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Find video protocols related to scientific articles indexed in Pubmed.
Did Hospital Engagement Networks Actually Improve Care?
N. Engl. J. Med.
PUBLISHED: 11-20-2014
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To the Editor: The Partnership for Patients model test (PfP), discussed in a Perspective article by Pronovost and Jha (Aug. 21 issue),(1) is a large-scale quality-improvement program designed to make hospital care safer, more reliable, and less costly by engaging the nation's hospitals in work to reduce 30-day all-cause readmissions and preventable all-cause harm. We are writing to respond to several points made in the article. First, the test model, like all models from the Centers for Medicare and Medicaid Services (CMS) Innovation Center, does have an independent evaluation. The first evaluation report is posted publicly.(2),(3) Second, the evaluation . . .
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Opportunities for quality measurement to improve the value of care for patients with multiple chronic conditions.
Ann. Intern. Med.
PUBLISHED: 11-18-2014
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Quality measurement efforts have not historically focused on patients with multiple chronic conditions (MCCs), despite them comprising one quarter of the population and two thirds of health care spending. The Patient Protection and Affordable Care Act (ACA) creates several mechanisms for the Centers for Medicare & Medicaid Services (CMS) to transform quality measurement into an organized enterprise designed to support clinicians caring for this vulnerable population. This article highlights 3 emerging policy opportunities for CMS to guide public and private quality measurement efforts for patients with MCCs. First, it discusses infusing an MCC framework into measure development to promote patient-centered, as opposed to single-disease-specific, performance measurement. Second, it describes the importance of using common performance measures for individual clinicians, hospitals, and communities to accelerate meaningful improvement in the prevention and management of chronic conditions across local populations. Finally, the need for longitudinal measurement as a foundation for sustained quality improvement is presented. The ACA's expansion of insurance access and portability necessitates collaborative alignment of chronic condition quality measurement efforts between public and private programs to develop a high-value lifelong health system.
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The Patient Protection and Affordable Care Act: opportunities for prevention and public health.
Lancet
PUBLISHED: 06-30-2014
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The Patient Protection and Affordable Care Act, which was enacted by the US Congress in 2010, marks the greatest change in US health policy since the 1960s. The law is intended to address fundamental problems within the US health system, including the high and rising cost of care, inadequate access to health insurance and health services for many Americans, and low health-care efficiency and quality. By 2019, the law will bring health coverage--and the health benefits of insurance--to an estimated 25 million more Americans. It has already restrained discriminatory insurance practices, made coverage more affordable, and realised new provisions to curb costs (including tests of new health-care delivery models). The new law establishes the first National Prevention Strategy, adds substantial new funding for prevention and public health programmes, and promotes the use of recommended clinical preventive services and other measures, and thus represents a major opportunity for prevention and public health. The law also provides impetus for greater collaboration between the US health-care and public health systems, which have traditionally operated separately with little interaction. Taken together, the various effects of the Patient Protection and Affordable Care Act can advance the health of the US population.
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Oral antibiotics at discharge for children with acute osteomyelitis: a rapid cycle improvement project.
BMJ Qual Saf
PUBLISHED: 12-17-2013
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Substantial evidence demonstrates comparable cure rates for oral versus intravenous therapy for routine osteomyelitis. Evidence adoption is often slow and in our centre virtually all patients with osteomyelitis were discharged on intravenous therapy.
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Comparative effectiveness research in practice: the Drug Effectiveness Review Project experience.
J Comp Eff Res
PUBLISHED: 11-19-2013
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Assess the effect of the Drug Effectiveness Review Projects comparative effectiveness research findings on prescribing behavior independently and in conjunction with a Medicaid preferred drug list.
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Physician professionalism and accountability: the role of collaborative improvement networks.
Pediatrics
PUBLISHED: 06-05-2013
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The medical profession is facing an imperative to deliver more patient-centered care, improve quality, and reduce unnecessary costs and waste. With significant unexplained variation in resource use and outcomes, even physicians and health care organizations with "the best" reputations cannot assume they always deliver the best care possible. Going forward, physicians will need to demonstrate professionalism and accountability in a different way: to their peers, to society in general, and to individual patients. The new accountability includes quality and clinical outcomes but also resource utilization, appropriateness and patient-centeredness of recommended care, and the responsibility to help improve systems of care. The pediatric collaborative improvement network model represents an important framework for helping transform health care. For individual physicians, participation in a multisite network offers the opportunity to demonstrate accountability by measuring and improving care as part of an approach that addresses the problems of small sample size, attribution, and unnecessary variation in care by pooling patients from individual practices and requiring standardization of care to participate. For patients and families, the model helps ensure that they are likely to receive the current best evidence-based recommendation. Finally, this model aligns with payers goals of purchasing value-based care, rewarding quality and improvement, and reducing unnecessary variation around current best evidenced-based, effective, and efficient care. In addition, within the profession, the American Board of Pediatrics recognizes participation in a multisite quality improvement network as one of the most rigorous and meaningful approaches for a diplomate to meet practice performance maintenance of certification requirements.
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Quality Improvement Research in Pediatric Hospital Medicine and the Role of the Pediatric Research in Inpatient Settings (PRIS) Network.
Acad Pediatr
PUBLISHED: 04-03-2013
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Pediatric hospitalists care for many hospitalized children in community and academic settings, and they must partner with administrators, other inpatient care providers, and researchers to assure the reliable delivery of high-quality, safe, evidence-based, and cost-effective care within the complex inpatient setting. Paralleling the growth of the field of pediatric hospital medicine is the realization that innovations are needed to address some of the most common clinical questions. Some of the unique challenges facing pediatric hospitalists include the lack of evidence for treating common conditions, children with chronic complex conditions, compressed time frame for admissions, and the variety of settings in which hospitalists practice. Most pediatric hospitalists are engaged in some kind of quality improvement (QI) work as hospitals provide many opportunities for QI activity and innovation. There are multiple national efforts in the pediatric hospital medicine community to improve quality, including the Childrens Hospital Association (CHA) collaboratives and the Value in Pediatrics Network (VIP). Pediatric hospitalists are also challenged by the differences between QI and QI research; understanding that while improving local care is important, to provide consistent quality care to children we must study single-center and multicenter QI efforts by designing, developing, and evaluating interventions in a rigorous manner, and examine how systems variations impact implementation. The Pediatric Research in Inpatient Setting (PRIS) network is a leader in QI research and has several ongoing projects. The Prioritization project and Pediatric Health Information System Plus (PHIS+) have used administrative data to study variations in care, and the IIPE-PRIS Accelerating Safe Sign-outs (I-PASS) study highlights the potential for innovative QI research methods to improve care and clinical training. We address the importance, current state, accomplishments, and challenges of QI and QI research in pediatric hospital medicine; define the role of the PRIS Network in QI research; describe an exemplary QI research project, the I-PASS Study; address challenges for funding, training and mentorship, and publication; and identify future directions for QI research in pediatric hospital medicine.
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Diabetes prevention and the role of risk factor reduction in the Medicare population.
Am J Prev Med
PUBLISHED: 03-19-2013
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Medicare is keenly aware of the secular changes in weight gain and of the nearly parallel increases in both the incidence and prevalence of type 2 diabetes throughout the U.S. population. The Medicare population, however, differs from the population at large because of its advanced age and frequency of comorbid conditions and/or disability. These factors affect life span as well as participation in and potential benefit from lifestyle modification and risk-factor reduction activities. Further, macrovascular disease is the greatest burden for older beneficiaries with diabetes, and its risks may antedate the appearance of hyperglycemia. Both diabetes prevention and treatment must be considered in this context. Medicare benefits focus on reduction of cardiovascular risk and mitigation of more temporally immediate complications of weight gain and glucose elevation. These preventive services and interventions are described.
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Development of heart and respiratory rate percentile curves for hospitalized children.
Pediatrics
PUBLISHED: 03-11-2013
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To develop and validate heart and respiratory rate percentile curves for hospitalized children and compare their vital sign distributions to textbook reference ranges and pediatric early warning score (EWS) parameters.
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Rapid adoption of Lactobacillus rhamnosus GG for acute gastroenteritis.
Pediatrics
PUBLISHED: 03-05-2013
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A 2007 meta-analysis showed probiotics, specifically Lactobacillus rhamnosus GG (LGG), shorten diarrhea from acute gastroenteritis (AGE) by 24 hours and decrease risk of progression beyond 7 days. In 2005, our institution published a guideline recommending consideration of probiotics for patients with AGE, but only 1% of inpatients with AGE were prescribed LGG. The objective of this study was to increase inpatient prescribing of LGG at admission to >90%, for children hospitalized with AGE, within 120 days.
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Quality improvement project to reduce perioperative opioid oversedation events in a paediatric hospital.
BMJ Qual Saf
PUBLISHED: 06-21-2011
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Narcotics are responsible for many adverse drug events in children and there has been an increase in opioid oversedation events in hospitalised patients.
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Building academic health centers capacity to shape and respond to comparative effectiveness research policy.
Acad Med
PUBLISHED: 04-23-2011
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In recent years, the focus on comparative effectiveness research (CER), the funding available to support it, and the range of possible effects of CER policy on academic health centers (AHCs) have increased substantially. CER has implications for the research, education, and clinical care components of AHCs missions. The current funding and policy environment have created specific opportunities for AHCs to shape and respond to CER policies across the four dimensions of the CER enterprise: research, human and scientific capital, data infrastructure, and translation and dissemination. Characteristics such as the degree of physician-hospital integration, the status of a health information technology infrastructure, and the presence of a well-developed cross-functional health services research capacity linked to the care delivery enterprise could help AHCs respond to these opportunities and influence future policies. AHCs are also essential to the development of methodologies and the training of the next cadre of researchers. Further, a focus on understanding what works in health care and increasing adoption of evidence-based practice must become embedded in the fabric of AHCs. Those AHCs most successful in responding to the CER challenge may leverage it as a point of differentiation in the marketplace for health care and lead transformational improvements in health.
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Pediatric hospital medicine: a strategic planning roundtable to chart the future.
J Hosp Med
PUBLISHED: 03-05-2011
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Given the growing field of Pediatric Hospital Medicine (PHM) and the need to define strategic direction, the Society of Hospital Medicine, the American Academy of Pediatrics, and the Academic Pediatric Association sponsored a roundtable to discuss the future of the field. Twenty-one leaders were invited plus a facilitator utilizing established health care strategic planning methods. A "vision statement" was developed. Specific initiatives in 4 domains (clinical practice, quality of care, research, and workforce) were identified that would advance PHM with a plan to complete each initiative. Review of the current issues demonstrated gaps between the current state of affairs and the full vision of the potential impact of PHM. Clinical initiatives were to develop an educational plan supporting the PHM Core Competencies and a clinical practice monitoring dashboard template. Quality initiatives included an environmental assessment of PHM participation on key committees, societies, and agencies to ensure appropriate PHM representation. Three QI collaboratives are underway. A Research Leadership Task Force was created and the Pediatric Research in Inpatient Settings (PRIS) network was refocused, defining a strategic framework for PRIS, and developing a funding strategy. Workforce initiatives were to develop a descriptive statement that can be used by any PHM physician, a communications tool describing "value added" of PHM; and a tool to assess career satisfaction among PHM physicians. We believe the Roundtable was successful in describing the current state of PHM and laying a course for the near future.
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Comparative effectiveness of pleural drainage procedures for the treatment of complicated pneumonia in childhood.
J Hosp Med
PUBLISHED: 03-03-2011
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To determine the comparative effectiveness of common pleural drainage procedures for treatment of pneumonia complicated by parapneumonic effusion (ie, complicated pneumonia).
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Utilising improvement science methods to optimise medication reconciliation.
BMJ Qual Saf
PUBLISHED: 02-11-2011
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In 2005, The Joint Commission included medication reconciliation as a National Patient Safety Goal to reduce medication errors related to omissions, duplications and interactions. Hospitals continue to struggle to implement successful programmes that meet these objectives.
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Pediatric hospitalist systems versus traditional models of care: effect on quality and cost outcomes.
J Hosp Med
PUBLISHED: 01-03-2011
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Pediatric hospitalist systems are increasing in popularity, but data regarding the effects of hospitalist systems on the quality of care has been sparse, in part because rigorous metrics for analysis have not yet been established. We conducted a literature review of studies comparing the performance of pediatric hospitalists and traditional attendings.
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Optimizing health information technologys role in enabling comparative effectiveness research.
Am J Manag Care
PUBLISHED: 12-12-2010
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Health information technology (IT) is a key enabler of comparative effectiveness research (CER). Health IT standards for data sharing are essential to advancing the research data infrastructure, and health IT is critical to the next step of incorporating clinical data into data sources. Four key principles for advancement of CER are (1) utilization of data as a strategic asset, (2) leveraging public-private partnerships, (3) building robust, scalable technology platforms, and (4) coordination of activities across government agencies. To maximize the value of the resources, payers and providers must contribute data to initiatives, engage with government agencies on lessons learned, continue to develop new technologies that address key challenges, and utilize the data to improve patient outcomes and conduct research.
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Patient-centered care categorization of U.S. health care expenditures.
Health Serv Res
PUBLISHED: 11-19-2010
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To categorize national medical expenditures into patient-centered categories.
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How the Recovery Acts Federal Coordinating Council paved the way for the Patient-Centered Outcomes Research Institute.
Health Aff (Millwood)
PUBLISHED: 10-05-2010
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The American Recovery and Reinvestment Act of 2009 provided $1.1 billion for comparative effectiveness research and established the Federal Coordinating Council for Comparative Effectiveness Research to direct that investment. The council laid a critical foundation for comparative effectiveness research in the steps it took to gather information, invite public input, set priorities, coordinate project solicitations, and stress the importance of evaluating research investments. Although the council has been superseded by a successor--the Patient-Centered Outcomes Research Institute--the experiences of the council can and should inform the work of the new institute as it begins its operations.
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Length of intravenous antibiotic therapy and treatment failure in infants with urinary tract infections.
Pediatrics
PUBLISHED: 07-12-2010
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The goal was to determine the association between short-duration (< or =3 days) and long-duration (> or =4 days) intravenous antibiotic therapy and treatment failure in a cohort of young infants hospitalized with urinary tract infections (UTIs).
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Previous antimicrobial exposure is associated with drug-resistant urinary tract infections in children.
Pediatrics
PUBLISHED: 03-01-2010
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The aim of this study was to evaluate the impact of previous antimicrobial exposure on the development of antimicrobial resistance in children with their first urinary tract infection (UTI).
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Local recurrence of invasive micropapillary breast cancer after MammoSite brachytherapy: a case report and literature review.
Clin. Breast Cancer
PUBLISHED: 11-26-2009
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Controversy exists over the optimal patient selection criteria for accelerated partial-breast irradiation (APBI), which has been introduced as an alternative to whole-breast irradiation. The goal is to select patients with the lowest risk for tumor spread outside of the original lumpectomy bed targeted by the local internal radiation dose. Therefore, patients with more aggressive types of breast cancer might not be ideal candidates for partial breast irradiation. We discuss the case of a 67-year-old woman who presented with local recurrence of invasive micropapillary breast cancer, a rare aggressive tumor type, 5 years after MammoSite brachytherapy. The patients primary tumor possessed all favorable indicators except for the histology of invasive micropapillary carcinoma. This is the first report of invasive micropapillary carcinoma recurring after APBI. Although this is a single case, it supports the hypothesis that more aggressive types of breast cancer have a higher risk of local recurrence after APBI. We propose that invasive micropapillary carcinoma be considered a potential exclusion criterion until it can be validated in prospective clinical trials. More aggressive treatment approaches including whole-breast irradiation and/or chemotherapy might be needed to reduce the risk of local recurrence for invasive micropapillary breast cancer.
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Value-driven health care: implications for hospitals and hospitalists.
J Hosp Med
PUBLISHED: 10-14-2009
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There is increasing concern about the quality and cost of health care delivered in the United States. This has led to a focus on value-driven health care, meaning how we can achieve better quality outcomes per dollar spent on health care. Since a large percentage of costs and patient outcomes are directly related to care received in the hospital, the focus on value-driven health care by policymakers and payers is likely to increasingly impact hospitals and hospitalists. Hospitalists can play an essential role in leading and facilitating programs to improve hospital system performance. There are many government initiatives and policies focused on improving quality and value with major implications for hospitals and hospitalists, including: value-based purchasing, quality and cost reporting, Medicare demonstrations, hospital-acquired conditions, incentives for use of effective health information technology (HIT), and the Physician Quality Reporting Initiative (PQRI). The goal of these programs is to reward hospitals and physicians who achieve high-quality, efficient care. As our system and its incentives continue to progress toward alignment with value-based high-quality care, hospitalists should lead change and facilitate solutions to transform our health care system to one that provides high-value care to all.
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Factors associated with variability in outcomes for children hospitalized with urinary tract infection.
J. Pediatr.
PUBLISHED: 01-06-2009
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To describe the variability in outcomes and care processes for children hospitalized for urinary tract infection (UTI), and to identify patient and hospital factors that may account for variability.
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The public role in promoting child health information technology.
Pediatrics
PUBLISHED: 01-06-2009
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The public sector plays an important role in promoting child health information technology. Public sector support is essential in 5 main aspects of child health information technology, namely, data standards, pediatric functions in health information systems, privacy policies, research and implementation funding, and incentives for technology adoption. Some innovations in health information technology for adult populations can be transferred to or adapted for children, but there also are unique needs in the pediatric population. Development of health information technology that addresses childrens needs and effective adoption of that technology are critical for US children to receive care of the highest possible quality in the future.
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Improving situation awareness to reduce unrecognized clinical deterioration and serious safety events.
Pediatrics
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Failure to recognize and treat clinical deterioration remains a source of serious preventable harm for hospitalized patients. We designed a system to identify, mitigate, and escalate patient risk by using principles of high-reliability organizations. We hypothesized that our novel care system would decrease transfers determined to be unrecognized situation awareness failures events (UNSAFE). These were defined as any transfer from an acute care floor to an ICU where the patient received intubation, inotropes, or ? 3 fluid boluses in first hour after arrival or before transfer.
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Hospitalist utilization and hospital performance on 6 publicly reported patient outcomes.
J Hosp Med
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The increase in hospitalist-provided inpatient care may be accompanied by an expectation of improvement on patient outcomes. To date, the association between utilization of hospitalists and the publicly reported patient outcomes is unknown.
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A new taxonomy for stakeholder engagement in patient-centered outcomes research.
J Gen Intern Med
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Despite widespread agreement that stakeholder engagement is needed in patient-centered outcomes research (PCOR), no taxonomy exists to guide researchers and policy makers on how to address this need. We followed an iterative process, including several stages of stakeholder review, to address three questions: (1) Who are the stakeholders in PCOR? (2) What roles and responsibilities can stakeholders have in PCOR? (3) How can researchers start engaging stakeholders? We introduce a flexible taxonomy called the 7Ps of Stakeholder Engagement and Six Stages of Research for identifying stakeholders and developing engagement strategies across the full spectrum of research activities. The path toward engagement will not be uniform across every research program, but this taxonomy offers a common starting point and a flexible approach.
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From comparative effectiveness research to patient-centered outcomes research: integrating emergency care goals, methods, and priorities.
Ann Emerg Med
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Federal legislation placed comparative effectiveness research and patient-centered outcomes research at the center of current and future national investments in health care research. The role of this research in emergency care has not been well described. This article proposes an agenda for researchers and health care providers to consider comparative effectiveness research and patient-centered outcomes research methods and results to improve the care for patients who seek, use, and require emergency care. This objective will be accomplished by (1) exploring the definitions, frameworks, and nomenclature for comparative effectiveness research and patient-centered outcomes research; (2) describing a conceptual model for comparative effectiveness research in emergency care; (3) identifying specific opportunities and examples of emergency care-related comparative effectiveness research; and (4) categorizing current and planned funding for comparative effectiveness research and patient-centered outcomes research that can include emergency care delivery.
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Utilizing improvement science methods to improve physician compliance with proper hand hygiene.
Pediatrics
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In 2009, The Joint Commission challenged hospitals to reduce the risk of health care-associated infections through hand hygiene compliance. At our hospital, physicians had lower compliance rates than other health care workers, just 68% on general pediatric units. We used improvement methods and reliability science to increase compliance with proper hand hygiene to >95% by inpatient general pediatric teams.
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Enhancing accurate identification of food insecurity using quality-improvement techniques.
Pediatrics
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Infants who live in households experiencing food insecurity are at risk for negative health and developmental outcomes. Despite large numbers of households within our population experiencing food insecurity, identification of household food insecurity during standard clinical care is rare. The objective of this study was to use quality-improvement methods to increase identification of household food insecurity by the second-year pediatric residents working in the Pediatric Primary Care Center from 1.9% to 15.0% within 6 months. A secondary aim was to increase the proportion of second-year pediatric residents identifying food insecurity.
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Relaxation of backbone bond geometry improves protein energy landscape modeling.
Protein Sci.
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A key issue in macromolecular structure modeling is the granularity of the molecular representation. A fine-grained representation can approximate the actual structure more accurately, but may require many more degrees of freedom than a coarse-grained representation and hence make conformational search more challenging. We investigate this tradeoff between the accuracy and the size of protein conformational search space for two frequently used representations: one with fixed bond angles and lengths and one that has full flexibility. We performed large-scale explorations of the energy landscapes of 82 protein domains under each model, and find that the introduction of bond angle flexibility significantly increases the average energy gap between native and non-native structures. We also find that incorporating bonded geometry flexibility improves low resolution X-ray crystallographic refinement. These results suggest that backbone bond angle relaxation makes an important contribution to native structure energetics, that current energy functions are sufficiently accurate to capture the energetic gain associated with subtle deformations from chain ideality, and more speculatively, that backbone geometry distortions occur late in protein folding to optimize packing in the native state.
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

How does it work?

We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.