Practice Patterns Contributing to Positive Patient Outcomes by Nurse Practitioners

Purpose: The purpose of this study was to identify NP practice patterns most important for positive patient outcomes. Data Sources: A convenience sample (n = 93) of Nurse Practitioners attending the 2005 California Association for Nurse Practitioners Conference (N = 535) completed the survey. Conclusions: The most important practice patterns identified were associated with patient-centered care. When analyzed with years in practice, patient-centered practice patterns continued to be the most important. This study suggests that patient-centered practice patterns are most important to positive patient outcomes for NPs. Implications for practice: Identifying the practice patterns that are most important to positive patient outcomes creates a distinct picture of the quality of care that is unique to nursing. As the role of NP continues to expand and be defined, these practice patterns will provide evidence of the unique quality of care given by the NP profession

Benefit Plan Design and Prescription Drug Utilization Among Asthmatics: Do Patient Copayments Matter?

Objective: The ratio of controller to reliever medication use has been proposed as a measure of treatment quality for asthma patients. In this study we examine the effects of plan level mean out-of-pocket asthma medication patient copayments and other features of benefit plan design on the use of controller medications alone, controller and reliever medications (combination therapy), and reliever medications alone. Methods: 1995-2000 MarketScan claims data were used to construct plan-level out-of-pocket copayment and physician/practice prescriber preference variables for asthma medications. Separate multinomial logit models were estimated for patients in fee-for-service (FFS) and non-FFS plans relating benefit plan design features, physician/practice prescribing preferences, patient demographics, patient comorbidities and county-level income variables to patient-level asthma treatment patterns. Results: We find that the controller reliever ratio rose steadily over 1995-2000, along with out-of-pocket payments for asthma medications, which rose more for controllers than for relievers. However, after controlling for other variables, plan level mean out-of-pocket copayments were not found to have a statistically significant influence upon patient-level asthma treatment patterns. On the other hand, physician practice prescribing patterns strongly influenced patient level treatment patterns. Conclusions: There is no strong statistical evidence that higher levels of out-of-pocket copayments for prescription drugs influence asthma treatment patterns. However, physician/practice prescribing preferences influence patient treatment.

Testing Interestingness Measures in Practice: A Large-Scale Analysis of Buying Patterns

Understanding customer buying patterns is of great interest to the retail industry and has shown to benefit a wide variety of goals ranging from managing stocks to implementing loyalty programs. Association rule mining is a common technique for extracting correlations such as "people in the South of France buy ros\'e wine" or "customers who buy pat\'e also buy salted butter and sour bread." Unfortunately, sifting through a high number of buying patterns is not useful in practice, because of the predominance of popular products in the top rules. As a result, a number of "interestingness" measures (over 30) have been proposed to rank rules. However, there is no agreement on which measures are more appropriate for retail data. Moreover, since pattern mining algorithms output thousands of association rules for each product, the ability for an analyst to rely on ranking measures to identify the most interesting ones is crucial. In this paper, we develop CAPA (Comparative Analysis of PAtterns), a framework that provides analysts with the ability to compare the outcome of interestingness measures applied to buying patterns in the retail industry. We report on how we used CAPA to compare 34 measures applied to over 1,800 stores of Intermarch\'e, one of the largest food retailers in France

A scientific approach to microphone placement for cymbals in live sound

Current practice regarding overhead microphone placement on drum kits at live events is largely informed by personal experience and industry-standard practice, where there seems to be a lack of scientific evidence supporting these placements. This research addresses this by first recordings from points around different cymbals which are struck by three types of drumsticks. The measurements are processed in MATLAB to produce visual representations of the auditory data. The work puts forward evidence that cymbal radiation patterns are dependent on shape, size, profile and striking method while the attack and sustain are primarily dependent on cymbal weight. Ideal overhead microphone placement diagrams are generated based on these results to give live sound engineers a quick reference guide for best practice at live events

Stereotactic Radiosurgery Practice Patterns for Brain Metastases in the United States: A National Survey

Background: Stereotactic radiosurgery (SRS) has emerged as an important modality for the treatment of intracranial metastases. There are currently few established guidelines delineating indications for SRS use and fewer still regarding plan evaluation in the treat- ment of multiple brain metastases. Methods: An 18 question electronic survey was distributed to radiation oncologists at National Cancer Institute (NCI) designated cancer centers in the US (60). Centers without radiation oncologists were excluded. Physicians who indicated that they do not prescribe SRS were excluded from the remaining survey questions. Sign test and Chi-square test were used to determine if responses differed significantly from random distribution. Results: 116 of the 697 radiation oncologists surveyed completed the questionnaire, representing 51 institutions. 62% reported treating patients with brain metastases using SRS. Radiation oncologists prescribing SRS most commonly treat CNS (66.2%) and lung (49.3%) malignancies. SRS was used more frequently for \u3c10 brain metastases (73.7%; p\u3c.0001) and whole brain radiation therapy (WBRT) for \u3e10 brain metastases (82.5%; p\u3c.0001). The maximum number of lesions physicians were willing to treat with SRS without WBRT was 1-4 (40.4%) and 5-10 (42.4%) (p\u3c.0001 compared to 11-15, 16-20 and no limit). The most important criteria for choosing SRS or WBRT were number of lesions (p\u3c.0001) and performance status (p=.016). The most common margin for SRS was 0 mm (49.1%; p=.0021). The most common dose constraints other than critical structure was conformity index (84.2%) and brain V12 (61.4%). The LINAC was the most common treatment modality (54.4%) and mono-isocenter technique for multiple brain metastases was commonly used (43.9%; p=.23). Most departments do not have a policy for brain metastases treatment (64.9%; p=.024). Conclusions: This is one of the first national surveys assessing the use of SRS for brain metastases in clinical practice. These data highlight some clinical considerations for physicians treating brain metastases with SRS. Summary: This is among the first national surveys to assess the use of SRS for brain metastases in clinical practice. Specifically, radiation oncologist reported increasingly using SRS instead of WBRT for treating \u3c10 metastases, with the LINAC being the most common modality. Further, treatment parameters considered the most important included 0 mm margins, conformity index, brain V12, and mono- isocenter technique for multiple brain metastases. These results may provide context regarding the use of SRS for brain metastases in clinical practice

Gaston Memorial Hospital: Driving Quality Improvement With Data, Guidelines, and Real-Time Feedback

Describes efforts to reduce variance in provider practice patterns through data analysis and benchmarking of process-of-care measures. Discusses strategies such as sharing data, feedback, and best practices in ways physicians can utilize them immediately