American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Jul 2017
Effects of Physician-Targeted Pay-for-Performance on Use of Spontaneous Breathing Trials in Mechanically Ventilated Patients.
Pay for performance is an increasingly common quality improvement strategy despite the absence of robust supporting evidence. ⋯ In hospitals with low baseline SBT completion, physician-targeted financial incentives were associated with increased SBT rates driven in part by increased exclusion rates, without consistent improvements in outcome.
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Am. J. Respir. Crit. Care Med. · Jul 2017
Multicenter Study Observational StudyPalivizumab Prophylaxis in Preterm Infants and Subsequent Recurrent Wheezing: 6 Year Follow Up Study.
Respiratory syncytial virus (RSV) induces not only infantile recurrent wheezing but also potentially atopic asthma. ⋯ Palivizumab prophylaxis administered to preterm infants did not suppress the onset of atopic asthma but resulted in a significantly lower incidence of recurrent wheezing during the first 6 years. Clinical trial registered with www.clinicaltrials.gov (NCT 01545245).
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Am. J. Respir. Crit. Care Med. · Jul 2017
Chronic Obstructive Pulmonary Disease Readmissions and Other Measures of Hospital Quality.
The Centers for Medicare and Medicaid Services recently implemented financial penalties to reduce hospital readmissions for select conditions, including chronic obstructive pulmonary disease (COPD). Despite growing pressure to reduce COPD readmissions, it is unclear how COPD readmission rates are related to other measures of quality, which could inform efforts on common organizational factors that affect high-quality care. ⋯ These findings suggest there may be common organizational factors that influence multiple disease-specific outcomes. As pay-for-performance programs focus attention on individual disease outcomes, hospitals may benefit from in-depth assessments of organizational factors that affect multiple aspects of hospital quality.
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Am. J. Respir. Crit. Care Med. · Jul 2017
Accuracy of Immunofluorescence in the Diagnosis of Primary Ciliary Dyskinesia.
The standard approach to diagnosis of primary ciliary dyskinesia (PCD) in the United Kingdom consists of assessing ciliary function by high-speed microscopy and ultrastructure by election microscopy, but equipment and expertise is not widely available internationally. The identification of biallelic disease-causing mutations is also diagnostic, but many disease-causing genes are unknown, and testing is not widely available outside the United States. Fluorescent antibodies to ciliary proteins are used to validate research genetic studies, but diagnostic utility in this disease has not been systematically evaluated. ⋯ Immunofluorescence is a highly specific diagnostic test for PCD, and it improves the speed and availability of diagnostic testing. However, sensitivity is limited and immunofluorescence is not suitable as a stand-alone test.