If in Doubt, Cut It Out

2021 ◽  
pp. 150-188
Author(s):  
Louise Marie Roth
Keyword(s):  
Medical Training ◽  
Standard Of Care ◽  
Care Providers ◽  
Medical Risk ◽  
Legal Risk ◽  
Cesarean Deliveries ◽  
Obstetric Medicine ◽  
The Us ◽  
Liability Risk ◽  
Professional Guidelines

This chapter examines the effects of malpractice on cesarean deliveries in light of historical trends and changes in the standard of care. Nearly one third of births in the US involve a cesarean delivery, and cesareans are usually the first thing that people think about when they think about defensive obstetric medicine. While some popular accounts attribute the rise in cesareans to women’s requests, most maternity care providers and public health experts are skeptical of the idea that “choice” is driving the trend. This chapter highlights the ways that providers respond to three types of risk when they do cesarean deliveries: medical risk, iatrogenic risk, and legal risk. A culture of malpractice fear encourages obstetricians to prioritize legal risk, and they know that patients are more likely to sue them for not doing a cesarean than for doing an unnecessary one. Providers also described expedience, organizational efficiency, and changes in medical training as important causes of medically questionable cesareans. Analyses reveal that the odds of a cesarean are higher in states where providers face more liability risk, but the effect is extremely small. Professional guidelines, which changed over time, also mediate this effect.

scholarly journals HIV Standard of Care for ART Adherence and Retention in Care Among HIV Medical Care Providers Across Four CNICS Clinics in the US

2018 ◽  
Vol 23 (4) ◽  
pp. 947-956 ◽  
Author(s):  
Sarah Shaw ◽  
Riddhi Modi ◽  
Michael Mugavero ◽  
Carol Golin ◽  
Evelyn Byrd Quinlivan ◽  
...  
Keyword(s):  
Medical Care ◽  
Standard Of Care ◽  
Retention In Care ◽  
Art Adherence ◽  
Care Providers ◽  
The Us

The Machine That Goes Ping!

2021 ◽  
pp. 114-149
Author(s):  
Louise Marie Roth
Keyword(s):  
Maternity Care ◽  
Reproductive Rights ◽  
Fetal Monitoring ◽  
Evidence Based ◽  
Reproductive Justice ◽  
Care Providers ◽  
Legal Risk ◽  
Electronic Fetal Monitoring ◽  
Liability Risk

This chapter explores the use of electronic fetal monitoring (EFM) as a prime example of technology fetishism. EFM is not evidence based, but most maternity care providers routinely use it. Obstetricians say that they use EFM to defend themselves against liability, and malpractice attorneys often fetishize the paper strips that the EFM produces as “evidence.” At the same time, an analysis demonstrates that EFM is more common in tort reform states that limit providers’ liability risk, which contradicts the idea that providers use it to reduce legal risk. The chapter then explores institutional motivations for EFM use, including scheduling, workload, and profit benefits. These institutional priorities can undermine patients’ rights, quality of care, and informed consent, which are issues of reproductive justice. This chapter then explores the effects of reproductive rights laws on EFM, finding that more fetus-centered laws encourage more EFM, while EFM is less common in states that protect women’s reproductive rights.

Treatment of venous leg ulcers using bilayered living cellular construct

2020 ◽  
Vol 9 (13) ◽  
pp. 907-918
Author(s):  
Aseel Bin Sawad ◽  
Fatema Turkistani
Keyword(s):  
Healthcare System ◽  
Cost Savings ◽  
Standard Of Care ◽  
Healthcare Resource Utilization ◽  
Psychological Status ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Time Period ◽  
The Us ◽  
Economic Analyses

Background: Venous leg ulcers (VLUs) present a significant economic burden on the US healthcare system and payers (US$14.9 billion). Aim: To evaluate the quality of life (QoL) of patients with VLUs; to analyze the limitations of standard of care (SOC) for VLUs; and to explain how using bilayered living cellular construct (BLCC) with SOC for treatment of VLUs can help heal more VLUs faster (than using SOC alone) as well as help improve QoL and help reduce the burden on the US healthcare system and payers. Materials & methods: This is a review study. The search was conducted in February 2020 by way of electronic databases to find relevant articles that provided information related to QoL of patients with VLUs, limitations of SOC for VLUs and economic analyses of using BLCC for treatment of VLUs. Results: VLUs impact patients’ physical, functional and psychological status and reduce QoL. A total 75% of VLU patients who used SOC alone failed to achieve healing in a timely fashion, which led to increased healthcare costs and healthcare resource utilization. Although the upfront cost is high, the greater effectiveness of BLCC offsets the added cost of the product during the time period of the studies. Therefore, BLCC helps to improve the QoL of VLU patients. As an example, for every 100 VLU patients in a healthcare plan, the use of BLCC can create cost savings of US$1,349,829.51. Conclusion: Payers’ coverage of BLCC results in reduction of the overall medical cost for treating VLU patients.

scholarly journals Engaging and Educating Older Adults and Caregivers in Age-Friendly Healthcare

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 686-686
Author(s):  
Erin Emery-Tiburcio ◽  
Rani Snyder
Keyword(s):  
Older Adults ◽  
New York ◽  
Health System ◽  
Medical Center ◽  
Health Resources ◽  
Primary Care Providers ◽  
Care Providers ◽  
New York University ◽  
The Us ◽  
Treatment Plans

Abstract As the Age-Friendly Health System initiative moves across the US and around the world, not only do health system staff require education about the 4Ms, but older adults, caregivers, and families need education. Engaging and empowering the community about the 4Ms can improve communication, clarify and improve adherence to treatment plans, and improve patient satisfaction. Many methods for engaging the community in age-friendly care are currently in development. Initiated by Health Resources and Services Administration (HRSA)-funded Geriatric Workforce Enhancement Programs (GWEPs), Community Catalyst is leading the co-design of Age-Friendly Health System materials with older adults and caregivers. Testing these materials across the country in diverse populations of older adults and caregivers will yield open-source documents for local adaptation. Rush University Medical Center is testing a method for identifying, engaging, educating, and providing health services for family caregivers of older adults. This unique program integrates with the Age-Friendly Health System efforts in addressing all 4Ms for caregivers. The Bronx Health Corps (BHC) was created by the New York University Hartford Institute of Geriatric Nursing to educate older adults in the community about health and health behaviors. BHC developed a method for engaging and educating older adults that is replicable in other communities. Baylor College of Medicine adapted and tested the Patient Priorities Care model to educate primary care providers about how to engage older adults in conversations about What Matters to them. Central to the Age-Friendly movement, John A. Hartford Foundation leadership will discuss the implications of this important work.

scholarly journals Inadvertent Stent Retriever Detachment: A Multicenter Case Series and Review of Device Experience FDA Reports

2015 ◽  
Vol 4 (3-4) ◽  
pp. 75-82 ◽  
Author(s):  
Hesham Masoud ◽  
Thanh N. Nguyen ◽  
Coleman O. Martin ◽  
William E. Holloway ◽  
Sudheer Ambekar ◽  
...  
Keyword(s):  
First Generation ◽  
Mechanical Thrombectomy ◽  
Rare Complication ◽  
Case Series ◽  
Standard Of Care ◽  
Stent Retriever ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
The Us ◽  
Solitaire Fr

Mechanical thrombectomy using retrievable stents or stent retriever devices has become the mainstay of intra-arterial therapy for acute ischemic stroke. The recent publication of a series of positive trials supporting intra-arterial therapy as standard of care for the treatment of large vessel occlusion will likely further increase stent retriever use. Rarely, premature stent detachment during thrombectomy may be encountered. In our multicenter case series, we found a rate of detachment of less than 1% (n = 7/1,067), and all were first-generation Solitaire FR devices. A review of the US Food and Drug Administration database of device experience yielded 90 individual adverse reports of detachment. There were 82, 1 and 7 detachments of Solitaire FR (first generation), Solitaire FR2 (second generation) and Trevo devices, respectively. We conclude with a brief overview of the technical and procedural considerations which may be helpful in avoiding this rare complication.

Digital Health Engagement in the US Population: Insights From the 2018 Health Information National Trends Survey

2021 ◽  
pp. e1-e4
Author(s):  
Chelsea L. Ratcliff ◽  
Melinda Krakow ◽  
Alexandra Greenberg-Worisek ◽  
Bradford W. Hesse
Keyword(s):  
Public Health ◽  
Health Information ◽  
Health Care Providers ◽  
Digital Health ◽  
Smart Device ◽  
P Value ◽  
Care Providers ◽  
Cross Sectional ◽  
The Us ◽  
National Trends

Objectives. To examine prevalence and predictors of digital health engagement among the US population. Methods. We analyzed nationally representative cross-sectional data on 7 digital health engagement behaviors, as well as demographic and socioeconomic predictors, from the Health Information National Trends Survey (HINTS 5, cycle 2, collected in 2018; n = 2698–3504). We fitted multivariable logistic regression models using weighted survey responses to generate population estimates. Results. Digitally seeking health information (70.14%) was relatively common, whereas using health apps (39.53%) and using a digital device to track health metrics (35.37%) or health goal progress (38.99%) were less common. Digitally communicating with one’s health care providers (35.58%) was moderate, whereas sharing health data with providers (17.20%) and sharing health information on social media (14.02%) were uncommon. Being female, younger than 65 years, a college graduate, and a smart device owner positively predicted several digital health engagement behaviors (odds ratio range = 0.09–4.21; P value range < .001–.03). Conclusions. Many public health goals depend on a digitally engaged populace. These data highlight potential barriers to 7 key digital engagement behaviors that could be targeted for intervention. (Am J Public Health. Published online ahead of print May 20, 2021: e1–e4. https://doi.org/10.2105/AJPH.2021.306282 )

scholarly journals An expanded pharmacogenomics warfarin dosing table with utility in generalised dosing guidance

2016 ◽  
Vol 116 (08) ◽  
pp. 337-348 ◽  
Author(s):  
Payman Shahabi ◽  
Laura Scheinfeldt ◽  
Daniel Lynch ◽  
Tara Schmidlen ◽  
Sylvie Perreault ◽  
...  
Keyword(s):  
Standard Dose ◽  
Anticoagulation Therapy ◽  
Standard Of Care ◽  
Clinical Decision ◽  
Drug Label ◽  
Therapy Decision ◽  
Dosing Algorithm ◽  
The Us ◽  
Supplementary Material ◽  
Warfarin Dosing

SummaryPharmacogenomics (PGx) guided warfarin dosing, using a comprehensive dosing algorithm, is expected to improve dose optimisation and lower the risk of adverse drug reactions. As a complementary tool, a simple genotype-dosing table, such as in the US Food and Drug Administration (FDA) Coumadin drug label, may be utilised for general risk assessment of likely over- or under-anticoagulation on a standard dose of warfarin. This tool may be used as part of the clinical decision support for the interpretation of genetic data, serving as a first step in the anticoagulation therapy decision making process. Here we used a publicly available warfarin dosing calculator (www.warfarindosing.org) to create an expanded gene-based warfarin dosing table, the CPMC-WD table that includes nine genetic variants in CYP2C9, VKORC1, and CYP4F2. Using two datasets, a European American cohort (EUA, n=73) and the Quebec Warfarin Cohort (QWC, n=769), we show that the CPMC-WD table more accurately predicts therapeutic dose than the FDA table (51 % vs 33 %, respectively, in the EUA, McNemar’s two-sided p=0.02; 52 % vs 37 % in the QWC, p<1×10−6). It also outperforms both the standard of care 5 mg/day dosing (51 % vs 34 % in the EUA, p=0.04; 52 % vs 31 % in the QWC, p<1×10−6) as well as a clinical-only algorithm (51 % vs 38 % in the EUA, trend p=0.11; 52 % vs 45 % in the QWC, p=0.003). This table offers a valuable update to the PGx dosing guideline in the drug label.Supplementary Material to this article is available at www.thrombosis-online.com.

scholarly journals Health Care Providers’ Advice on Lifestyle Modification in the US Population: Results from the NHANES 2011-2016

2019 ◽  
Vol 132 (4) ◽  
pp. 489-497.e1 ◽  
Author(s):  
Igor Grabovac ◽  
Lee Smith ◽  
Sinisa Stefanac ◽  
Sandra Haider ◽  
Chao Cao ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Lifestyle Modification ◽  
Care Providers ◽  
The Us

scholarly journals AN EXTENSIVE REVIEW ON CHEMOTHERAPY INDUCED NAUSEA AND VOMITING

2018 ◽  
Vol 8 (5-s) ◽  
pp. 79-81
Author(s):  
P Bhulakshmi ◽  
GV Nagaraju ◽  
K Srilaya
Keyword(s):  
Receptor Antagonist ◽  
Standard Of Care ◽  
Emetogenic Chemotherapy ◽  
Nausea And Vomiting ◽  
Fixed Dose ◽  
Nk1 Receptor Antagonist ◽  
The Us ◽  
Dose Combination ◽  
Delayed Cinv

Chemotherapy induced nausea and vomiting is the among most feared and debilitating adverse events experienced by the cancer patients. Left unaddressed, CINV symptoms not only decrease quality of life, but may also affect patients’ willingness to continue chemotherapy treatment. However, adherence to guideline recommendations continues to be suboptimal therapy, and many patients still suffer unnecessarily from CINV. In addition, breakthrough/refractory CINV continues to present particular challenges. The development of effective CINV treatments with diverse mechanisms of action has expanded the options available for preventing symptoms. The US Food and Drug Administration have recently approved several new therapies for the management of CINV. NEPA is a fixed-dose combination of Netupitant (300 mg) plus Palonosetron (0.5 mg). In combination with Dexamethasone, NEPA has demonstrated superior efficacy to Palonosetron alone in patients receiving highly or moderately emetogenic chemotherapy. Rolapitant is a nextgeneration neurokinin-1receptor antagonist. Both palonosetron and rolapitant have proven particularly effective in controlling delayed CINV. Regimens that combine a serotonin 5-hydroxytryptamine–3 receptor antagonist, an NK1 receptor antagonist, and a corticosteroid now represent the standard of care for managing both acute and delayed CINV in patients receiving highly emetogenic chemotherapy. Keywords: CINV, Seratonin, Dopamine, Neurokinin, Antiemetics.

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