The Experts below are selected from a list of 72162 Experts worldwide ranked by ideXlab platform
Deborah Korenstein - One of the best experts on this subject based on the ideXlab platform.
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2019 update on medical Overuse a review
JAMA Internal Medicine, 2019Co-Authors: Daniel J. Morgan, Deborah Korenstein, Scott M. Wright, Sanket S. Dhruva, Eric R CoonAbstract:Importance Medical Overuse is an important cause of patient harm and medical waste. Observation This structured literature review of English-language articles supplemented by examination of tables of contents of high-impact journals published in 2018 identified articles related to medical Overuse. Articles were appraised for their methodologic quality, clinical relevance, and influence on patients. Of 1499 candidate articles, 839 addressed medical Overuse. Of these, 117 were deemed to be most significant, with the 10 highest-ranking articles selected by author consensus. The most important articles on medical Overuse identified issues with testing, including that procalcitonin does not affect antibiotic duration in patients with lower respiratory tract infection (4.2 vs 4.3 days); incidentalomas are present in 22% to 38% of common magnetic resonance imaging or computed tomography studies; 9% of women dying of stage IV cancer are still screened with mammography; and computed tomography lung cancer screening offers stable benefit and higher rates of harm for patients at lower risk. Articles related to overtreatment reported that urgent care clinics commonly overprescribe antibiotics (in 39% of all visits, patients received antibiotics) and that treatment of subclinical hypothyroidism had no effect on clinical outcomes. Three studies highlighted services that should be questioned, including using opioids for chronic noncancer pain (meta-analysis found no clinically significant benefit), stress ulcer prophylaxis for intensive care unit patients (mortality, 31.1% with pantoprazole vs 30.4% with placebo), and supplemental oxygen for patients with normal oxygen levels (mortality relative risk, 1.21; 95% CI, 1.03-1.43). A policy article found that state medical liability reform was associated with reduced invasive testing for coronary artery disease, including 24% fewer angiograms. Conclusions and Relevance The findings suggest that many tests are Overused, overtreatment is common, and unnecessary care can lead to patient harm. This review of these 2018 findings aims to inform practitioners who wish to reduce Overuse and improve patient care.
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development of a conceptual map of negative consequences for patients of Overuse of medical tests and treatments
JAMA Internal Medicine, 2018Co-Authors: Deborah Korenstein, Susan Chimonas, Brooke Barrow, Salomeh Keyhani, Aaron Troy, Allison LipitzsnydermanAbstract:Importance Overuse of medical tests and treatments is an increasingly recognized problem across health systems; best practices for reducing Overuse are not clear. Framing the problem in terms of the spectrum of potential patient harm is likely to be an effective strategy for clinician and patient engagement in efforts to reduce Overuse, but the scope of negative consequences of Overuse for patients has not been well described. Observations We sought to generate a comprehensive conceptual map documenting the processes through which Overused tests and treatments lead to multiple domains of negative consequences for patients. For map development, an iterative consensus process was informed by structured review of the literature on Overuse using PubMed and input from a panel of 6 international experts. For map verification, a systematic review was performed of case reports involving Overused services, identified through literature review and manual review of relevant article collections. The conceptual map documents that Overused tests and treatments and resultant downstream services generate 6 domains of negative consequences for patients: physical, psychological, social, financial, treatment burden, and dissatisfaction with health care. Negative consequences can result from Overused services and from downstream services; they can also trigger further downstream services that in turn can lead to more negative consequences, in an ongoing feedback loop. Case reports on Overuse confirmed the processes and domains of the conceptual map. Cases also revealed strengths and weaknesses in published communication about Overuse: they were dominated by physical harms, with other negative consequences receiving far less attention. Conclusions and Relevance This evidence-based conceptual map clarifies the processes by which Overused tests and treatments result in negative consequences for patients; it also documents multiple domains of negative consequences experienced by patients. The map will be useful for facilitating comprehensive communication about Overuse, estimating harms and costs associated with Overused services, and informing health system efforts to reduce Overuse.
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A Practical Framework for Understanding and Reducing Medical Overuse: Conceptualizing Overuse Through the Patient-Clinician Interaction.
Journal of hospital medicine, 2017Co-Authors: Daniel J. Morgan, Aaron L. Leppin, Cynthia D. Smith, Deborah KorensteinAbstract:Overuse of medical services is an increasingly recognized driver of poor-quality care and high cost. A practical framework is needed to guide clinical decisions and facilitate concrete actions that can reduce Overuse and improve care. We used an iterative, expert-informed, evidence-based process to develop a framework for conceptualizing interventions to reduce medical Overuse. Given the complexity of defining and identifying Overused care in nuanced clinical situations and the need to define care appropriateness in the context of an individual patient, this framework conceptualizes the patient-clinician interaction as the nexus of decisions regarding inappropriate care. This interaction is influenced by other utilization drivers, including healthcare system factors, the practice environment, the culture of professional medicine, the culture of healthcare consumption, and individual patient and clinician factors. The variable strength of the evidence supporting these domains highlights important areas for further investigation. Journal of Hospital Medicine 2017;12:346-351.
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Reducing Overuse-Is Patient Safety the Answer?
JAMA, 2017Co-Authors: Allison Lipitz-snyderman, Deborah KorensteinAbstract:In this issue of JAMA, Zapata and colleagues discuss framing the provision of unnecessary medical care as a patient safety problem and managing this problem using the hospital patient safety committee.1 The case presented highlights the lack of clarity about who is accountable for addressing Overuse issues. All hospitals are concerned with the safety of their patients, and the authors provide a thoughtful discussion of the merits and challenges of using patient safety infrastructure to target Overuse. To retain focus on safety issues while facilitating greater attention to Overuse requires defining the relationship between Overuse and patient safety.
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Systematic review of Overuse in oncology.
Journal of Clinical Oncology, 2016Co-Authors: Shrujal S. Baxi, Salomeh Keyhani, Minal S. Kale, Benjamin R. Roman, Annie Yang, Antonio P. Derosa, Azalea Kim, Deborah KorensteinAbstract:e18257Background: Overuse is an increasingly important target for improving health outcomes and reducing cost in oncology. To inform policies for reducing Overuse, we performed a systematic review ...
Salomeh Keyhani - One of the best experts on this subject based on the ideXlab platform.
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development of a conceptual map of negative consequences for patients of Overuse of medical tests and treatments
JAMA Internal Medicine, 2018Co-Authors: Deborah Korenstein, Susan Chimonas, Brooke Barrow, Salomeh Keyhani, Aaron Troy, Allison LipitzsnydermanAbstract:Importance Overuse of medical tests and treatments is an increasingly recognized problem across health systems; best practices for reducing Overuse are not clear. Framing the problem in terms of the spectrum of potential patient harm is likely to be an effective strategy for clinician and patient engagement in efforts to reduce Overuse, but the scope of negative consequences of Overuse for patients has not been well described. Observations We sought to generate a comprehensive conceptual map documenting the processes through which Overused tests and treatments lead to multiple domains of negative consequences for patients. For map development, an iterative consensus process was informed by structured review of the literature on Overuse using PubMed and input from a panel of 6 international experts. For map verification, a systematic review was performed of case reports involving Overused services, identified through literature review and manual review of relevant article collections. The conceptual map documents that Overused tests and treatments and resultant downstream services generate 6 domains of negative consequences for patients: physical, psychological, social, financial, treatment burden, and dissatisfaction with health care. Negative consequences can result from Overused services and from downstream services; they can also trigger further downstream services that in turn can lead to more negative consequences, in an ongoing feedback loop. Case reports on Overuse confirmed the processes and domains of the conceptual map. Cases also revealed strengths and weaknesses in published communication about Overuse: they were dominated by physical harms, with other negative consequences receiving far less attention. Conclusions and Relevance This evidence-based conceptual map clarifies the processes by which Overused tests and treatments result in negative consequences for patients; it also documents multiple domains of negative consequences experienced by patients. The map will be useful for facilitating comprehensive communication about Overuse, estimating harms and costs associated with Overused services, and informing health system efforts to reduce Overuse.
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Systematic review of Overuse in oncology.
Journal of Clinical Oncology, 2016Co-Authors: Shrujal S. Baxi, Salomeh Keyhani, Minal S. Kale, Benjamin R. Roman, Annie Yang, Antonio P. Derosa, Azalea Kim, Deborah KorensteinAbstract:e18257Background: Overuse is an increasingly important target for improving health outcomes and reducing cost in oncology. To inform policies for reducing Overuse, we performed a systematic review ...
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Overuse of health care services in the united states an understudied problem
JAMA Internal Medicine, 2012Co-Authors: Deborah Korenstein, Raphael Falk, Elizabeth A Howell, Tara F Bishop, Salomeh KeyhaniAbstract:Background Overuse, the provision of health care services for which harms outweigh benefits, represents poor quality and contributes to high costs. A better understanding of Overuse in US health care could inform efforts to reduce inappropriate care. We performed an extensive search for studies of Overuse of therapeutic procedures, diagnostic tests, and medications in the United States and describe the state of the literature. Methods We searched MEDLINE (1978-2009) for studies measuring US rates of Overuse of procedures, tests, and medications, augmented by author tracking, reference tracking, and expert consultation. Four reviewers screened titles; 2 reviewers screened abstracts and full articles and extracted data including Overuse rate, type of service, clinical area, and publication year. Results We identified 172 articles measuring Overuse: 53 concerned therapeutic procedures; 38, diagnostic tests; and 81, medications. Eighteen unique therapeutic procedures and 24 diagnostic services were evaluated, including 10 preventive diagnostic services. The most commonly studied services were antibiotics for upper respiratory tract infections (59 studies), coronary angiography (17 studies), carotid endarterectomy (13 studies), and coronary artery bypass grafting (10 studies). Overuse of carotid endarterectomy and antibiotics for upper respiratory tract infections declined over time. Conclusions The robust evidence about Overuse in the United States is limited to a few services. Reducing inappropriate care in the US health care system likely requires a more substantial investment in Overuse research.
Kaitlin Krebs - One of the best experts on this subject based on the ideXlab platform.
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modulation of salience network intranetwork resting state functional connectivity in women with chronic migraine
Cephalalgia, 2018Co-Authors: Michelle X Androulakis, Chris Rorden, Lee B Peterlin, Kaitlin KrebsAbstract:Objective To investigate the intranetwork resting state fMRI connectivity within the Salience Network of chronic migraine with and without medication Overuse headache. Methods We compared 351 pairs of intranetwork connectivity in chronic migraine (n = 13) and chronic migraine with medication Overuse headache (n = 16) compared to matched controls, and between each chronic migraine subgroup. Results Compared to controls, 17 pairs of intranetwork connections in chronic migraine and 27 pairs in chronic migraine with medication Overuse headache were decreased. When comparing chronic migraine with medication Overuse headache versus chronic migraine, connectivity between bilateral extended amygdala, and between paracingulate to right ventral tegmental area/substantia nigra were decreased in chronic migraine (chronic migraine < chronic migraine with medication Overuse headache). Connectivity between left dorsolateral prefrontal cortex to bilateral ventral striatum/pallidum, to bilateral dorsal anterior cingulate cortex; left anterior prefrontal cortex to contralateral orbitofrontal insula; and left ventral striatum/pallidum to ipsilateral supplementary motor area (SMA)/preSMA were decreased in chronic migraine with medication Overuse headache (chronic migraine with medication Overuse headache < chronic migraine). Conclusion Both chronic migraine subgroups had shared intranetwork connectivity abnormality, however, each subgroup had unique pattern of disruption within the salience network. The results suggest that the aberrant assignment of salience to external and internal stimuli plays an important role in chronic migraine and chronic migraine with medication Overuse headache interictally, mostly involving mesolimbic pathways (especially bilateral extended amygdala) in chronic migraine, and prefrontal-subcortical limbic pathways in chronic migraine with medication Overuse headache.
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Modulation of salience network intranetwork resting state functional connectivity in women with chronic migraine.
Cephalalgia : an international journal of headache, 2017Co-Authors: X. Michelle Androulakis, Chris Rorden, B. Lee Peterlin, Kaitlin KrebsAbstract:Objective To investigate the intranetwork resting state fMRI connectivity within the Salience Network of chronic migraine with and without medication Overuse headache. Methods We compared 351 pairs of intranetwork connectivity in chronic migraine (n = 13) and chronic migraine with medication Overuse headache (n = 16) compared to matched controls, and between each chronic migraine subgroup. Results Compared to controls, 17 pairs of intranetwork connections in chronic migraine and 27 pairs in chronic migraine with medication Overuse headache were decreased. When comparing chronic migraine with medication Overuse headache versus chronic migraine, connectivity between bilateral extended amygdala, and between paracingulate to right ventral tegmental area/substantia nigra were decreased in chronic migraine (chronic migraine
Xiaoyi Fang - One of the best experts on this subject based on the ideXlab platform.
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Trajectory of problematic internet use across the college years: The role of peer internet Overuse behavior and peer attitude toward internet Overuse.
Journal of adolescence, 2020Co-Authors: Jichao Jia, Wei Tong, Jin-tao Zhang, Fenge Liu, Xiaoyi FangAbstract:Abstract Introduction College students are at high risk of problematic internet use (PIU). A great amount of research has focused on the PIU among college students. However, little is known about the change pattern of PIU across the college years. Moreover, how peer internet Overuse behavior and peer attitude toward internet Overuse work together to shape college students’ PIU trajectory, and whether such peer contagion effects are equal for all students remain unclear. The present study used latent growth curve model to examine these issues. Methods A total of 2572 Chinese college students (Mage = 18.37, SD = 0.85; 65% girls) participated in the study. They completed questionnaires regarding demographics, peer internet Overuse behavior, peer attitude toward internet Overuse, and friendship satisfaction at Wave 1, and PIU at Waves 1–4. Results After controlling for covariates, the findings revealed that (a) PIU slightly increased before the second year of college and then declined rapidly; (b) both peer internet Overuse behavior and peer attitude toward internet Overuse were related to the PIU at baseline; however, only peer internet Overuse behavior was associated with the change of PIU; and (c) the effect of peer internet Overuse behavior on PIU change was moderated by friendship satisfaction and gender. Conclusions These findings emphasized the dynamic and context-sensitive nature of PIU and clarified how peer contagion unfolded with peer internet Overuse behavior and peer attitude toward internet Overuse. Theoretical implications and application of these findings are discussed.
Sanket S. Dhruva - One of the best experts on this subject based on the ideXlab platform.
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2019 update on medical Overuse a review
JAMA Internal Medicine, 2019Co-Authors: Daniel J. Morgan, Deborah Korenstein, Scott M. Wright, Sanket S. Dhruva, Eric R CoonAbstract:Importance Medical Overuse is an important cause of patient harm and medical waste. Observation This structured literature review of English-language articles supplemented by examination of tables of contents of high-impact journals published in 2018 identified articles related to medical Overuse. Articles were appraised for their methodologic quality, clinical relevance, and influence on patients. Of 1499 candidate articles, 839 addressed medical Overuse. Of these, 117 were deemed to be most significant, with the 10 highest-ranking articles selected by author consensus. The most important articles on medical Overuse identified issues with testing, including that procalcitonin does not affect antibiotic duration in patients with lower respiratory tract infection (4.2 vs 4.3 days); incidentalomas are present in 22% to 38% of common magnetic resonance imaging or computed tomography studies; 9% of women dying of stage IV cancer are still screened with mammography; and computed tomography lung cancer screening offers stable benefit and higher rates of harm for patients at lower risk. Articles related to overtreatment reported that urgent care clinics commonly overprescribe antibiotics (in 39% of all visits, patients received antibiotics) and that treatment of subclinical hypothyroidism had no effect on clinical outcomes. Three studies highlighted services that should be questioned, including using opioids for chronic noncancer pain (meta-analysis found no clinically significant benefit), stress ulcer prophylaxis for intensive care unit patients (mortality, 31.1% with pantoprazole vs 30.4% with placebo), and supplemental oxygen for patients with normal oxygen levels (mortality relative risk, 1.21; 95% CI, 1.03-1.43). A policy article found that state medical liability reform was associated with reduced invasive testing for coronary artery disease, including 24% fewer angiograms. Conclusions and Relevance The findings suggest that many tests are Overused, overtreatment is common, and unnecessary care can lead to patient harm. This review of these 2018 findings aims to inform practitioners who wish to reduce Overuse and improve patient care.
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2017 update on pediatric medical Overuse a review
JAMA Pediatrics, 2018Co-Authors: Eric R Coon, Daniel J. Morgan, Sanket S. Dhruva, Paul C Young, Ricardo A Quinonez, Alan R SchroederAbstract:Importance Medical Overuse has historically focused on adult health care, but interest in how children are affected by medical Overuse is increasing. This review examines important research articles published in 2016 that address pediatric Overuse. Observations A structured search of PubMed and a manual review of the tables of contents of 10 journals identified 169 articles related to pediatric Overuse published in 2016, from which 8 were selected based on the quality of methods and potential harm to patients in terms of prevalence and magnitude. Articles were categorized by overtreatment, overmedicalization, and overdiagnosis. Findings included evidence of overtreatment with commercial rehydration solution, antidepressants, and parenteral nutrition; overmedicalization with planned early deliveries, immobilization of ankle injuries, and use of hydrolyzed infant formula; and evidence of overdiagnosis of hypoxemia among children recovering from bronchiolitis. Conclusions and Relevance The articles were of high quality, with most based on randomized clinical trials. The potential harms associated with pediatric Overuse were significant, including increased risk of infection, developmental disability, and suicidality.
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Update on medical Overuse
JAMA internal medicine, 2015Co-Authors: Daniel J. Morgan, Scott M. Wright, Sanket S. DhruvaAbstract:Importance Overuse of medical care, consisting primarily of overdiagnosis and overtreatment, is a common clinical problem. Objective To identify and highlight the most significant clinical articles published in 2013 related to medical Overuse. Evidence Review A systematic review of English-language articles published in 2013 that related to medical Overuse in adults. Findings We reviewed 478 published articles that met our inclusion criteria. Of these, 126 were ranked most relevant based on quality of methodology, strength of results, potential effects on patient care, and the number of patients potentially affected. The 10 most relevant articles were selected using the same criteria. These 10 articles (organized into the categories overdiagnosis, overtreatment, and methods to avoid Overuse) were reviewed and interpreted for their effect on clinical medicine. Conclusions and Relevance The literature on Overuse of medical care is rapidly expanding. In 2013, both clinical trials and observational studies highlighted frequently Overused or unnecessary care. Overuse of testing causes false-positive results and overdiagnosis. Negative test results do not appear to genuinely reassure patients. Overtreatment, with both medical therapies and procedural interventions, places patients at risk of unnecessary adverse events.