Articles: outcome-assessment-health-care.
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Health care systems provide care to increasingly complex and elderly patients. Colorectal surgery is a prime example, with high volumes of major procedures, significant morbidity, prolonged hospital stays, and unplanned readmissions. This situation is exacerbated by an exponential rise in costs that threatens the stability of health care systems. Enhanced recovery pathways (ERP) have been proposed as a means to reduce morbidity and improve effectiveness of care. We have reviewed the evidence supporting the implementation of ERP in clinical practice. ⋯ Adherence to ERP achieves a reproducible improvement in the quality of care by enabling standardization of health care processes. Thus, while accelerating recovery and safely reducing hospital stay, ERPs optimize utilization of health care resources. ERPs can and should be routinely used in care after colorectal and other major gastrointestinal procedures.
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Review Meta Analysis Comparative Study
Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence.
This article presents a comparison of the effectiveness of traditional clinical education toward skill acquisition goals versus simulation-based medical education (SBME) with deliberate practice (DP). ⋯ Although the number of reports analyzed in this meta-analysis is small, these results show that SBME with DP is superior to traditional clinical medical education in achieving specific clinical skill acquisition goals. SBME is a complex educational intervention that should be introduced thoughtfully and evaluated rigorously at training sites. Further research on incorporating SBME with DP into medical education is needed to amplify its power, utility, and cost-effectiveness.
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Cochrane Db Syst Rev · Mar 2011
Review Meta AnalysisInterventions for improving palliative care for older people living in nursing care homes.
Residents of nursing care homes for older people are highly likely to die there, making these places where palliative care is needed. ⋯ We found few studies, and all were in the USA. Although the results are potentially promising, high quality trials of palliative care service delivery interventions which assess outcomes for residents are needed, particularly outside the USA. These should focus on measuring standard outcomes, assessing cost-effectiveness, and reducing bias.
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Am. J. Respir. Crit. Care Med. · Nov 2010
Review Meta AnalysisAn official American Thoracic Society systematic review: insurance status and disparities in lung cancer practices and outcomes.
Insurance coverage is an important determinant of access to care and is one potential cause of disparities in lung cancer care outcomes. ⋯ Patients with Medicaid or no insurance consistently had worse outcomes than other patients with lung cancer. Some of the disparities may be secondary to residual confounding from smoking and other health behaviors, but available data suggest that patients with lung cancer without insurance do poorly because access to care is limited and/or they present with more advanced disease that is less amenable to treatment.
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Acta neurochirurgica · Aug 2010
Review Meta AnalysisSurgery for extratemporal nonlesional epilepsy in adults: an outcome meta-analysis.
To better evaluate surgery for extratemporal lobe epilepsy (ETLE) in adults, we conducted a meta-analysis of previous studies that analyzed postoperative seizure outcomes for ETLE. ⋯ This meta-analysis confirms the findings of other centers: ETLE surgical outcomes are less desirable than those for temporal lobe epilepsy. None of the factors studied in adults showed significant association with outcome. Contrary to some reports, shortening the duration of epilepsy by pursuing surgery as early as possible also does not appear to improve outcomes. The creation of standard protocols among epilepsy centers is needed to allow for a detailed evaluation of outcomes across different centers and, ultimately, to better assess the factors associated with improved outcomes.