyde Business School, University of Strathclyde, 16 Richmond Street, Glasgow G1 1XQ, United Kingdom.
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Daly A. Procurement. The gloves are off with new spending rules. Health Serv J 2014; 124:28-30. [PMID: 25029770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
The RAFAELA system was developed in Finland during the 1990s to help with the systematic and daily measurement of nursing intensity (NI) and allocation of nursing staff. The system has now been rolled out across almost all hospitals in Finland, and implementation has started elsewhere in Europe and Asia. This article describes the system, which aims to uphold staffing levels in accordance with patients' care needs, and its structure, which consists of three parts: the Oulu Patient Classification instrument; registration of available nursing resources; and the Professional Assessment of Optimal Nursing Care Intensity Level method, as an alternative to classical time studies. The article also highlights the benefits of using a systematic measurement of NI.
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Affiliation(s)
- Lisbeth Fagerström
- Buskerud and Vestfold University College faculty of health sciences, Kongsberg, Norway
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Thornton S. Don't look back: the NHS of the past is a foreign country. Health Serv J 2014; 123:18-19. [PMID: 24956706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Goettsch WG, Enzing J. Review: report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force. Value Health 2014; 17:1-2. [PMID: 24438710 DOI: 10.1016/j.jval.2013.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 09/20/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Wim G Goettsch
- Health Care Insurance Board (CVZ), Diemen, The Netherlands
| | - Joost Enzing
- Health Care Insurance Board (CVZ), Diemen, The Netherlands
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Abstract
Public health emergencies implicate difficult decisions among medical and emergency first responders about how to allocate essential resources. While various actors have proffered approaches on how to make these tough choices, meaningful guidance on shifting standards of care in major emergencies remained lacking. In March 2012, the Institute of Medicine (IOM) released additional guidance to assist facilities and practitioners to address scarce resource allocation through the development of "crisis standards of care" in catastrophes. As discussed in the article, identifying and resolving of complex practical, ethical, and legal challenges underlying real-time implementation of these standards are indispensable to protecting the public's health.
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Affiliation(s)
- James G Hodge
- Health Law and Ethics, Sandra Day O'Connor College of Law, Arizona State University, AZ, USA
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Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Value Health 2013; 16:e1-5. [PMID: 23538200 DOI: 10.1016/j.jval.2013.02.010] [Citation(s) in RCA: 444] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication. The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website: (www.ispor.org/TaskForces/EconomicPubGuidelines.asp). We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years.
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Affiliation(s)
- Don Husereau
- Institute of Health Economics, Edmonton, Canada.
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Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)--explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health 2013; 16:231-50. [PMID: 23538175 DOI: 10.1016/j.jval.2013.02.002] [Citation(s) in RCA: 1481] [Impact Index Per Article: 134.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Economic evaluations of health interventions pose a particular challenge for reporting because substantial information must be conveyed to allow scrutiny of study findings. Despite a growth in published reports, existing reporting guidelines are not widely adopted. There is also a need to consolidate and update existing guidelines and promote their use in a user-friendly manner. A checklist is one way to help authors, editors, and peer reviewers use guidelines to improve reporting. OBJECTIVE The task force's overall goal was to provide recommendations to optimize the reporting of health economic evaluations. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines into one current, useful reporting guidance. The CHEERS Elaboration and Explanation Report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force facilitates the use of the CHEERS statement by providing examples and explanations for each recommendation. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication. METHODS The need for new reporting guidance was identified by a survey of medical editors. Previously published checklists or guidance documents related to reporting economic evaluations were identified from a systematic review and subsequent survey of task force members. A list of possible items from these efforts was created. A two-round, modified Delphi Panel with representatives from academia, clinical practice, industry, and government, as well as the editorial community, was used to identify a minimum set of items important for reporting from the larger list. RESULTS Out of 44 candidate items, 24 items and accompanying recommendations were developed, with some specific recommendations for single study-based and model-based economic evaluations. The final recommendations are subdivided into six main categories: 1) title and abstract, 2) introduction, 3) methods, 4) results, 5) discussion, and 6) other. The recommendations are contained in the CHEERS statement, a user-friendly 24-item checklist. The task force report provides explanation and elaboration, as well as an example for each recommendation. The ISPOR CHEERS statement is available online via Value in Health or the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices - CHEERS Task Force webpage (http://www.ispor.org/TaskForces/EconomicPubGuidelines.asp). CONCLUSIONS We hope that the ISPOR CHEERS statement and the accompanying task force report guidance will lead to more consistent and transparent reporting, and ultimately, better health decisions. To facilitate wider dissemination and uptake of this guidance, we are copublishing the CHEERS statement across 10 health economics and medical journals. We encourage other journals and groups to consider endorsing the CHEERS statement. The author team plans to review the checklist for an update in 5 years.
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Affiliation(s)
- Don Husereau
- Institute of Health Economics, Edmonton, Canada.
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Abstract
Has not the time fully come to lift the prohibition on a regulated market in organs for transplantation? Is there a price for such a market that would be too high to pay? The author revisits the cases for and against organ markets in the light of cultural shifts in society and asks whether the traditional insistence on altruism represents a hindrance to much needed developments or a safeguard for much valued public goods.
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Musio M, Sauleau EA, Augustin NH. Resources allocation in healthcare for cancer: a case study using generalised additive mixed models. Geospat Health 2012; 7:83-89. [PMID: 23242683 DOI: 10.4081/gh.2012.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Our aim is to develop a method for helping resources re-allocation in healthcare linked to cancer, in order to replan the allocation of providers. Ageing of the population has a considerable impact on the use of health resources because aged people require more specialised medical care due notably to cancer. We propose a method useful to monitor changes of cancer incidence in space and time taking into account two age categories, according to healthcar general organisation. We use generalised additive mixed models with a Poisson response, according to the methodology presented in Wood, Generalised additive models: an introduction with R. Chapman and Hall/CRC, 2006. Besides one-dimensional smooth functions accounting for non-linear effects of covariates, the space-time interaction can be modelled using scale invariant smoothers. Incidence data collected by a general cancer registry between 1992 and 2007 in a specific area of France is studied. Our best model exhibits a strong increase of the incidence of cancer along time and an obvious spatial pattern for people more than 70 years with a higher incidence in the central band of the region. This is a strong argument for re-allocating resources for old people cancer care in this sub-region.
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Affiliation(s)
- Monica Musio
- Dipartimento di Matematica ed Informatica, Università di Cagliari, Cagliari, Italy.
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