Brown C.H.,Santa Clara Valley Medical Center
Advances in Intelligent Systems and Computing | Year: 2017
During the past two decades in health care, increasing numbers of preventable hospital deaths and medical errors, an explosion of technologies, pharmaceuticals, and diagnostic and therapeutic techniques, and rising costs have resulted in a shift in focus away from “one doctor, one patient” to the systems and processes that support care delivery. While leaders in health care have begun to recognize the contribution of engineering tools and principles in improving health care safety and quality, integration of these techniques and the engagement of engineers has not been fully realized. Creating an infrastructure that promotes a collaborative foundation begins in the academic setting. This article describes a three-pronged approach to integration that will ultimately improve results, efficiency, efficacy, and clinical and operational outcomes in health care facilities. © Springer International Publishing Switzerland 2017.
Mission J.F.,Oregon Health And Science University |
Ohno M.S.,Santa Clara Valley Medical Center |
Cheng Y.W.,University of California at San Francisco |
Caughey A.B.,Oregon Health And Science University
American Journal of Obstetrics and Gynecology | Year: 2012
Objective: This study investigates the cost effectiveness of gestational diabetes mellitus screening using the new International Association of Diabetes in Pregnancy Study Group (IADPSG) guidelines. Study Design: A decision analytic model was built comparing routine screening with the 2-hour (2h) oral glucose tolerance test (OGTT) vs the 1-hour glucose challenge test. All probabilities, costs, and benefits were derived from the literature. Base case, sensitivity analyses, and a Monte Carlo simulation were performed. Results: Screening with the 2h OGTT was more expensive, more effective, and cost effective at $61,503/quality-adjusted life year. In a 1-way sensitivity analysis, the more inclusive IADPSG diagnostic approach remained cost effective as long as an additional 2.0% or more of patients were diagnosed and treated for gestational diabetes mellitus. Conclusion: Screening at 24-28 weeks' gestational age under the new IADPSG guidelines with the 2h OGTT is expensive but cost effective in improving maternal and neonatal outcomes. How the health care system will provide expanded care to this group of women will need to be examined. © 2012 Mosby, Inc. All rights reserved.
Williams J.E.,Santa Clara Valley Medical Center |
Williams J.E.,Oregon Health And Science University |
Holub J.L.,Oregon Health And Science University |
Faigel D.O.,Mayo Medical School
Gastrointestinal Endoscopy | Year: 2012
Background: The adenoma detection rate (ADR) is one of the main quality measures for colonoscopy, but it is burdensome to calculate and is not amenable to claims-based reporting. Objective: To validate the correlation between polypectomy rates (PRs) and ADRs by using a large group of endoscopists. Design: Retrospective study. Setting: Community and academic endoscopy units in the United States. Subjects: Sixty endoscopists and their patients. Main outcome measurements: Proportion of patients with any adenoma and any polyp removed; correlation between ADRs and PRs. Results: In total, 14,341 screening colonoscopies were included, and there was high correlation between endoscopists' PRs and ADRs in men (rs=.91, P <.0001) and women (rs =.91, P <.0001). Endoscopists with PRs in the highest quartile had a significantly higher ADR than did those in the lowest quartile in men (44.6% vs 19.4%, P <.0001) and women (33.6% vs 11.6%, P <.0001). Endoscopists in the top polypectomy quartile also found more advanced adenomas than did endoscopists in the bottom quartile (men: 9.6% vs 4.6%, P =.0006; women: 6.3% vs 3.0%, P =.01). Benchmark PRs of 40% and 30% correlated with ADRs greater than 25% and 15% for men and women, respectively. Limitation: Retrospective analysis of a subset of a national endoscopic database. Conclusions: Endoscopists' PRs correlate well with their ADRs. Given its clinical relevance, its simplicity, and the ease with which it can be incorporated into claims-based reporting programs, the PR may become an important quality measure. © 2012 American Society for Gastrointestinal Endoscopy.
Coon E.R.,University of Utah |
Quinonez R.A.,Baylor College of Medicine |
Moyer V.A.,American Board of Pediatrics |
Schroeder A.R.,Santa Clara Valley Medical Center
Pediatrics | Year: 2014
Overdiagnosis occurs when a true abnormality is discovered, but detection of that abnormality does not benefit the patient. It should be distinguished from misdiagnosis, in which the diagnosis is inaccurate, and it is not synonymous with overtreatment or overuse, in which excess medication or procedures are provided to patients for both correct and incorrect diagnoses. Overdiagnosis for adult conditions has gained a great deal of recognition over the last few years, led by realizations that certain screening initiatives, such as those for breast and prostate cancer, may be harming the very people they were designed to protect. In the fall of 2014, the second international Preventing Overdiagnosis Conference will be held, and the British Medical Journal will produce an overdiagnosis-themed journal issue. However, overdiagnosis in children has been less well described. This special article seeks to raise awareness of the possibility of overdiagnosis in pediatrics, suggesting that overdiagnosis may affect commonly diagnosed conditions such as attention-deficit/hyperactivity disorder, bacteremia, food allergy, hyperbilirubinemia, obstructive sleep apnea, and urinary tract infection. Through these and other examples, we discuss why overdiagnosis occurs and how it may be harming children. Additionally, we consider research and education strategies, with the goal to better elucidate pediatric overdiagnosis and mitigate its influence. Copyright © 2014 by the American Academy of Pediatrics.
News Article | March 2, 2017
In June 2016, on the day before his high school graduation, nineteen-year-old Jake Javier suffered a terrible diving accident that left him paralyzed. The incident was covered widely across Bay Area news media and residents quickly mobilized to support Jake and his family. In the March issue of Diablo Magazine, Senior Editor Pete Crooks revisits the story of Jake’s bravery and trailblazing medical care. Crooks caught up with Jake and his parents to discuss life after the accident and explore the life-saving treatments he received at John Muir’s Walnut Creek Medical Center and Santa Clara Valley Medical Center. As part of his therapy, Jake participated in a groundbreaking stem cell procedure by the California Institute for Regenerative Medicine in Oakland. Jake was one of five people in the world to receive an injection of 10 million embryonic stem cells. “This story needed to be revisited.” says Crooks. “Diablo magazine is the town square of the East Bay, and we needed to give Jake’s story time to develop and really share how brave and pioneering he is.” The article details the days and months following the accident and how the community rallied around Jake. Friends, classmates and even strangers joined forces to organize fundraising drives and provide support for the Javier family. To read about the incredible support from the community, Jake’s plans for a future as a college freshman, and view a link to support Jake through the JaviStrong54 Foundation, visit diablomag.com. About Diablo Magazine Covering topics ranging from travel, culture, and personalities to entertainment, recreation, and food, Diablo magazine is written specifically for the San Francisco East Bay market—from Central Contra Costa, into the Oakland and Berkeley hills, and throughout the Tri-Valley. With locally driven editorial content, beautiful photography, and resource listings, Diablo is a unique celebration of the San Francisco East Bay. Published since 1979, Diablo has been recognized for its editorial and design with numerous awards, including previous Maggie Awards for Best Overall Publication and Best Regional and State Magazine in the consumer category. About Diablo Publications For 35 years, Diablo Publications has been creating award-winning publications, including Diablo magazine, Napa Sonoma magazine, Diablo Weddings, the Oakland Visitors' Guide, Diablo Arts, and the Tri-Valley California Visitors Guide. Covering travel, theater, lifestyle, and home design, Diablo Publications celebrates the people, places, and pleasures of the East Bay and North Bay. Diablo Publications’ custom content division, Diablo Custom Publishing (DCP), provides complete print and online marketing communications and customer publishing services for corporate clients nationwide. For more information, visit diablomag.com or dcpubs.com. Diablo Publications is an employee-owned company.
Chetty S.,Stanford University |
Garabedian M.J.,Santa Clara Valley Medical Center |
Norton M.E.,Stanford University
Prenatal Diagnosis | Year: 2013
Objective: The aim of this study was to investigate how the introduction of noninvasive prenatal testing (NIPT) impacted women's testing choices following a positive prenatal screening (PNS) result. Methods: Beginning in March 2012, women referred to our Prenatal Diagnosis Center following a positive PNS result were offered NIPT or invasive prenatal diagnosis. Rates of invasive testing and declining follow-up were compared with testing decisions the prior year. Differences were compared using t-test and chi-square. Multivariable logistic regression was performed to identify predictors of test choice. Results: Between March 2012 and February 2013, 398 screen positive women were seen: 156 (39.2%) underwent invasive testing, 157 (39.4%) had NIPT and 84 (21.1%) declined further testing. In the prior year, 638 screen positive patients were seen: 301 (47.2%) had invasive testing and 337 (52.8%) declined. The rate of invasive testing declined significantly (p=0.012). Moreover, fewer women declined follow-up testing after introduction of NIPT, 21.2% versus 52.8%, p≤0.001. Race/ethnicity and timing of results (first versus second trimester) were predictors of testing choices; payer and maternal age were not. Conclusion: The introduction of NIPT resulted in a significant decrease in invasive diagnostic testing. Additionally, fewer women declined further testing when NIPT was available. © 2013 John Wiley & Sons, Ltd.
Schroeder A.R.,Santa Clara Valley Medical Center |
Mansbach J.M.,Harvard University
Current Opinion in Pediatrics | Year: 2014
PURPOSE OF REVIEW: Bronchiolitis is a common condition in children less than 2years of age and is a leading cause of infant hospitalization. Although there is significant variability in testing and treatment of children with bronchiolitis, diagnostic testing rarely improves care, and no currently available pharmacologic options have been proven to provide meaningful benefits or improve outcomes. RECENT FINDINGS: Beta-agonists continue to be used frequently despite evidence that they do not reduce hospital admissions or length of stay. In general, therapies initially considered promising were subsequently proven ineffective, a pattern seen in studies on corticosteroids, and more recently with nebulized racemic epinephrine and hypertonic saline. Recent research has improved our understanding of the viral epidemiology of bronchiolitis, with increasing recognition of viruses other than respiratory syncytial virus and better awareness of the role of viral coinfections. How these findings will translate into improved outcomes remains uncertain. SUMMARY: Much of the emphasis of the last few decades of bronchiolitis clinical care and research has centered on the identification and testing of novel therapies. Future quality improvement efforts should focus more on the limitation of unnecessary testing and treatments. Future research should include identification of subgroups of children with bronchiolitis that may benefit from focused clinical interventions. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Kochar R.,Stanford University |
Shah N.,Stanford University |
Shah N.,Santa Clara Valley Medical Center
Gastrointestinal Endoscopy | Year: 2013
Because of significant advances in endoscopic techniques and the development of high-quality stents, endoscopic enteral stent placement is increasingly being performed for the management of malignant GI obstruction. Palliative stenting is now routinely performed for malignant esophageal, gastric, duodenal, and colon obstruction. In addition to palliative indications, preoperative stenting in the colon may be performed as a bridge to surgery to achieve immediate decompression and convert an emergent surgery into an elective, 1-stage procedure. The realm of enteral stenting has recently expanded to include management of benign conditions such as leaks, fistulas, and benign strictures in the GI tract. Further research is required to study the use of enteral stents in benign conditions and to adequately compare endoscopic stent placement with surgical intervention. Promising new technologies such as biodegradable stents and drug-eluting stents also require further investigation. With continued innovation in endoscopic techniques and stenting devices, the field of enteral stenting is likely to expand further, with an increase in indications and improvement in outcomes. Copyright © 2013 by the American Society for Gastrointestinal Endoscopy.
Hart N.D.,Santa Clara Valley Medical Center
The journal of knee surgery | Year: 2012
Quadriceps rupture off the patella is traditionally repaired by a transosseous tunnel technique, although a single-row suture anchor repair has recently been described. This study biomechanically tested a new transosseous equivalent (TE) double-row suture anchor technique compared with the transosseous repair for quadriceps repair. After simulated quadriceps-patella avulsion in 10 matched cadaveric knees, repairs were completed by either a three tunnel transosseous (TT = 5) or a TE suture anchor (TE = 5) technique. Double-row repairs were done using two 5.5 Bio-Corkscrew FT (fully threaded) (Arthrex, Inc., Naples, FL, USA) and two 3.5 Bio-PushLock anchors (Arthrex, Inc., Naples, FL, USA) with all 10 repairs done with #2 FiberWire suture (Arthrex, Inc., Naples, FL). Cyclic testing from 50 to 250 N for 250 cycles and pull to failure load (1 mm/s) were undertaken. Gap formation and ultimate tensile load (N) were recorded and stiffness data (N/mm) were calculated. Statistical analysis was performed using a Mann-Whitney U test and survival characteristics examined with Kaplan-Meier test. No significant difference was found between the TE and TT groups in stiffness (TE = 134 +/- 15 N/mm, TT = 132 +/- 26 N/mm, p = 0.28). The TE group had significantly less ultimate tensile load (N) compared with the TT group (TE = 447 +/- 86 N, TT = 591 +/- 84 N, p = 0.04), with all failures occurring at the suture eyelets. Although both quadriceps repairs were sufficiently strong, the transosseous repairs were stronger than the TE suture anchor repairs. The repair stiffness and gap formation were similar between the groups.
News Article | February 15, 2017
Syndicate Group is proud to announce that it will be exhibiting at HIMSS 2017 to be held in Orlando from February 19th to 23rd, 2017. Syndicate’s goal is to contribute to positive patient identification & patient safety and improve inventory tracking through its range of innovative healthcare products. As an exhibitor, Syndicate Group will be showcasing their range of Laser Printable & Direct Thermal Wristbands and RFID Wristbands for Patient Identification, and RFID Labels for Inventory Tracking. Patient safety is a top priority in every hospital. Failure to correctly identify patients leads to patients being given incorrect treatment, surgical procedure or medication leading to serious medical complications. Syndicate Group's ultimoID® MED Direct Thermal and RFID Wristbands solve this problem as they provide secure and positive patient identification through the use of barcode and RFID technology thereby helping healthcare practitioners in achieving the “five rights of medical administration”. Another challenge which hospitals face is due to high-value equipment getting lost or stolen which costs them millions of dollars each year and affects staff productivity. For example, in 2015, the Santa Clara Valley Medical Center in San Jose, CA, reported 383 items missing from 2010 to 2014, valued at more than $11 million. There are many similar incidents reported each year. Syndicate Group’s range of RFID Labels for Asset Tracking help healthcare practitioners gain better visibility, increase staff productivity and also ensure patient safety by: To learn more about Syndicate Group, visit booth # 4493 during HIMSS ’17. Syndicate Group is a leader in the access control, track & trace and authentication sectors catering to a diverse client base in healthcare, manufacturing, logistics, amusement and other industries. With over 30 years of experience, it is driven by passion for its products and aims to turn customers into partners. Visit us on: http://www.syndicategroup.net