Is there bias in the treatment of degenerative spine disease? Analysis of anonymous voting via a multidisciplinary conference.

Many institutions have developed shared decision-making conferences as a mechanism for reducing treatment costs and improving patient outcomes. Little is known about the process of shared decision-making that takes place in these conferences, and there is the possibility of bias among surgeons and nonsurgeons for treatment within their respective specialties. This study was conducted to determine who is contributing to the decision-making process in a multidisciplinary spine conference and to what extent treatment biases exist among the surgical and nonsurgical members of this conference.

A multifaceted intervention to improve the quality of care for patients undergoing total joint arthroplasty.

Knee and hip arthroplasties vary in cost, quality and outcomes. We developed a Lean quality improvement intervention for knee and hip arthroplasty patients encompassing the recognition, readiness, restoration and recovery phases of care. The intervention included standardised, evidence-based pathways, shared decision making, patient and family member engagement, and transdisciplinary rounding, implemented successively through a series of rapid process improvement workshops.

A systematic multidisciplinary initiative for reducing the risk of complications in adult scoliosis surgery.

OBJECTIVE Systematic multidisciplinary approaches to improving quality and safety in complex surgical care have shown promise. Complication rates from complex spine surgery range from 10% to 90% for all surgeries, and the overall mortality rate is 1%-4%. These rates suggest the need for improved perioperative complex spine surgery processes designed to minimize risk and improve quality.

Multidisciplinary Evaluation Leads to the Decreased Utilization of Lumbar Spine Fusion: An Observational Cohort Pilot Study.

Study Design: Observational cohort pilot study.

Objective: To determine the impact of a multidisciplinary conference on treatment decisions for lumbar degenerative spine disease.

Summary Of Background Data: Multidisciplinary decision making improves outcomes in many disciplines.

The Employer-Led Health Care Revolution.

To tame its soaring health care costs, intel tried many popular approaches: "consumer-driven health care" offerings such as high-deductible/low-premium plans, on-site clinics and employee wellness programs. But by 2009 intel realized that those programs alone would not enable the company to solve the problem, because they didn't affect its root cause: the steadily rising cost of the care employees and their families were receiving. Intel projected that its health care expenditures would hit a whopping $1 billion by 2012.

Improving acute respiratory infection care through nurse phone care and academic detailing of physicians.

Introduction: To address unnecessary use of antibiotics for uncomplicated acute respiratory infection, we implemented a standardized care pathway composed of: (1) academic detailing of primary care providers, and (2) telephonic care from nurses.

Methods: To evaluate the intervention, we performed a retrospective time series study and cost analysis at a primary care provider network in the Pacific Northwest with 118 providers at seven sites. The main outcomes were: (1) antibiotic rate, (2) provider visits avoided, and (3) cost savings from the payer and health care system perspectives.

Nurse practitioner-staffed clinic at Virginia Mason improves care and lowers costs for women with benign breast conditions.

The implementation of a breast clinic based on the use of an advanced registered nurse practitioner at Virginia Mason Medical Center in Seattle, Washington, substantially improved care timeliness and efficiency for women with symptomatic benign breast conditions. Women received their final benign diagnosis in an average of four rather than sixteen days, with fewer imaging studies and physician visits, when compared to a control group. Savings to the employer were estimated at $316 per woman, primarily from increased work productivity.

At Virginia Mason, collaboration among providers, employers, and health plans to transform care cut costs and improved quality.

Virginia Mason Medical Center in Seattle has worked in collaboration with health plans and employers to facilitate development of standardized approaches to care of patients with common conditions. These efforts have eliminated unnecessary treatment and decreased costs to employers, health plans, patients, and providers. We describe our collaborative approach and illustrate it with the example of improved treatment for patients with uncomplicated headache, for which we have achieved 91 percent patient satisfaction, decreased use of advanced imaging by 23 percent, and provided same-day appointments in 95 percent of cases.

Effectiveness of clinical decision support in controlling inappropriate imaging.

Background: Decision support systems for advanced imaging are being implemented with increased frequency and are mandated under some new governmental health care initiatives. However, evidence of effectiveness in reducing inappropriate imaging utilization is limited.

Methods: A retrospective cohort study was performed of the staged implementation of evidence-based clinical decision support built into ordering systems for selected high-volume imaging procedures: lumbar MRI, brain MRI, and sinus CT.

The molecular phylogeny of Rebutia (Cactaceae) and its allies demonstrates the influence of paleogeography on the evolution of South American mountain cacti.

The tropical Andes harbor a major part of the world's plant biodiversity. The montane cacti of the tribes Browningieae, Cereeae, and Trichocereeae underwent extensive radiation and thus are well suited as a model group to study the diversification of Andean plants. We reconstructed their phylogeny employing three noncoding chloroplast regions and explained it in the context of the geological history of South America.

Public health aspects of tobacco control: setting the agenda for action by oral health professions across Europe.

Tobacco use is a significant public health problem across Europe. Each year over half a million Europeans die prematurely due to a smoking-related disease. Tobacco use is a primary cause of many oral diseases and adverse oral conditions.

Public health issues in treating tobacco use.

Comprehensive strategies are needed to prevent initiation of tobacco use, to help users quit, and to reduce morbidity, mortality and indirect social costs. Using an agent-host-vector model for disease, all forms of tobacco are the "agent," whether they are manufactured by large companies or are traditional tobacco products. "Host" refers to tobacco users and everyone else because all are in some way adversely affected, including the unborn.

Tobacco prevention and control in dental practice: the future.

Tobacco use adversely affects oral health and dental care. Globally, the health consequences of tobacco use are worsening, particularly those caused by cigarette smoking. Concerned government and nongovernmental organizations are attempting to contain the transnational tobacco companies' promotion of tobacco use and its disregard for the serious health consequences.

The impact of National Cancer Institute training on clinical tobacco use cessation services by oral health teams.

The authors surveyed participants in a National Cancer Institute, or NCI, training program that provides brief tobacco cessation services. They found significant improvements in the frequency with which practitioners ask patients about tobacco use and assist patients in stopping tobacco use. Improvements also were found in the participants' level of confidence and preparedness to help patients quit.

Tobacco control activities in U.S. dental practices.

The authors surveyed general dentists, periodontists, pediatric dentists and dental hygienists in three U.S. geographical regions to estimate the percentage who practiced tobacco use cessation activities in their dental offices.

The COMMIT dental model: tobacco control practices and attitudes.

The National Cancer Institute's program to help dentists reduce tobacco use among their patients is part of the Community Intervention Trial for Smoking Cessation, a 22-community, randomly controlled trial of an intervention program for smoking cessation. Results of COMMIT baseline surveys of dentists in the 11 intervention communities are presented.