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Improving Value: Prespectives from Oral Surgeons

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An interesting editorial appears in the 2014, issue of the Journal of Oral and Maxillofacial Surgery titled “The Value of Improving Value,” by James Hupp (pp. 843-845, issue 72). In this Dr. Hupp presents a formula for patient value Value = A(Q + PS)/C A = appropriateness, Q = quality, PS = patient satisfaction, and C = costs The author states “First, one can improve outcomes while keeping costs the same. Second, one can decrease costs while keeping outcomes the same. Or third, both outcomes and costs increase, but outcomes per unit of cost improve.” In the article the author discusses how in the past, value in health care was really just about cost cutting. Clinical outcomes were not really taken into account. Now that health care outcomes are being considered, physicians need to find ways to measure value using the … Read more

Exploring the Alternative to Medical Injury Claims in New Hampshire

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In a post last year I dicussed briefly the early offer system in New Hampshire see The Optional Alternative to Medical Injury Claims. This is the first of the kind system in the United States that is an alternative to the traditional medical malpractice system. An article in the 2013 issue 4 of the American Journal of Law and Medicine has explored this titled “Evaluating New Hampshire’s First-In-The-Nation Early Offer Alternative to Medical Malpractice Litigation,” and written by John W. Masland. The article states “Many states have enacted medical malpractice reforms, recognizing that their tort systems result in protracted litigation, high costs, and a large number of uncompensated victims. One proposed reform, an “early offer” system, allows a medical provider to make a financial offer covering an injured patient’s economic damages, which, if the patient accepts, precludes litigation…On June 27, 2012, … Read more

New Blood Pressure Medication for Migraines

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A new study by the Norway and the Norwegian University of Science and Technology shows that a blood pressure medication, candesartan, is as effective as propranolol which is prescribed to prevent migraine. Further, candesartan may work better for those migraine suffers who don’t find propranolol to be useful. The study by the norwegian researchers was a triple blind test which means that neither patients nor doctors nor those who analyzed the results knew whether the patients had been given the drug or a placebo. Seventy two patients took part in the study and all patients were affected by migraine attacks at least twice a month. The patients used each treatment candesartan, propranolol, or placebo for 12 weeks and also underwent four weeks before start and finish between each treatment without anything. As such each patient was tested for nearly a … Read more

Patient Safety and the Culture of Cover-Up

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An interesting article was written by George Lundberg titled “A culture of cover-up has slowed the patient safety movement” on December 1, 2012, on KevinMd.com located at http://www.kevinmd.com/blog/2012/12/culture-coverup-slowed-patient-safety-movement.html. In the article Dr. Lundberg says “Promoting patient safety, preventing medical error, preventing physician error, preventing errors in diagnosis, preventing nurse error, preventing surgical error, preventing communication error, preventing health illiteracy error, preventing errors from language barriers, preventing laboratory error, preventing computer error, preventing patient mix-ups, preventing right and left side of body mix-ups, preventing mistakes, since mistakes are the stepping stones to failure. Recognizing human frailty, recognizing physician humanity, recognizing system fallibility, owning up to problems, eliminating cover-up, acting out professionalism, recognizing that professionalism means self governance, individually and as groups. Self criticism, peer criticism, a culture of peer review, honesty, truth, disclosure, fairness, and negotiated settlements. Objective evaluation and commitment … Read more

Retractions and Corrections From Scientific Misconduct

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An interesting article appears in the Journal of Medical Ethics, January 2013, vol. 39, pp. 46-50, titled “Scientific retractions and corrections related to misconduct findings,” by David B Resnik and Gregg E Dinse. The authors explored 208 closed cases involving official findings of research misconduct published by the U.S. Office of Research Integrity from 1992 to 2011 in order to determine how often scientists mention in a retraction or correction notice that there was an ethical problem with the article. The issue of fraudulent articles appear in the scientific literature is a problem as many articles and the data within them can be falsified. See for example Industry Bias in Biomedical Science and The Right to Health and Information. The authors mention that typically when a retraction or correction is made to an article they are usually electronically linked to … Read more