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Metropolitan Government of Nashville-Davidson (balance), TN, United States

Lara-Smalling A.,Michael bakey Va Medical Center | Cakiner-Egilmez T.,Boston VA Healthcare System | Miller D.,Tennessee Valley VA Healthcare System | Redshirt E.,Veteran Affairs Medical Center | Williams D.,John Cochran Medical Center
Insight - Journal of the American Society of Ophthalmic Registered Nurses | Year: 2011

Currently, ophthalmic surgical cases are not included in the Veterans Administration Surgical Quality Improvement Project data collection. Furthermore, there is no comprehensive protocol in the health system for prospectively measuring outcomes for eye surgery in terms of safety and quality. There are 400,000 operative cases in the system per year. Of those, 48,000 (12%) are ophthalmic surgical cases, with 85% (41,000) of those being cataract cases. The Ophthalmic Surgical Outcome Database Pilot Project was developed to incorporate ophthalmology into VASQIP, thus evaluating risk factors and improving cataract surgical outcomes. Nurse reviewers facilitate the monitoring and measuring of these outcomes. Since its inception in 1778, the Veterans Administration (VA) Health System has provided comprehensive healthcare to millions of deserving veterans throughout the U.S. and its territories. Historically, the quality of healthcare provided by the VA has been the main focus of discussion because it did not meet a standard of care comparable to that of the private sector. Information regarding quality of healthcare services and outcomes data had been unavailable until 1986, when Congress mandated the VA to compare its surgical outcomes to those of the private sector (PL-99-166). 1Risk adjustment of VA surgical outcomes began in 1987 with the Continuous Improvement in Cardiac Surgery Program (CICSP) in which cardiac surgical outcomes were reported and evaluated. 2Between 1991 and 1993, the National VA Surgical Risk Study (N VASRS) initiated a validated risk-adjustment model for predicting surgical outcomes and comparative assessment of the quality of surgical care in 44 VA medical centers. 3The success of NVASRS encouraged the VA to establish an ongoing program for monitoring and improving the quality of surgical care, thus developing the National Surgical Quality Improvement Program (NSQIP) in 1994. 4According to a prospective study conducted between 1991-1997 in 123 VA medical centers by Khuri et al., the 30-day mortality and morbidity rates for major surgeries had decreased by 9% and 30%, respectively. 5 Recently renamed the VA Surgical Quality Improvement Program (VASQIP) in 2010, the quality of surgical outcomes has continued to improve among all documented surgical specialties. Ophthalmic surgery is presumed to have a very low mortality rate and therefore has not been included in the VASQIP database.

Gamble B.T.,Oregon Health And Science University | Brush M.,Oregon Health And Science University | Zirkle M.,Portland VA Healthcare System | Finch D.,James A. Haley Veterans Hospital | And 11 more authors.
CEUR Workshop Proceedings | Year: 2014

Ontologies play an increasingly important role in annotation, integration, and analysis of biomedical data. In this paper, we describe the design and development of a Post-Traumatic Stress Disorder (PTSD) Ontology and how we can use this ontology as a controlled vocabulary for supporting automatic annotation of clinical text. The automated annotation is performed using a natural language processing (NLP) tool called YTEX. In addition, we demonstrate how we can use the concepts and relationships defined in the PTSD Ontology to perform data summarization and categorization.

Blumhardt R.,University of Texas Health Science Center at San Antonio | Wolin E.A.,University of Texas Health Science Center at San Antonio | Wolin E.A.,San Antonio Military Medical Center | Phillips W.T.,University of Texas Health Science Center at San Antonio | And 5 more authors.
Endocrine-Related Cancer | Year: 2014

Differentiated thyroid cancer (DTC) is the most common endocrine malignancy and the fifth most common cancer in women. DTC therapy requires a multimodal approach, including surgery,which is beyond the scope of this paper. However, for over 50 years, the post operative management of the DTC post-thyroidectomy patient has included radioactive iodine (RAI) ablation and/or therapy. Before 2000, a typical RAI post-operative dose recommendation was 100 mCi for remnant ablation, 150 mCi for locoregionalnodal disease, and 175-200 mCi for distant metastases. Recent recommendations have been made to decrease the dose in order to limit the perceived adverse effects of RAI including salivary gland dysfunction and inducing secondary primary malignancies. A significant controversy has thus arisen regarding the use of RAI, particularly in the management of the low-risk DTC patient. This debate includes the definition of the low-risk patient, RAI dose selection, and whether or not RAI is needed in all patients. To allow the reader to forman opinion regarding post-operative RAI therapy in DTC, a literature review of the risks and benefits is presented. © 2014 Society for Endocrinology Printed in Great Britain.

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