PATIENT SATISFACTION SCORES FROM RATING WEBSITES FOR PHYSICIAN SPECIALTIES AT SELECT ILLINOIS HOSPITALS

Patients are starting to use online physician ratings and comments from online resources to choose their doctor instead of the physician\u27s qualifications. The purpose of the study was to compare the patient reviews of physicians between different physician specialties of three hospital types; one large (Northwestern Memorial Hospital), one medium sized local (Advocate Bromenn Medical Center), and three critical access hospitals (John Warner Hospital, Advocate Eureka, and Kirby Medical Center). The audit team selected hospitals from three different demographics. Due to critical access hospitals\u27 limited staff, only data from the specialty family/internal medicine was collected, and multiple hospitals were used to fill this category. The audit team used the selected hospitals\u27 websites to find ten physicians from six different specialties. The three rating sites that were selected were then used to search for the selected physicians by name. Physicians were identified in the search results by name, location and specialty to ensure the correct physician was identified. Searches yielding ratings for the physicians were recorded in tables created by the audit team. The ratings for each physician were averaged to give each physician one overall rating. These ratings were then averaged to give each hospital\u27s specialty an overall average rating. The average ratings for the specialties were then averaged with the other hospitals for comparison between specialties. The average of all the specialties set the standard benchmark for assessment. This report summarizes the physician ratings for different specialties and highlights their average online rating standing

The ombudsman enterprise and administrative justice.

Contents: Foreword; Preface; Part I Theory and Context: The ombudsman enterprise: an introduction; The constitutional role of the ombudsman; Concepts, theories and policies of administrative justice. Part II The Ombudsman Technique: Putting it right: resolving complaints and assisting citizens; Promoting good administration and helping to get it right. Part III Setting It Right: Independence and accountability: legitimising the ombudsman; Relationships, networks and the administrative justice system; Part IV Conclusion: The 21st century ombudsman enterprise; Appendices; Bibliography; Index.The statutory duty of public service ombudsmen (PSO) is to investigate claims of injustice caused by maladministration in the provision of public services. This book examines the modern role of the ombudsman within the overall emerging system of administrative justice and makes recommendations as to how PSO should optimize their potential within the wider administrative justice context. Recent developments are discussed and long standing questions that have yet to be adequately resolved in the ombudsman community are re-evaluated given broader changes in the administrative justice sector. The work balances theory and empirical research conducted in a number of common law countries. Although there has been much debate within the ombudsman community in recent years aimed at developing and improving the practice of ombudsmanry, this work represents a significant advance on current academic understanding of the discipline

Protocol of a scoping review of outcome domains in dermatology

Introduction: Core outcome sets (COSs) are agreed outcomes (domains (subdomains) and instruments) that should be measured as a minimum in clinical trials or practice in certain diseases or clinical fields. Worldwide, the number of COSs is increasing and there might be conceptual overlaps of domains (subdomains) and instruments within disciplines. The aim of this scoping review is to map and to classify all outcomes identified with COS projects relating to skin diseases.Methods and analysis: We will conduct a scoping review of outcomes of skin disease-related COS initiatives to identify all concepts and their definitions. We will search PubMed, Embase and Cochrane library. The search dates will be 1 January 2010 (the point at which Core Outcome Measures in Effectiveness Trials (COMET) was established) to 1 January 2024. We will also review the COMET database and C3 website to identify parts of COSs (domains and/or instruments) that are being developed and published. This review will be supplemented by querying relevant stakeholders from COS organisations, dermatology organisations and patient organisations for additional COSs that were developed. The resulting long lists of outcomes will then be mapped into conceptually similar concepts

Enamel crystals of mice susceptible or resistant to dental fluorosis: an AFM study

Objective: This study aimed to assess the overall apatite crystals profile in the enamel matrix of mice susceptible (A/J strain) or resistant (129P3/J strain) to dental fluorosis through analyses by atomic force microscopy (AFM). Material and Methods: Samples from the enamel matrix in the early stages of secretion and maturation were obtained from the incisors of mice from both strains. All detectable traces of matrix protein were removed from the samples by a sequential extraction procedure. The purified crystals (n=13 per strain) were analyzed qualitatively in the AFM. Surface roughness profile (Ra) was measured. Results: The mean (±SD) Ra of the crystals of A/J strain (0.58±0.15 nm) was lower than the one found for the 129P3/J strain (0.66±0.21 nm) but the difference did not reach statistical significance (t=1.187, p=0.247). Crystals of the 129P3/J strain (70.42±6.79 nm) were found to be significantly narrower (t=4.013, p=0.0013) than the same parameter measured for the A/J strain (90.42±15.86 nm). Conclusion: enamel crystals of the 129P3/J strain are narrower, which is indicative of slower crystal growth and could interfere in the occurrence of dental fluorosis

Core outcome domains for early-phase clinical trials of sound-, psychology-, and pharmacology-based interventions to manage chronic subjective tinnitus in adults: the COMIT'ID study protocol for using a Delphi process and face-to-face meetings to establish consensus

Background: The reporting of outcomes in clinical trials of subjective tinnitus indicates that many different tinnitus-related complaints are of interest to investigators, from perceptual attributes of the sound (e.g. loudness) to psychosocial impacts (e.g. quality of life). Even when considering one type of intervention strategy for subjective tinnitus, there is no agreement about what is critically important for deciding whether a treatment is effective. The main purpose of this observational study is therefore to develop Core Outcome Domain Sets for the three different intervention strategies (sound, psychological, and pharmacological) for adults with chronic subjective tinnitus that should be measured and reported in every clinical trial of these interventions. Secondary objectives are to identify the strengths and limitations of our study design for recruiting and reducing attrition of participants, and to explore uptake of the core outcomes. Methods: The ‘Core Outcome Measures in Tinnitus: International Delphi’ (COMIT’ID) study will use a mixed methods approach that incorporates input from healthcare users at the pre-Delphi stage, a modified three round Delphi survey and final consensus meetings (one for each intervention). The meetings will generate recommendations by stakeholder representatives on agreed Core Outcome Domain Sets specific to each intervention. A subsequent step will establish a common cross-cutting Core Outcome Domain Set by identifying the common outcome domains included in all three intervention-specific Core Outcome Domain Sets. To address the secondary objectives, we will gather feedback from participants about their experience of taking part in the Delphi process. We aspire to conduct an observational cohort study to evaluate uptake of the core outcomes in published studies at 7 years following core outcome set publication. Discussion: The COMIT’ID study aims to develop a Core Outcome Domain Set that are agreed as critically important for deciding whether a treatment for subjective tinnitus is effective. Such a recommendation would help to standardise future clinical trials worldwide and so we will determine if participation increases use of the core outcome set in the long term. Trial registration: This project has been registered in the database of the Core Outcome Measures in Effectiveness Trials (COMET) initiative

Fluid balance and renal replacement therapy initiation strategy : a secondary analysis of the STARRT-AKI trial

Background: Among critically ill patients with acute kidney injury (AKI), earlier initiation of renal replacement therapy (RRT) may mitigate fluid accumulation and confer better outcomes among individuals with greater fluid overload at randomization.Methods: We conducted a pre-planned post hoc analysis of the STandard versus Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial. We evaluated the effect of accelerated RRT initiation on cumulative fluid balance over the course of 14 days following randomization using mixed models after censoring for death and ICU discharge. We assessed the modifying effect of baseline fluid balance on the impact of RRT initiation strategy on key clinical outcomes. Patients were categorized in quartiles of baseline fluid balance, and the effect of accelerated versus standard RRT initiation on clinical outcomes was assessed in each quartile using risk ratios (95% CI) for categorical variables and mean differences (95% CI) for continuous variables.Results: Among 2927 patients in the modified intention-to-treat analysis, 2738 had available data on baseline fluid balance and 2716 (92.8%) had at least one day of fluid balance data following randomization. Over the subsequent 14 days, participants allocated to the accelerated strategy had a lower cumulative fluid balance compared to those in the standard strategy (4509 (- 728 to 11,698) versus 5646 (0 to 13,151) mL, p = 0.03). Accelerated RRT initiation did not confer greater 90-day survival in any of the baseline fluid balance quartiles (quartile 1: RR 1.11 (95% CI 0.92 to 1.34), quartile 2: RR 1.03 (0.87 to 1.21); quartile 3: RR 1.08 (95% CI 0.91 to 1.27) and quartile 4: RR 0.87 (95% CI 0.73 to 1.03), p value for trend 0.08).Conclusions: Earlier RRT initiation in critically ill patients with AKI conferred a modest attenuation of cumulative fluid balance. Nonetheless, among patients with greater fluid accumulation at randomization, accelerated RRT initiation did not have an impact on all-cause mortality.Peer reviewe

Investigation of CTBT OSI Radionuclide Techniques at the DILUTED WATERS Nuclear Test Site

Under the Comprehensive Nuclear-Test-Ban Treaty (CTBT), a verification regime that includes the ability to conduct an On-Site Inspection (OSI) will be established. The Treaty allows for an OSI to include many techniques, including the radionuclide techniques of gamma radiation surveying and spectrometry and environmental sampling and analysis. Such radioactivity detection techniques can provide the “smoking gun” evidence that a nuclear test has occurred through the detection and quantification of indicative recent fission products. An OSI faces restrictions in time and manpower, as dictated by the Treaty; not to mention possible logistics difficulties due to the location and climate of the suspected explosion site. It is thus necessary to have a good understanding of the possible source term an OSI will encounter and the proper techniques that will be necessary for an effective OSI regime. One of the challenges during an OSI is to locate radioactive debris that has escaped an underground nuclear explosion (UNE) and settled on the surface near and downwind of ground zero. To support the understanding and selection of sampling and survey techniques for use in an OSI, we are currently designing an experiment, the Particulate Release Experiment (PRex), to simulate a small-scale vent from an underground nuclear explosion. PRex will occur at the Nevada National Security Site (NNSS). The project is conducted under the National Center for Nuclear Security (NCNS) funded by the National Nuclear Security Agency (NNSA). Prior to the release experiment, scheduled for Spring of 2013, the project scheduled a number of activities at the NNSS to prepare for the release experiment as well as to utilize the nuclear testing past of the NNSS for the development of OSI techniques for CTBT. One such activity—the focus of this report—was a survey and sampling campaign at the site of an old UNE that vented: DILUTED WATERS. Activities at DILUTED WATERS included vehicle-based survey, in situ measurements with high-purity germanium (HPGe) and hand-held LaBr3 systems, soil sampling with a variety of tools, and laboratory gamma spectrometric analysis of those samples. A further benefit of the measurement campaign was to gain familiarity with the many logistical aspects of performing radiological field work at NNSS ahead of the PRex. Many practical lessons concerning the proper methodologies and logistics of using the surveying and sampling equipment were noted. These Lessons Learned are compiled together in Appendix A. The vehicle-based survey was successful in that it found a previously unknown hotspot (determined to be 232Th) while it demonstrated that a better method for keeping a serpentine track without staking was needed. Some of the soil sampling equipment was found to be impractical for the application, though core sampling would not be the correct way to take soil samples for a fresh vent deposit (as opposed to an old site like DILUTED WATERS). Due to the site’s age, 137Cs was the only fission radioisotope identified, though others were searched for. While not enough samples were taken and analyzed to definitively link the 137Cs to DILUTED WATERS as opposed to other NNSS activities, results were consistent with the historical DILUTED WATERS plume. MDAs were compared for soil sampling and in situ measurements

Protocol of a scoping review of outcome domains in dermatology

Introduction: Core outcome sets (COSs) are agreed outcomes (domains (subdomains) and instruments) that should be measured as a minimum in clinical trials or practice in certain diseases or clinical fields. Worldwide, the number of COSs is increasing and there might be conceptual overlaps of domains (subdomains) and instruments within disciplines. The aim of this scoping review is to map and to classify all outcomes identified with COS projects relating to skin diseases. Methods and analysis: We will conduct a scoping review of outcomes of skin disease-related COS initiatives to identify all concepts and their definitions. We will search PubMed, Embase and Cochrane library. The search dates will be 1 January 2010 (the point at which Core Outcome Measures in Effectiveness Trials (COMET) was established) to 1 January 2024. We will also review the COMET database and C3 website to identify parts of COSs (domains and/or instruments) that are being developed and published. This review will be supplemented by querying relevant stakeholders from COS organisations, dermatology organisations and patient organisations for additional COSs that were developed. The resulting long lists of outcomes will then be mapped into conceptually similar concepts. Ethics and dissemination: This study was supported by departmental research funds from the Department of Dermatology at Northwestern University. An ethics committee review was waived since this protocol was done by staff researchers with no involvement of patient care. Conflicts of interests, if any, will be addressed by replacing participants with relevant conflicts or reassigning them. The results will be disseminated through publication in peer-reviewed journals, social media posts and promotion by COS organisations

Development of a consensus core dataset in juvenile dermatomyositis for clinical use to inform research

Objectives This study aimed to develop consensus on an internationally agreed dataset for juvenile dermatomyositis (JDM), designed for clinical use, to enhance collaborative research and allow integration of data between centres. Methods A prototype dataset was developed through a formal process that included analysing items within existing databases of patients with idiopathic inflammatory myopathies. This template was used to aid a structured multistage consensus process. Exploiting Delphi methodology, two web-based questionnaires were distributed to healthcare professionals caring for patients with JDM identified through email distribution lists of international paediatric rheumatology and myositis research groups. A separate questionnaire was sent to parents of children with JDM and patients with JDM, identified through established research networks and patient support groups. The results of these parallel processes informed a face-to-face nominal group consensus meeting of international myositis experts, tasked with defining the content of the dataset. This developed dataset was tested in routine clinical practice before review and finalisation. Results A dataset containing 123 items was formulated with an accompanying glossary. Demographic and diagnostic data are contained within form A collected at baseline visit only, disease activity measures are included within form B collected at every visit and disease damage items within form C collected at baseline and annual visits thereafter. Conclusions Through a robust international process, a consensus dataset for JDM has been formulated that can capture disease activity and damage over time. This dataset can be incorporated into national and international collaborative efforts, including existing clinical research databases

Seizures in 204 comatose children: incidence and outcome

Purpose: Seizures are common in comatose children, but may be clinically subtle or only manifest on continuous electroencephalographic monitoring (cEEG); any association with outcome remains uncertain. Methods: cEEG (one to three channels) was performed for a median 42 h (range 2–630 h) in 204 unventilated and ventilated children aged $\leq$ 15 years (18 neonates, 61 infants) in coma with different aetiologies. Outcome at 1 month was independently determined and dichotomized for survivors into favourable (normal or moderate neurological handicap) and unfavourable (severe handicap or vegetative state). Results: Of the 204 patients, 110 had clinical seizures (CS) before cEEG commenced. During cEEG, 74 patients (36 %, 95 % confidence interval, 95 % CI, 32–41 %) had electroencephalographic seizures (ES), the majority without clinical accompaniment (non-convulsive seizures, NCS). CS occurred before NCS in 69 of the 204 patients; 5 ventilated with NCS had no CS observed. Death (93/204; 46 %) was independently predicted by admission Paediatric Index of Mortality (PIM; adjusted odds ratio, aOR, 1.027, 95 % CI 1.012–1.042; p 3 % fast, aOR 5.43, 95 % CI 1.90–15.6; excess slow with <3 % fast, aOR 8.71, 95 % CI 2.58–29.4; low amplitude, 10th centile <9 $\mu$V, aOR 3.78, 95 % CI 1.23–11.7; and burst suppression, aOR 10.68, 95 % CI 2.31–49.4) compared with normal cEEG, as well as absence of CS at any time (aOR 2.38, 95 % CI 1.18–4.81). Unfavourable outcome (29/111 survivors; 26 %) was independently predicted by the presence of ES (aOR 15.4, 95 % CI 4.7–49.7) and PIM (aOR 1.036, 95 % CI 1.013–1.059). Conclusion: Seizures are common in comatose children, and are associated with an unfavourable outcome in survivors. cEEG allows the detection of subtle CS and NCS and is a prognostic tool