Off-pump coronary artery bypass graft vs. on-pump coronary artery bypass graft surgery : what matters---procedure volume or specificity/specialization?

Context: Existing research has associated higher provider volume with a lower rate of adverse patient outcomes after coronary artery bypass graft (CABG). However, the relationship between surgical procedural volume and specialization and clinical outcomes has been understudied. Research Objectives: This research examined the effect of surgical procedural volume and specialization on patient outcomes for 119,559 patients undergoing CABG in Florida short-term acute hospitals from 2000-2006. Methods: Florida Hospital Discharge Data were linked with Practitioner Profile Database available from Florida Department of Health by using unique surgeon identifiers. Surgeon on-pump and off-pump CABG volume was assessed in quartiles. In-hospital complications were measured by using Patient Safety Indicators developed by the Agency for Healthcare Research and Quality (AHRQ). Analyses included chi-square, t-test, logistic regression and multilevel regression to adjust for nested surgeon and hospital effects. Results: In adjusted analyses stratified by on- and off-pump CABG, patients operated by surgeons with lower volume of a specific CABG type were more likely to have in-hospital mortality: for off-pump CABG quartile 1 OR=3.05, 95% CI: 1.68-5.53, quartile 2 OR=1.57, 95% CI: 1.10-2.26 and quartile 3 OR=1.35, 95% CI: 1.01-1.81, and for on-pump CABG quartile 2 OR=1.82, 95% CI: 1.34-2.47 and quartile 3 OR=1.51, 95% CI: 1.21-1.90. Surgeries performed by physicians in lower on-pump CABG quartiles were also significantly associated with increased odds of complications (quartile 1 OR=1.97, 95% CI: 1.19-3.26, quartile 2 OR=1.43, 95% CI: 1.14-1.80 and quartile 3 OR=1.33, 95% CI: 1.14-1.57). For off-pump CABG only quartile 2 physicians retained significance (OR=1.80, 95% CI: 1.29-2.51) for complications. Discussion: The volume/outcome relationship for CABG surgery is specific to the type of procedure, but not total (all procedures) volume. This finding may suggest the need of specialized and focused training of cardiac surgeons as well as development of specific CABG outcome reporting protocols to enable sufficient differentiation in outcomes of two different types of CABG

The Online Bingo Boom in the UK: A Qualitative Examination of Its Appeal

Online bingo has seen significant growth in recent years. This study sought to increase understanding of this growth by exploring the appeal of online bingo. Our aim was to examine the content of ten online bingo websites in the UK and analyse a qualitative secondary dataset of 12 female bingo players to investigate the appeal of online bingo. Using two distinct data sources allowed us to assess how the key messages online websites are trying to convey compare with actual players' motivation to play bingo. Our analysis of bingo websites found a common theme where websites were easy to navigate and structured to present a light-hearted, fun, reassuring, social image of gambling. In addition, the design decisions reflected in the bingo sites had the effect of positioning online bingo as a benign, child-like, homely, women-friendly, social activity. Comparison of the website content with our participants' reasons to play bingo showed congruence between the strategies used by the bingo websites and the motivations of bingo players themselves and the benefits which they seek; suggesting that bingo websites strive to replicate and update the sociability of traditional bingo halls. Online bingo differs from traditional forms of bingo in its ability to be played anywhere and at any time, and its capacity to offer a deeply immersive experience. The potential for this type of online immersion in gambling to lead to harm is only just being investigated and further research is required to understand how the industry is regulated, as well as the effects of online bingo on individual gambling ‘careers'

Patients covertly recording clinical encounters: threat or opportunity? A qualitative analysis of online texts

Contains fulltext : 153607.pdf (publisher's version ) (Open Access)BACKGROUND: The phenomenon of patients covertly recording clinical encounters has generated controversial media reports. This study aims to examine the phenomenon and analyze the underlying issues. METHODS AND FINDINGS: We conducted a qualitative analysis of online posts, articles, blogs, and forums (texts) discussing patients covertly recording clinical encounters. Using Google and Google Blog search engines, we identified and analyzed 62 eligible texts published in multiple countries between 2006 and 2013. Thematic analysis revealed four key themes: 1) a new behavior that elicits strong reactions, both positive and negative, 2) an erosion of trust, 3) shifting patient-clinician roles and relationships, and 4) the existence of confused and conflicting responses. When patients covertly record clinical encounters - a behavior made possible by various digital recording technologies - strong reactions are evoked among a range of stakeholders. The behavior represents one consequence of an erosion of trust between patients and clinicians, and when discovered, leads to further deterioration of trust. Confused and conflicting responses to the phenomenon by patients and clinicians highlight the need for policy guidance. CONCLUSIONS: This study describes strong reactions, both positive and negative, to the phenomenon of patients covertly recording clinical encounters. The availability of smartphones capable of digital recording, and shifting attitudes to patient-clinician relationships, seems to have led to this behavior, mostly viewed as a threat by clinicians but as a welcome and helpful innovation by some patients, possibly indicating a perception of subordination and a lack of empowerment. Further examination of this tension and its implications is needed

Using a 'talk' model of shared decision making to propose an observation-based measure: Observer OPTION 5 Item

Item does not contain fulltextOBJECTIVE: To propose a revised Observer OPTION measure of shared decision making. METHODS: We analyzed published models to identify the core components of a parsimonious conceptual framework of shared decision making. By using this framework, we developed a revised measure combining data from an observational study of clinical practice in Canada with our experience of using Observer OPTION(12 Item). RESULTS: Our conceptual framework for shared decision making composed of justifying deliberative work, followed by the steps of describing options, information exchange, preference elicitation, and preference integration. By excluding items in Observer OPTION(12 Item) that were seldom observed or not aligned to a robust construct, we propose Observer OPTION(5 Item). CONCLUSION: Although widely used, Observer OPTION(12 Item) did not give sufficient attention to preference elicitation and integration, and included items that were not specific to a core construct of shared decision making. We attempted to remedy these shortcomings by proposing a shorter, more focused measure. PRACTICE IMPLICATIONS: Observer OPTION(5 Item) requires evaluation; we hope that it will be useful as both a research tool and as a formative measure of clinical practice

Cycling as a novel approach to resistance training increases muscle strength, power, and selected functional abilities in healthy older women

OBJECTIVES: Observer OPTION(5) was designed as a more efficient version of OPTION(12), the most commonly used measure of shared decision making (SDM). The current paper assesses the psychometric properties of OPTION(5). METHODS: Two raters used OPTION(5) to rate recordings of clinical encounters from two previous patient decision aid (PDA) trials (n=201; n=110). A subsample was re-rated two weeks later. We assessed discriminative validity, inter-rater reliability, intra-rater reliability, and concurrent validity. RESULTS: OPTION(5) demonstrated discriminative validity, with increases in SDM between usual care and PDA arms. OPTION(5) also demonstrated concurrent validity with OPTION(12), r=0.61 (95%CI 0.54, 0.68) and intra-rater reliability, r=0.93 (0.83, 0.97). The mean difference in rater score was 8.89 (95% Credibility Interval, 7.5, 10.3), with intraclass correlation (ICC) of 0.67 (95% Credibility Interval, 0.51, 0.91) for the accuracy of rater scores and 0.70 (95% Credibility Interval, 0.56, 0.94) for the consistency of rater scores across encounters, indicating good inter-rater reliability. Raters reported lower cognitive burden when using OPTION(5) compared to OPTION(12). CONCLUSIONS: OPTION(5) is a brief, theoretically grounded observer measure of SDM with promising psychometric properties in this sample and low burden on raters. PRACTICE IMPLICATIONS: OPTION(5) has potential to provide reliable, valid assessment of SDM in clinical encounters