Risk Factors for Hospital Malpractice Exposure: Implications for Managers and Insurers

The possibility of identifying certain variables that might serve as predictors of above- or below-average medical malpractice claims experience was explored. Results showed that it is possible to identify significant risk factors

Smoking Cessation Interventions After Lung Cancer Screening Guideline Change

Introduction: Recent guideline changes for lung cancer screening with low-dose computed tomography recommend smoking cessation interventions be done in parallel with screening. The purpose of this study is to determine the post-guideline rates of smoking cessation interventions among patients eligible and ineligible for lung cancer screening.Methods: Using electronic health records collected from a large ambulatory care system in northern California between 2010 and 2017, authors identified new patients who were current smokers aged 55–80 years visiting a primary care provider, and grouped patients into lung cancer screening–eligible heavy smokers, screening-ineligible moderate smokers, and screening-ineligible light smokers. Screening-eligible smokers versus screening-ineligible smokers were compared in receipt of smoking cessation interventions before (2010–2013) and after (2014–2017) the guideline change, overall and by intervention type (formal counseling, informal counseling, pharmacotherapy) using hierarchical generalized linear models. Analyses were conducted in 2018–2019.Results: After the guideline change, the likelihood of receiving any smoking cessation intervention (OR=1.44, 95% CI=1.28, 1.61, p<0.05), informal counseling (OR=1.29, 95% CI=1.15, 1.46, p<0.05), and pharmacotherapy (OR=1.24, 95% CI=1.02, 1.50, p<0.05) during a new patient visit significantly increased, with the increase not varying by level of smoking. For formal counseling, the post-guideline increase was greater for screening-eligible heavy smokers (OR=3.15, 95% CI=1.18, 8.36, p<0.05) and moderate smokers (OR=3.58, 95% CI=1.29, 9.95, p<0.05) relative to light smokers.Conclusions: Smoking cessation interventions increased after new lung cancer screening guidelines. Given the sizable adverse impacts of smoking on morbidity and mortality, small increases in implementation of smoking cessation interventions could have substantial public health benefits

Economic Incentives to Promote Innovation in Healthcare Delivery

Economics influences how medical care is delivered, organized, and progresses. Fee-for-service payment encourages delivery of services. Fee-for-individual-service, however, offers no incentives for clinicians to efficiently organize the care their patients need. Global capitation provides such incentives; it works well in highly integrated practices but not for independent practitioners. The failures of utilization management in the 1990s demonstrated the need for a third alternative to better align incentives, such as bundling payment for an episode of care. Building on Medicare’s approach to hospital payment, one can define expanded diagnosis-related groups that include all hospital, physician, and other costs during the stay and appropriate preadmission and postdischarge periods. Physicians and hospitals voluntarily forming a new entity (a care delivery team) would receive such bundled payments along with complete flexibility in allocating the funds. Modifications to gainsharing and antikickback rules, as well as reforms to malpractice liability laws, will facilitate the functioning of the care delivery teams. The implicit financial incentives encourage efficient care for the patient; the episode focus will facilitate measuring patient outcomes. Payment can be based on the resources used by those care delivery teams achieving superior outcomes, thereby fostering innovation improving outcomes and reducing waste

Cultural Memory and Intellectual History: Locating Austrian Literature

Cultural Memory and Intellectual History: Locating Austrian Literature is an essay about the way intellectuals contributed to reshaping cultural memory in Austria after the Second World War. By cultural memory I mean collective memory of the cultural past, of the creative achievements of a society, in this case the achievements of writers. At the center of my story are five intellectuals trying to make sense of the significance of Austrian literature and the Austrian cultural past, usually in a mode of advocacy, both recalling and creating a cultural past for the tiny postwar republic. Cultural memory of this kind is both collective, in the sense of repeating what is known and accepted, and individual, in the sense of being actively selective and inventive. I am concerned here primarily with five cultural commentators who helped to shape understandings of Austrian literature in the early years of the Second Republic: Heimito von Doderer (1896-1966), Friedrich Heer (1916-1983), Ivar Ivask (1927-1992), Herbert Eisenreich (1925-1986), and Herbert Seidler (1905- ). These intellectuals developed a view of Austrian literature that contributed to discourse about Austrian national identity by both expressing and refining Austrian understandings of their cultural past. In my discussion of their work, I concentrate on five texts that defined the concept of Austrian literature between 1955 and 1970

Long non-coding RNA in health and disease

Long non-coding RNAs (lncRNAs) interact with the nuclear architecture and are involved in fundamental biological mechanisms, such as imprinting, histone-code regulation, gene activation, gene repression, lineage determination, and cell proliferation, all by regulating gene expression. Understanding the lncRNA regulation of transcriptional or post-transcriptional gene regulation expands our knowledge of disease. Several associations between altered lncRNA function and gene expression have been linked to clinical disease phenotypes. Early advances have been made in developing lncRNAs as biomarkers. Several mouse models reveal that human lncRNAs have very diverse functions. Their involvement in gene and genome regulation as well as disease underscores the importance of lncRNA-mediated regulatory networks. Because of their tissue-specific expression potential, their function as activators or repressors, and their selective targeting of genes, lncRNAs are of potential therapeutic interest. We review the regulatory mechanisms of lncRNAs, their major functional principles, and discuss their role in Mendelian disorders, cancer, cardiovascular disease, and neurological disorders

Kaliopenic nephropathy revisited

In the 'older' literature, a definitive renal pathology was described in patients with long-standing hypokalaemia and depletion of the body's potassium reserves. The topic is relevant because possibly a quite cheaply reversible element in the course of chronic kidney disease progression could be addressed. Earlier, pathologists drew attention to vacuolar changes in renal tubular epithelium accompanied by inflammatory interstitial changes in patients with potassium losses. The diagnostic term 'kaliopenic nephropathy' was coined to describe such patients. Kaliopenic nephropathy now receives less emphasis than in earlier times. However, with eating disorders, laxative abuse and other potential causes, we suggest that the syndrome should be resurrected

Erdheim-Chester disease and knee pain in a dialysis patient

Erdheim–Chester disease is a rare inflammatory condition characterized by a non-Langerhans histiocytic infiltration, involving the skeleton, nervous system, viscera, retroperitoneum and elsewhere. The aetiology is unknown. Positron emission tomography shows areas of involvement. We managed a dialysis patient with knee pain; a bone marrow specimen showed typical CD68 positive, but CD1a negative cells. We initiated interferon-α therapy although other options remain open. In our patient, the simultaneous presence of secondary hyperparathyroidism with tumorous calcifications provided an interesting additional differential diagnostic possibility regarding skeletal pain

Advancing Learning Health Systems Through Embedded Research: The 23rd Annual Conference of the Health Care Systems Research Network

The 23rd annual conference of the Health Care Systems Research Network (HCSRN, formerly the HMO Research Network) was held in San Diego, California, March 21–23, 2017, attracting 387 attendees. As a consortium of 20 research organizations embedded in or affiliated with large health care delivery organizations, the HCSRN has held annual research conferences since 1994. The overall aim of the conferences is to bring researchers, project staff, research funders and other stakeholders together to share latest scientific findings and foster new research ideas and collaborations. The 2017 conference was hosted by the Palo Alto Medical Foundation Research Institute. Each host site takes responsibility for the content and structure of the conference, and the 2017 team introduced several new features. In particular, past conferences used concurrent sessions to present research results in different topical areas, such as chronic disease, cancer, health informatics, mental health or precision medicine. This year, concurrent sessions shifted to panel discussions about how research results were achieved, including the use of methods, partnerships and analytic approaches. The 35 panels were organized into tracks such as engagement, data and informatics, partnerships and research implementation. Scientific results from HCSRN projects were presented via 120 posters in two poster sessions. Plenary sessions included a town hall-style panel with different funding agency representatives, an opening presentation on the range of opportunities and benefits to studying health systems, and a concluding presentation on how researchers can apply design thinking in their work