The Experts below are selected from a list of 120 Experts worldwide ranked by ideXlab platform
Peter Rock - One of the best experts on this subject based on the ideXlab platform.
-
the future of anesthesiology is perioperative medicine
Anesthesiology Clinics of North America, 2000Co-Authors: Peter RockAbstract:Anesthesiology is perioperative medicine. To some anesthesiologists, this statement is gospel and that simple phrase exactly describes the real practice of anesthesiology and the current activities of anesthesiologists. To others, the statement is unrealistic, unattainable, or an unnecessary extension of the specialty; for them, anesthesiology is and should remain a medical specialty largely confined to intraoperative Care. What perspective on anesthesiology provides the best prospects for a robust, enduring specialty? Anesthesiology (i.e., perioperative medicine) has evolved from a specialty based on procedures (e.g., intubation, epidural catheter placement) to one with a firm scientific basis and one in which research is leading to improvements in practice. Perioperative medicine is the practice of medicine that relates to and encompasses all aspects of Care rendered to patients in the continuum of Care from the decision to operate to when the patient is discharged from the hospital after surgery (and perhaps beyond). Anesthesiology is at a crossroads: it can remain a specialty largely oriented around procedures and intraoperative Care, or it could expand the boundaries of its clinical practice and what it claims as its intellectual domain. This article addresses how the specialty of anesthesiology reached this crossroad, discusses the new paradigm of perioperative medicine, and speculates on its future. The article hypothesizes that perioperative medicine, although not without difficulties of its own, offers the best chances for the specialty to survive and prosper. A broad view of anesthesiology, encompassing the continuum of Care, strengthened by the production of new information relevant to perioperative Care and cognizant of the realities of Health Care Economics, provides a strong basis for a Healthy specialty that is attractive to trainees and can provide its practitioners with long-term satisfying Careers. While anesthesiology considers its options and ponders whether perioperative medicine is the right path to take, a third option may emerge. Reinventing anesthesiology may yield a specialty that is greater than what is practiced currently but is not as ambitious a change and is one that may not commit to the totality of perioperative medicine. Debate and thoughtful consideration of the future of the specialty probably will cause changes in the practice and meaning of anesthesiology and perioperative medicine.
William J Mack - One of the best experts on this subject based on the ideXlab platform.
-
factors associated with burnout among us neurosurgery residents a nationwide survey
Journal of Neurosurgery, 2018Co-Authors: Frank J Attenello, Ian A Buchanan, Timothy Wen, Daniel A Donoho, Shirley Mccartney, Steven Cen, Alexander A Khalessi, Aaron A Cohengadol, Joseph S Cheng, William J MackAbstract:OBJECTIVEExcessive dissatisfaction and stress among physicians can precipitate burnout, which results in diminished productivity, quality of Care, and patient satisfaction and treatment adherence. Given the multiplicity of its harms and detriments to workforce retention and in light of the growing physician shortage, burnout has garnered much attention in recent years. Using a national survey, the authors formally evaluated burnout among neurosurgery trainees.METHODSAn 86-item questionnaire was disseminated to residents in the American Association of Neurological Surgeons database between June and November 2015. Questions evaluated personal and workplace stressors, mentorship, Career satisfaction, and burnout. Burnout was assessed using the previously validated Maslach Burnout Inventory. Factors associated with burnout were determined using univariate and multivariate logistic regression.RESULTSThe response rate with completed surveys was 21% (346/1643). The majority of residents were male (78%), 26-35 years old (92%), in a stable relationship (70%), and without children (73%). Respondents were equally distributed across all residency years. Eighty-one percent of residents were satisfied with their Career choice, although 41% had at some point given serious thought to quitting. The overall burnout rate was 67%. In the multivariate analysis, notable factors associated with burnout included inadequate operating room exposure (OR 7.57, p = 0.011), hostile faculty (OR 4.07, p = 0.008), and social stressors outside of work (OR 4.52, p = 0.008). Meaningful mentorship was protective against burnout in the multivariate regression models (OR 0.338, p = 0.031).CONCLUSIONSRates of burnout and Career satisfaction are paradoxically high among neurosurgery trainees. While several factors were predictive of burnout, including inadequate operative exposure and social stressors, meaningful mentorship proved to be protective against burnout. The documented negative effects of burnout on patient Care and Health Care Economics necessitate further studies for potential solutions to curb its rise.
James O Sanders - One of the best experts on this subject based on the ideXlab platform.
-
current evidence regarding the etiology prevalence natural history and prognosis of pediatric lumbar spondylolysis a report from the scoliosis research society evidence based medicine committee
Spine deformity, 2015Co-Authors: Charles H Crawford, Charles Gerald T Ledonio, Robert Shay Bess, Jacob M Buchowski, Douglas C Burton, Serena S Hu, Baron S Lonner, David W Polly, Justin S Smith, James O SandersAbstract:Abstract Study Design Structured literature review. Objectives To assess the current state of evidence as a first step in the development of practice guidelines for pediatric spondylolysis. Summary of Background Data Progress in published medical knowledge, changes in societal expectations, and developments in Health Care Economics have led medical organizations to develop evidence-based documents and products. Methods A comprehensive literature search for pediatric spondylolysis was performed with the assistance of a medical librarian. The authors reviewed citations and abstracts. Abstracts were reviewed for exclusions and data from included studies were analyzed by committee. A total of 44 articles provided the best available evidence for the questions of etiology, prevalence, natural history, and prognosis: 9 were graded as level I evidence, 23 were level II, 3 were level III, and 9 were level IV. No level V studies were included in the final list. Results There is good evidence that pediatric lumbar spondylolysis is an acquired fracture of the pars interarticularis that can occur unilaterally or bilaterally. Evidence shows that when chronic, bilateral pars defects develop, 43% to 74% of patients will progress to grade 1 or 2 spondylolisthesis. In addition, unilateral, incomplete, and early lesions can obtain bony union. With or without bony union or spondylolisthesis, short-term symptom resolution is the norm. Long-term prognosis is less clear, but there is fair evidence that most patients will have lumbar symptoms compared with the general population. There is also fair evidence that some patients will develop significant symptoms as adults and will undergo surgical treatment. There is insufficient knowledge to predict which patients will continue to do well in the long term with conservative or no treatment and which patients will develop symptoms significant enough to warrant early intervention. Conclusions The current medical literature provides fair to good evidence for clinically relevant questions regarding the etiology, prevalence, natural history, and prognosis of pediatric spondylolysis.
Lisa Patton - One of the best experts on this subject based on the ideXlab platform.
-
the economic impact of multiple sclerosis a preliminary look at the north american registry for Care and research in multiple sclerosis narcrms on behalf of the narcrms Health Economics outcomes research heor advisory group p4 2 065
Neurology, 2019Co-Authors: Terrie Livingston, Yang Maodraayer, K Rammohan, June Halper, Sara Mccurdy Murphy, Lisa PattonAbstract:Objective: Define the economic impact of having MS, namely the impact on employment and utilization of HealthCare resources. Background: NARCRMS enrolled its first patient in December 2016. Along with clinical and imaging data, NARCRMS collects information about the Health Care Economics of patients with MS and its effects on daily life. Examination of the economic impact of MS provides useful information that affects the allocation of resources towards patient Care. Design/Methods: NARCRMS established the Health Economics Outcomes Research (HEOR) Advisory Group in 2017 to assist our industry partners in implementing HEOR in decision-making processes. NARCRMS developed a Health-Related Productivity Questionnaire and Health Resource Utilization Questionnaire. They were incorporated into the Case Report Forms (CRFs) and are completed at enrollment, annual and exacerbation visits for each patient. Results: As of October 18, 2018, 245 people with MS were enrolled and 225 completed the HEOR CRFs. Among those patients who completed the HEOR CRFs, 170 are employed, 25 reported that MS kept them from work, 52 reported that MS impacted their work and 62 reported that MS kept them from completing household chores. Fatigue was the leading symptom reported to impact both work and household chores. In the three months prior to reporting, 8 patients were hospitalized, 14 patients visited the emergency room, 47 patients visited a general practitioner and 185 patients visited a neurologist. Conclusions: A preliminary review of the first 225 patients to complete the HEOR CRFs found that 75.5% are employed however 23.5% were underemployed or unemployed due to MS. MS seems to prevent people with MS from realizing their full potential at work/home. Overwhelmingly, fatigue was identified as the cause for this problem. The economic impact of identifying an effective treatment for this symptom of MS cannot be overstated. Disclosure: Dr. Livingston has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with EMD Serono, Biogen. Dr. Mao-Draayer has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Accorda, Biogen, Bayer Pharmaceutical, Celgene, Teva, Genentech, Sanofi-Genzyme, Novartis, Chugai and EMD Serono. Dr. Mao-Draayer has received research support from NIH NIAID Autoimmune Center of Excellence, Sanofi-Genzyme, Novartis and Chugai. Dr. Rammohan has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Genzyme, Biogen, EMD Serono, Novartis, TG Therapeutics. Dr. Rammohan has received research support from Genentech, Biogen, EMD Serono, Novartis, Department of Defense. Dr. Li has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Canadian Institute of Health Research and Multiple Sclerosis Society of Canada, Roche, Sanofi-Genzyme, Novartis, Vertex Pharmaceuticals, Adelphi Group, Biogen, Celgene, Academy of Health Care Learning . Dr. Halper has nothing to disclose. Dr. McCurdy Murphy has nothing to disclose. Dr. Patton has nothing to disclose.
Frank J Attenello - One of the best experts on this subject based on the ideXlab platform.
-
factors associated with burnout among us neurosurgery residents a nationwide survey
Journal of Neurosurgery, 2018Co-Authors: Frank J Attenello, Ian A Buchanan, Timothy Wen, Daniel A Donoho, Shirley Mccartney, Steven Cen, Alexander A Khalessi, Aaron A Cohengadol, Joseph S Cheng, William J MackAbstract:OBJECTIVEExcessive dissatisfaction and stress among physicians can precipitate burnout, which results in diminished productivity, quality of Care, and patient satisfaction and treatment adherence. Given the multiplicity of its harms and detriments to workforce retention and in light of the growing physician shortage, burnout has garnered much attention in recent years. Using a national survey, the authors formally evaluated burnout among neurosurgery trainees.METHODSAn 86-item questionnaire was disseminated to residents in the American Association of Neurological Surgeons database between June and November 2015. Questions evaluated personal and workplace stressors, mentorship, Career satisfaction, and burnout. Burnout was assessed using the previously validated Maslach Burnout Inventory. Factors associated with burnout were determined using univariate and multivariate logistic regression.RESULTSThe response rate with completed surveys was 21% (346/1643). The majority of residents were male (78%), 26-35 years old (92%), in a stable relationship (70%), and without children (73%). Respondents were equally distributed across all residency years. Eighty-one percent of residents were satisfied with their Career choice, although 41% had at some point given serious thought to quitting. The overall burnout rate was 67%. In the multivariate analysis, notable factors associated with burnout included inadequate operating room exposure (OR 7.57, p = 0.011), hostile faculty (OR 4.07, p = 0.008), and social stressors outside of work (OR 4.52, p = 0.008). Meaningful mentorship was protective against burnout in the multivariate regression models (OR 0.338, p = 0.031).CONCLUSIONSRates of burnout and Career satisfaction are paradoxically high among neurosurgery trainees. While several factors were predictive of burnout, including inadequate operative exposure and social stressors, meaningful mentorship proved to be protective against burnout. The documented negative effects of burnout on patient Care and Health Care Economics necessitate further studies for potential solutions to curb its rise.
