Plastic Surgeon Financial Compensation–Incentivization Models in Surgical Care Delivery: The Past, Present, and Future

Our ability to unravel the mysteries of human health and disease have changed dramatically over the past 2 decades. Decoding health and disease has been facilitated by the recent availability of high-throughput genomics and multi-omics analyses and the companion tools of advanced informatics and computational science. Understanding of the human genome and its influence on phenotype continues to advance through genotyping large populations and using “light phenotyping” approaches in combination with smaller subsets of the population being evaluated using “deep phenotyping” approaches. Using our capability to integrate and jointly analyze genomic data with other multi-omic data, the knowledge of genotype-phenotype relationships and associated genetic pathways and functions is being advanced. Understanding genotype-phenotype relationships that discriminate human health from disease is speculated to facilitate predictive, precision health care and change modes of health care delivery. The American Association for Dental Research Fall Focused Symposium assembled experts to discuss how studies of genotype-phenotype relationships are illuminating the pathophysiology of craniofacial diseases and developmental biology. Although the breadth of the topic did not allow all areas of dental, oral, and craniofacial research to be addressed (e.g., cancer), the importance and power of integrating genomic, phenomic, and other -omic data are illustrated using a variety of examples. The 8 Fall Focused talks presented different methodological approaches for ascertaining study populations and evaluating population variance and phenotyping approaches. These advances are reviewed in this summary.

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“So Quick Bright Things Come to Confusion”

American Journal of Law & Medicine ◽

10.1017/s0098858800008327 ◽

1987 ◽

Vol 13 (2-3) ◽

pp. 169-187

Author(s):

Alexander Morgan Capron

Keyword(s):

Homo Sapiens ◽

Care Delivery ◽

Well Being ◽

Workplace Safety ◽

Selective Abortion ◽

Self Identity ◽

The Past ◽

Adverse Impacts ◽

The Rich ◽

Insurance Discrimination

In the past several decades, the problems facing those of us who labor in the vineyards of health policy and ethics have been the problems of success — first medicine's and then, though to a lesser extent, our own. By this I mean that it has been the remarkable fruits of biomedicine, from research to health care delivery, that have produced the rich harvest of ethical, social and legal issues that have drawn our, and society's, attention.In the basic science laboratory, scientists have developed means to splice pieces of DNA together, raising questions from workplace safety to the reengineering of homo sapiens. Of more immediate concern, tests for genetic susceptibility to disease in one's self and one's offspring have been developed, thereby generating questions about employment and insurance discrimination, selective abortion, and adverse impacts on self-identity and well-being.

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B.05 Hemi-laryngopharyngeal spasm (HELPS) syndrome: The discovery, cure, and characterization of a new neurological condition

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.76 ◽

2017 ◽

Vol 44 (S2) ◽

pp. S11-S11

Author(s):

C Honey ◽

M Morrison

Keyword(s):

Surgical Care ◽

Review Of The Literature ◽

The Past ◽

First Case ◽

Patient Reported ◽

Operative Outcome ◽

Small Cohort ◽

The Common ◽

Similar Motor

Background: We published the world’s first case of hemi-laryngpharyngeal spasm (HELPS) syndrome cured by microvascular decompression (MVD) of the Xth cranial nerve in 2016. We now present a small cohort of patients (n=3) successfully treated with surgery in order to better delineate the common characteristics of this syndrome, diagnostic tests of choice, nuances of their surgical care and outcomes of their treatment. Methods: The history and physical examination of three patients with HELPS syndrome are presented. Pre-operative laryngoscopy, neuroimaging, response to botox and intra-operative videos are detailed. Post-operative outcome and complications are presented. Results: Each patient reported similar motor (choking) and sensory (coughing) features in their history. Episodic choking relentlessly progressed over the years until it occurred while sleeping and with frightening severity prompting tracheostomy in one patient and intubation in another. A “tickling” sensation deep in the throat triggered episodic coughing that worsened over the years until it occurred while sleeping and with frightening severity (syncope and incontinence). Conclusions: A review of the literature suggests that patients with similar symptoms, often called episodic laryngospasm in the past, have been treated with psychotherapy or antacids. With the recognition that a clearly defined subset of these patients have HELPS syndrome, we can offer them the potential of a neurosurgical cure.

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CANADA'S FAILURE

PEDIATRICS ◽

10.1542/peds.93.4.569 ◽

1994 ◽

Vol 93 (4) ◽

pp. 569-569

Author(s):

J. F. L.

Keyword(s):

Health Care ◽

New England ◽

Care Delivery ◽

Health Care Facilities ◽

User Fees ◽

Capital Expenditures ◽

The Past ◽

Care Facilities ◽

Dog Owners ◽

The Government

The direct costs of Canada's national health insurance are not as troublesome as the distortive effect they have on health care delivery. Health care facilities have been forced to cut back severely on their capital expenditures, thus depleting the availability of advanced medical equipment. As a result, many patients must seek advanced treatment elsewhere. According to a recent study reported in the New England Journal of Medicine, nearly one-third of Canada's doctors have sent patients outside the country for treatment during the past five years. About 10% of all British Columbia residents requiring cancer therapy have been sent to the U.S. In Toronto, because the government doesn't provide enough money for personnel, 3,000 beds have been removed from service, while thousands of patients are on waiting lists for admission. Even where advanced equipment is available, bureaucratic absurdities prevent proper use. According to the April issue of "Fraser Forum," dogs at York Central Hospital in metropolitan Toronto were able to get CAT scans immediately while humans were put on a waiting list. The reason? Canadian patients are not allowed to pay for CAT scans, and the procedure costs too much to operate more than a few hours a day for nonpaying customers. Dog owners, on the other hand, were permitted to pay to use it. The user fees paid by the dog owners allowed the machine to operate longer, thus more human patients could be scanned. When this information was released, instead of considering user fees for humans, the Canadian government banned the tests for dogs!

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Global neurosurgery: models for international surgical education and collaboration at one university

Neurosurgical FOCUS ◽

10.3171/2018.7.focus18291 ◽

2018 ◽

Vol 45 (4) ◽

pp. E5 ◽

Cited By ~ 6

Author(s):

Joao Paulo Almeida ◽

Carlos Velásquez ◽

Claire Karekezi ◽

Miguel Marigil ◽

Mojgan Hodaie ◽

...

Keyword(s):

Organizational Support ◽

Surgical Education ◽

Care Delivery ◽

Surgical Care ◽

Outcome Evaluation ◽

Assessment Tools ◽

Ethical Challenges ◽

University Of Toronto ◽

The World ◽

The University

OBJECTIVEInternational collaborations between high-income (HICs) and low- and middle-income countries (LMICs) have been developed as an attempt to reduce the inequalities in surgical care around the world. In this paper the authors review different models for international surgical education and describe projects developed by the Division of Neurosurgery at the University of Toronto in this field.METHODSThe authors conducted a review of models of international surgical education reported in the literature in the last 15 years. Previous publications on global neurosurgery reported by the Division of Neurosurgery at the University of Toronto were reviewed to exemplify the applications and challenges of international surgical collaborations.RESULTSThe most common models for international surgical education and collaboration include international surgical missions, long-term international partnerships, fellowship training models, and online surgical education. Development of such collaborations involves different challenges, including limited time availability, scarce funding/resources, sociocultural barriers, ethical challenges, and lack of organizational support. Of note, evaluation of outcomes of international surgical projects remains limited, and the development and application of assessment tools, such as the recently proposed Framework for the Assessment of International Surgical Success (FAIRNeSS), is encouraged.CONCLUSIONSActions to reduce inequality in surgical care should be implemented around the world. Different models can be used for bilateral exchange of knowledge and improvement of surgical care delivery in regions where there is poor access to surgical care. Implementation of global neurosurgery initiatives faces multiple limitations that can be ameliorated if systematic changes occur, such as the development of academic positions in global surgery, careful selection of participant centers, governmental and nongovernmental financial support, and routine application of outcome evaluation for international surgical collaborations.

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Emergency Surgical Care Delivery in Post-earthquake Haiti: Partners in Health and Zanmi Lasante Experience

World Journal of Surgery ◽

10.1007/s00268-011-0961-6 ◽

2011 ◽

Vol 35 (4) ◽

pp. 745-750 ◽

Cited By ~ 22

Author(s):

Thomas McIntyre ◽

Christopher D. Hughes ◽

Thierry Pauyo ◽

Stephen R. Sullivan ◽

Selwyn O. Rogers ◽

...

Keyword(s):

Care Delivery ◽

Surgical Care

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811. Impact of the COVID-19 Pandemic on Surgical Volume and Surgical Site Infections (SSI) in a Large Network of Community Hospitals

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1007 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S499-S499

Author(s):

Erin Gettler ◽

Jessica Seidelman ◽

Becky A Smith ◽

Deverick J Anderson

Keyword(s):

Infection Prevention ◽

Care Delivery ◽

Operative Procedure ◽

Surgical Care ◽

Coronary Bypass ◽

Surgical Site Infections ◽

Large Network ◽

Community Hospitals ◽

Outbreak Management ◽

The Impact

Abstract Background The COVID-19 pandemic significantly impacted hospitalizations and healthcare utilization. Diversion of infection prevention resources toward COVID-19 mitigation limited routine infection prevention activities such as rounding, observations, and education in all areas, including the peri-operative space. There were also changes in surgical care delivery. The impact of the COVID-19 pandemic on SSI rates has not been well described, especially in community hospitals. Methods We performed a retrospective cohort study analyzing prospectively collected data on SSIs from 45 community hospitals in the southeastern United States from 1/2018 to 12/2020. We included the 14 most commonly performed operative procedure categories, as defined by the National Healthcare Safety Network. Coronary bypass grafting was included a priori due to its clinical significance. Only facilities enrolled in the network for the full three-year period were included. We defined the pre-pandemic time period from 1/1/18 to 2/29/20 and the pandemic period from 3/1/20 to 12/31/20. We compared monthly and quarterly median procedure totals and SSI prevalence rates (PR) between the pre-pandemic and pandemic periods using Poisson regression. Results Pre-pandemic median monthly procedure volume was 384 (IQR 192-999) and the pre-pandemic SSI PR per 100 cases was 0.98 (IQR 0.90-1.04). There was a transient decline in surgical cases beginning in March 2020, reaching a nadir of 185 cases in April, followed by a return to pre-pandemic volume by June (figure 1). Overall and procedure-specific SSI PRs were not significantly different in the COVID-19 period relative to the pre-pandemic period (total PR per 100 cases 0.96 and 0.97, respectively, figure 2). However, when stratified by quarter and year, there was a trend toward increased SSI PR in the second quarter of 2020 with a PRR of 1.15 (95% CI 0.96-1.39, table 1). Conclusion The decline in surgical procedures early in the pandemic was short-lived in our community hospital network. Although there was no overall change in the SSI PR during the study period, there was a trend toward increased SSIs in the early phase of the pandemic (figure 3). This trend could be related to deferred elective cases or to a shift in infection prevention efforts to outbreak management. Disclosures All Authors: No reported disclosures

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Patient Engagement Approaches in Total Joint Arthroplasty: A Review of Two Decades

Journal of Patient Experience ◽

10.1177/23743735211036525 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110365

Author(s):

Aaron Alokozai ◽

David N. Bernstein ◽

Linsen T. Samuel ◽

Atul F. Kamath

Keyword(s):

Decision Making ◽

Patient Engagement ◽

Total Joint Arthroplasty ◽

Remote Monitoring ◽

Patient Involvement ◽

Care Delivery ◽

Joint Arthroplasty ◽

Virtual Rehabilitation ◽

The Past ◽

Future Work

Patient engagement is a comprehensive approach to health care where the physician inspires confidence in the patient to be involved in their own care. Most research studies of patient engagement in total joint arthroplasty (TJA) have come in the past 5 years (2015-2020), with no reviews investigating the different patient engagement methods in TJA. The primary purpose of this review is to examine patient engagement methods in TJA. The search identified 31 studies aimed at patient engagement methods in TJA. Based on our review, the conclusions therein strongly suggest that patient engagement methods in TJA demonstrate benefits throughout care delivery through tools focused on promoting involvement in decision making and accessible care delivery (eg, virtual rehabilitation, remote monitoring). Future work should understand the influence of social determinants on patient involvement in care, and overall cost (or savings) of engagement methods to patients and society.

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The Pediatric Nurse Associate

PEDIATRICS ◽

10.1542/peds.57.5.813 ◽

1976 ◽

Vol 57 (5) ◽

pp. 813-814

Author(s):

Robert D. Burnett ◽

Keyword(s):

Health Care ◽

Child Health ◽

American Academy ◽

Health Care Delivery ◽

Care Delivery ◽

Child Health Care ◽

Pediatric Nurse ◽

The Past ◽

American Academy Of Pediatrics

During the past several years as Chairman of the American Academy of Pediatrics' Committee on Pediatric Manpower I have witnessed the development of the concept of the pediatric nurse associate (PNA) within the specialty of pediatrics. In addition, I have also been aware of the controversies within the AAP membership regarding the role of the PNA in child health care delivery. Many of you will recall the concern of the mid-1960's which widely publicized an impending catastrophic shortage of pediatricians.

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