The impact of statistical adjustment on economic profiles of interventional cardiologists

AbstractOBJECTIVESThe objective of this study was to identify preprocedure patient factors associated with percutaneous intervention costs and to examine the impact of these patient factors on economic profiles of interventional cardiologists.BACKGROUNDThere is increasing demand for information about comparative resource use patterns of interventional cardiologists. Economic provider profiles, however, often fail to account for patient characteristics.METHODSData were obtained from Duke Medical Center cost and clinical information systems for 1,949 procedures performed by 13 providers between July 1, 1997, and December 31, 1998. Patient factors that influenced cost were identified using multiple regression analysis. After assessing interprovider variation in unadjusted cost, mixed linear models were used to examine how much cost variability was associated with the provider when patient characteristics were taken into account.RESULTSTotal hospital costs averaged $15,643 (median,$13,809), $6,515 of which represented catheterization laboratory costs. Disease severity, acuity, comorbid illness and lesion type influenced total costs (R2= 38%), whereas catheterization costs were affected by lesion type and acuity (R2= 32%). Patient characteristics varied significantly among providers. Unadjusted total costs were weakly associated with provider, and this association disappeared after accounting for patient factors. The provider influence on catheterization costs persisted after adjusting for patient characteristics. Furthermore, the pattern of variation changed: the adjusted analysis identified three new outliers, and two providers lost their outlier status. Only one provider was consistently identified as an outlier in the unadjusted and adjusted analyses.CONCLUSIONSEconomic profiles of interventional cardiologists may be misleading if they do not adequately adjust for patient characteristics before procedure

Insecticide suggestions to control tree and shrub insects (Revised 1992)

1 online resource (PDF, 12 pages)This archival publication may not reflect current scientific knowledge or recommendations. Current information available from the University of Minnesota Extension: https://www.extension.umn.edu

Hypersensitivity to Orthopedic Implants: A Review of the Literature

<p><b>Article full text</b></p> <p><br></p> <p>The full text of this article can be found here<b>. </b><a href="https://link.springer.com/article/10.1007/s40744-017-0062-6">https://link.springer.com/article/10.1007/s40744-017-0062-6</a></p> <p><br></p> <p><b>Provide enhanced content for this article</b></p> <p><br></p> <p>If you are an author of this publication and would like to provide additional enhanced content for your article then please contact <a href="http://www.medengine.com/Redeem/”mailto:[email protected]”"><b>[email protected]</b></a>.</p> <p><br></p> <p>The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as ‘peer reviewed’ to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content.</p> <p><br></p> <p>Other enhanced features include, but are not limited to:</p> <p><br></p> <p>• Slide decks</p> <p>• Videos and animations</p> <p>• Audio abstracts</p> <p>• Audio slides</p

Man vs Machine: Software training for surgeons -an objective evaluation of human and computer-based training tools for cataract surgical performance

Both human and machine systems are currently used to train cataract surgeons but their performance has not been directly compared. This study aimed to address two queries. Firstly, the relationship between two cataract surgical feedback tools for training, one human and one software-based; and secondly, evaluate microscope control during phacoemulsification using the software. Videos of surgeons with varying experience were enrolled, and independently scored with the validated PhacoTrack motion capture software and the Objective Structured Assessment of Cataract Surgical Skill (OSACCS) human scoring tool. Microscope centration and path length travelled were also evaluated with the PhacoTrack software. Twenty-two videos correlated PhacoTrack motion capture with OSACCS. The PhacoTrack path length, number of movements and total procedure time were found to have high levels of Spearman's rank correlation of -0.6792619(p=0.001), - 0.6652021(p=0.002) and -0.771529(p=0001) respectively with OSACCS. The Bland-Altman plot found strong agreement within the +/-1.96 standard deviation. The path length measurements may overestimate /underestimate a surgeon's OSACSS score by 15 units, whilst for the log number of movements, an overestimate/underestimate of a surgeon's OSACSS score by 68 % was found. Sixty-two videos evaluated microscope camera control. Novice surgeons had their camera off the pupil centre at a far greater mean distance (SD) of 6.9(3.3) mm, compared with experts of 3.6 (1.6) mm (p<< 0.05). The expert surgeons maintained good microscope camera control and limited total pupil path length travelled 2512 (1031) mm compared with novices of 4049 (2709) mm (p<<0. 05). Good agreement between human and machine-quantified measurements of surgical skill exists. Our results demonstrate that surrogate markers for camera control are predictors of surgical skills

The Social Networks and Social Support of Siblings of Children with Cancer

Siblings of children with cancer need support to ameliorate the challenges they encounter; however, little is known about what types and sources of support exist for siblings. This study addresses this gap in our understanding of the social networks and sources of support for adolescents with a brother or sister who has cancer. Additionally, we describe how the support siblings receive addresses what they feel are the hardest aspects of being a sibling of a child with cancer. During semi-structured interviews, siblings (ages 12&ndash;17) constructed ecomaps describing their support networks. Data were coded for support type (emotional, instrumental, informational, validation, companionship) and support provider (e.g., mother, teacher, friend). Network characteristics and patterns of support were explored. Support network size ranged from 3 to 10 individuals (M = 6 &plusmn; 1.9); siblings most frequently reported mothers as sources of support (n = 22, 91.7%), followed by fathers (n = 19, 79.2%), close friends (n = 19, 79.2%) and siblings (with or without cancer) (n = 17, 70.8%). Friends and brothers or sisters most often provided validation and companionship while instrumental and informational supports came from parents. This study provides foundational knowledge about siblings&rsquo; support networks, which can be utilized to design interventions that improve support for siblings of children with cancer