subject:(Medical Elective)

University of Adelaide

1. Pham, Clarabelle Thuymai. Evaluation of Services for the Preoperative Assessment and Management of High-Risk Surgical Patients.

Degree: 2019, University of Adelaide

URL: http://hdl.handle.net/2440/120359

► Outpatient preoperative assessment clinics, such as the physician-led high-risk clinic in a large metropolitan public hospital in South Australia, have been established to assess and… (more)

▼ Outpatient preoperative assessment clinics, such as the physician-led high-risk clinic in a large metropolitan public hospital in South Australia, have been established to assess and manage surgical patients at high risk of morbidity and mortality due to their medical co-morbidities. To date, the design and implementation of preoperative medical assessment and management has been heterogeneous, with minimal detail on the actual services provided as part of the intervention. Further, there have been no published studies evaluating the costs and outcomes of physician-led preoperative assessment for patients with modifiable medical co-morbidities prior to elective surgery. Five distinct projects contributed to the main aims of this research: to evaluate the preoperative assessment and management services provided by the physician-led high-risk clinic, and provide recommendations for improvement using an explanatory sequential mixed methods approach. This research represents the first comprehensive evaluation of services for the preoperative assessment and management of high-risk surgical patients. Multiple regression analyses identified nine potentially modifiable medical co-morbidities to be associated with increased length of stay and postoperative complications, supporting the rationale that optimisation of poorly controlled medical co-morbidities prior to surgery could improve postoperative outcomes. The costs and effects of physician-led preoperative assessment and management were evaluated using a propensity score-based approach with retrospective and prospective data. It was found that the clinic reduced the frequency of unnecessary admissions and cancellations but significant uncertainty remained around the effect of the clinic on length of hospital stay, postoperative complications, hospital costs and post-discharge mortality. Supplemental data on a prospective cohort of patients identified preoperative health-related quality of life as a potential unmeasured confounder in the evaluation, with high-risk clinic patients reporting lower mean index scores. Semi-structured interviews with surgeons found that the factors influencing their decision to refer a patient to the high-risk clinic appear to be driven by the aim to manage the uncertainty and risk to the patient regarding surgery and it was seen as a strategy for managing difficult and complex cases. Additionally, the integration of the services provided by the clinic in this study appear to offer additional value in supporting the surgical decision-making process for the surgical team and patient beyond the clinical outcomes, such as managing the patient’s expectations regarding care and assistance after discharge from hospital. Further perspectives from patients and other medical professionals collaborating with the clinic should be explored and would provide further insight into the aspects of care that provide additional value. This evaluation provides a guide to the identification of elective surgical patients who are likely to benefit most from… Advisors/Committee Members: Karnon, Jonathan (advisor), Hoon, Elizabeth (advisor), Ben-Tovim, David (advisor), School of Public Health (school).

Subjects/Keywords: Economic evaluation; health services research; preoperative medical assessment; elective surgery

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APA (6^th Edition):

Pham, C. T. (2019). Evaluation of Services for the Preoperative Assessment and Management of High-Risk Surgical Patients. (Thesis). University of Adelaide. Retrieved from http://hdl.handle.net/2440/120359

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16^th Edition):

Pham, Clarabelle Thuymai. “Evaluation of Services for the Preoperative Assessment and Management of High-Risk Surgical Patients.” 2019. Thesis, University of Adelaide. Accessed February 27, 2021. http://hdl.handle.net/2440/120359.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7^th Edition):

Pham, Clarabelle Thuymai. “Evaluation of Services for the Preoperative Assessment and Management of High-Risk Surgical Patients.” 2019. Web. 27 Feb 2021.

Vancouver:

Pham CT. Evaluation of Services for the Preoperative Assessment and Management of High-Risk Surgical Patients. [Internet] [Thesis]. University of Adelaide; 2019. [cited 2021 Feb 27]. Available from: http://hdl.handle.net/2440/120359.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Pham CT. Evaluation of Services for the Preoperative Assessment and Management of High-Risk Surgical Patients. [Thesis]. University of Adelaide; 2019. Available from: http://hdl.handle.net/2440/120359

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

University of Toronto

2. Kuehner, Zachary. Peace Through Health: Theory and Practice of the International Pediatric Emergency Medicine Elective (IPEME).

Degree: 2010, University of Toronto

URL: http://hdl.handle.net/1807/24592

►

This thesis seeks to evaluate the International Pediatric Emergency Medicine Elective (IPEME) as a case study of a peace-through-health initiative. Using the reasoning of Scolnik… (more)

Subjects/Keywords: Peace Through Health; Medical Elective; Collaboration; Peacebuilding; Evaluation; IPEME; 0350; 0573; 0680

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Kuehner, Z. (2010). Peace Through Health: Theory and Practice of the International Pediatric Emergency Medicine Elective (IPEME). (Masters Thesis). University of Toronto. Retrieved from http://hdl.handle.net/1807/24592

Chicago Manual of Style (16^th Edition):

Kuehner, Zachary. “Peace Through Health: Theory and Practice of the International Pediatric Emergency Medicine Elective (IPEME).” 2010. Masters Thesis, University of Toronto. Accessed February 27, 2021. http://hdl.handle.net/1807/24592.

MLA Handbook (7^th Edition):

Kuehner, Zachary. “Peace Through Health: Theory and Practice of the International Pediatric Emergency Medicine Elective (IPEME).” 2010. Web. 27 Feb 2021.

Vancouver:

Kuehner Z. Peace Through Health: Theory and Practice of the International Pediatric Emergency Medicine Elective (IPEME). [Internet] [Masters thesis]. University of Toronto; 2010. [cited 2021 Feb 27]. Available from: http://hdl.handle.net/1807/24592.

Council of Science Editors:

Kuehner Z. Peace Through Health: Theory and Practice of the International Pediatric Emergency Medicine Elective (IPEME). [Masters Thesis]. University of Toronto; 2010. Available from: http://hdl.handle.net/1807/24592

3. Broström, Monika. Kvinnors önskan om kejsarsnitt utan medicinsk indikation.

Degree: Sophiahemmet University, 2020, Sophiahemmet University

URL: http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3835

► Trots att det i sjukvården betraktas som normalt att föda barn vaginalt väljer en del kvinnor att föda sina barn med hjälp av kejsarsnitt… (more)

▼ Trots att det i sjukvården betraktas som normalt att föda barn vaginalt väljer en del kvinnor att föda sina barn med hjälp av kejsarsnitt utan att det föreligger någon medicinsk indikation, varken för mor eller barn (elektivt sectio). Den medicinska vetenskapen visar att det både är säkrare och bättre i de flesta fall att föda vaginalt, men antalet elektiva kejsarsnitt ökar årligen. Kunskap om vad som driver kvinnor att önska elektivt kejsarsnitt kan öka möjligheten att minska kejsarsnitt som görs utan medicinsk indikation. Kunskapen är viktig för barnmorskor som kan hjälpa gravida kvinnor att i högre grad välja att föda sitt barn vaginalt då det inte föreligger indikation för kejsarsnitt. Syftet med arbetet var att beskriva kvinnors önskan om att föda sitt barn med hjälp av elektivt kejsarsnitt utan att det föreligger någon medicinsk indikation för kejsarsnitt. En litteraturstudie har genomförts där sökningar efter artiklar gjorts i databaserna PubMed, CINAHL och APA PsychInfo. Till studiens resultat har 20 vetenskapliga artiklar, både kvalitativa och kvantitativa artiklar använts. De publicerade studierna är genomförda i olika länder, en del i höginkomstländer och en del i medelinkomstländer enligt måttet bruttonationalprodukt per person och år, vilken beskriver ett lands produktion utifrån dess befolkningsutveckling (BNP per capita). Samtliga artiklar är publicerade mellan åren 2009-2019, och är etiskt godkända. Kvinnors anledning att önska elektivt kejsarsnitt utan medicinsk indikation sammanfattas i detta arbete med två övergripande teman: Vaginal förlossning ett hot och Kejsarsnitt garanterar hälsa och trygghet. Kvinnornas rädsla för vaginal förlossning var en framträdande anledning till att önska kejsarsnitt. Rädslan hade sitt ursprung i egna eller andras negativa erfarenheter av vaginal förlossning. Rädslan grundades också i en oro för att kvinnans utseende och hennes relation skulle påverkas av en vaginal förlossning. Önskan om kejsarsnitt utan medicinsk indikation grundades i en tro om att ingreppet skulle garantera hälsa och trygghet för mor och barn, något som vaginal förlossning inte kunde erbjuda. Den mest framträdande anledningen till att kvinnor önskade kejsarsnitt utan medicinsk indikation var en intensiv rädsla för en vaginal förlossning. Kvinnorna hade uppfattningen att ett kejsarsnitt skulle garantera säkerhet för mor och barn. Det kan inte uteslutas att önskan om elektivt kejsarsnitt kan bero på brist på kunskap. Det finns ytterligare behov av forskning på ämnet, förslagsvis på interventioner från sjukvården som fokuserar på att utbilda födande kvinnor om vinsterna med vaginal förlossning.

Subjects/Keywords: Kejsarsnitt; valbart kejsarsnitt; på moderns begäran; utan medicinsk indikation; cesarean section; elective ceasareans; maternal request; without medical indication; informed choice; Nursing; Omvårdnad

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Broström, M. (2020). Kvinnors önskan om kejsarsnitt utan medicinsk indikation. (Thesis). Sophiahemmet University. Retrieved from http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3835

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16^th Edition):

Broström, Monika. “Kvinnors önskan om kejsarsnitt utan medicinsk indikation.” 2020. Thesis, Sophiahemmet University. Accessed February 27, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3835.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7^th Edition):

Broström, Monika. “Kvinnors önskan om kejsarsnitt utan medicinsk indikation.” 2020. Web. 27 Feb 2021.

Vancouver:

Broström M. Kvinnors önskan om kejsarsnitt utan medicinsk indikation. [Internet] [Thesis]. Sophiahemmet University; 2020. [cited 2021 Feb 27]. Available from: http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3835.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Broström M. Kvinnors önskan om kejsarsnitt utan medicinsk indikation. [Thesis]. Sophiahemmet University; 2020. Available from: http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3835

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

University of Kansas

4. O'Toole, Thomas M. An analysis of factors association with responsibility attribution in incidents of medical malpractice.

Degree: PH.D., Communication Studies, 2007, University of Kansas

URL: http://hdl.handle.net/1808/4047

► Approximately twelve-hundred medical malpractice claims make it to the state courts each year. Within this setting, a growing concern is the influence of extralegal factors,… (more)

Subjects/Keywords: Law; Psychology; Speech communication; Medical severity elective malpractice responsibility attribution

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

O'Toole, T. M. (2007). An analysis of factors association with responsibility attribution in incidents of medical malpractice. (Doctoral Dissertation). University of Kansas. Retrieved from http://hdl.handle.net/1808/4047

Chicago Manual of Style (16^th Edition):

O'Toole, Thomas M. “An analysis of factors association with responsibility attribution in incidents of medical malpractice.” 2007. Doctoral Dissertation, University of Kansas. Accessed February 27, 2021. http://hdl.handle.net/1808/4047.

MLA Handbook (7^th Edition):

O'Toole, Thomas M. “An analysis of factors association with responsibility attribution in incidents of medical malpractice.” 2007. Web. 27 Feb 2021.

Vancouver:

O'Toole TM. An analysis of factors association with responsibility attribution in incidents of medical malpractice. [Internet] [Doctoral dissertation]. University of Kansas; 2007. [cited 2021 Feb 27]. Available from: http://hdl.handle.net/1808/4047.

Council of Science Editors:

O'Toole TM. An analysis of factors association with responsibility attribution in incidents of medical malpractice. [Doctoral Dissertation]. University of Kansas; 2007. Available from: http://hdl.handle.net/1808/4047

5. Jemander, Joel. Anestesidjup och anestesiduration hos elektiva ortopediska patienter som upplevt påverkan på kognitiv funktion postoperativt.

Degree: Nursing Care, 2019, Luleå University of Technology

URL: http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-74715

► Abstrakt Bakgrund: Forskning visar att generell anestesi kan bidra till kognitiv dysfunktion postoperativt. En alltför djup anestesi och/eller en lång duration av anestesi är… (more)

Subjects/Keywords: Depth of anesthesia; duration of anesthesia; cognitive dysfunction and elective orthopedic patients.; Anestesidjup och anestesiduration hos elektiva ortopediska patienter som upplevt påverkan på kognitiv funktion postoperativt.; Other Medical Sciences not elsewhere specified; Övrig annan medicin och hälsovetenskap; Nursing; Omvårdnad

…operative cognitive decline (POCD) in older patients undergoing elective surgery, a… …artery disease: A literature review. Journal of International Medical Research, 46(10)… …J. E. (2016). Guyton and hall, textbook of medical physiology. Elsevier. Hussain… …attention network test. Medical Science Monitor: International Medical Journal of Experimental and…

3 more images…

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Jemander, J. (2019). Anestesidjup och anestesiduration hos elektiva ortopediska patienter som upplevt påverkan på kognitiv funktion postoperativt. (Thesis). Luleå University of Technology. Retrieved from http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-74715

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16^th Edition):

Jemander, Joel. “Anestesidjup och anestesiduration hos elektiva ortopediska patienter som upplevt påverkan på kognitiv funktion postoperativt.” 2019. Thesis, Luleå University of Technology. Accessed February 27, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-74715.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7^th Edition):

Jemander, Joel. “Anestesidjup och anestesiduration hos elektiva ortopediska patienter som upplevt påverkan på kognitiv funktion postoperativt.” 2019. Web. 27 Feb 2021.

Vancouver:

Jemander J. Anestesidjup och anestesiduration hos elektiva ortopediska patienter som upplevt påverkan på kognitiv funktion postoperativt. [Internet] [Thesis]. Luleå University of Technology; 2019. [cited 2021 Feb 27]. Available from: http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-74715.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Jemander J. Anestesidjup och anestesiduration hos elektiva ortopediska patienter som upplevt påverkan på kognitiv funktion postoperativt. [Thesis]. Luleå University of Technology; 2019. Available from: http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-74715

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Virginia Commonwealth University

6. Lucas, D. Pulane. Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital.

Degree: PhD, Public Policy & Administration, 2013, Virginia Commonwealth University

URL: https://doi.org/10.25772/X2DF-RY91 ; https://scholarscompass.vcu.edu/etd/2996

► Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures… (more)

▼ Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into… Advisors/Committee Members: Carl F. Ameringer, Roice D. Luke, Wally R. Smith, I-Shian Suen.

Subjects/Keywords: Disruptive; Disruptive Innovation Theory; Disruptive Transformations; Disruptive Innovation; Innovation; Technology; Technological Innovation; Medical Innovation; Medical Technology; Medical Advancement; Laparoscopy; Laparoscopic Surgery; open surgery; appendectomy; cholecystectomy; bariatric surgery; weight loss surgery; appendectomies; cholecystectomies; inpatient; outpatient; ambulatory; ambulatory surgery; ambulatory surgery center; acute care general hospital; hospital; acute care hospital; general hospital; health care; healthcare; hospital industry; health care industry; Clayton Christensen; Clayton M Christensen; Michael Porter; Harvard Business School; Virginia Commonwealth University; Center for Medicare & Medicaid Services; CMS; Health policy; public policy; public administration; organizational theory; organization theory; Population Ecology Theory; Competitive Strategy; policy analysis; John Kimberly; Organization Size; Structural Inertia; liability of smallness; health spending; health care cost; specialty medical facility; open system; niche width dynamic; outpatient department; technology shift; surgical setting; surgical setting shift; medical facility shift; substitution threat; health system; system level analysis; Ecological Approach; hospital trends; ambulatory surgery trends; reimbursement rate; Medicare; CMS coverage decision; P J DiMaggio; DiMaggio and Powell; w w Powell; Hannan and Freeman; M T Hannan; Organizational change; minimally invasive surgery; less invasive surgery; Prospective Payment System; Outpatient Prospective Payment System; entreprenuerial physician; health care organization; health care management; Roice Luke; Carl Ameringer; new technology; surgical utilization; elective surgery; Medicare Payment Advisory Commission; MedPAC; coverage decision; trends in surgery; abdominal surgery; surgical variation; physician-owned; physician ownership; physician autonomy; outpatient clinic; utilization trends; unnecessary surgery; Pfeffer Salancik; technology diffusion; redefining health care; interdisciplinary research; health care delivery; panel design; diffusion of hospital technology; state variation; regional variation; local health care market; government intervention; medical facility; health care capacity; focused factory; advances in health care; physician organization relationship; hospital competition; medical specialization; hospital expansion; medical arms race; integrated care; integrated health system; J E Wennberg; health care transformation; reimbursement scheme; surgical volume; Florida; Wisconsin; policy making; health policy analysis; competitive dynamics; center of excellence; intervening factor; service line competition; service-line competition; surgical reimbursement; innovative business model; innovative technology; environmental influence; established firm; new market entrant; patient safety; sophisticated technology; Harvard Divinity School; Wilder School of Government and Public Affairs; Public Affairs, Public Policy and Public Administration; Social and Behavioral Sciences

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Lucas, D. P. (2013). Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital. (Doctoral Dissertation). Virginia Commonwealth University. Retrieved from https://doi.org/10.25772/X2DF-RY91 ; https://scholarscompass.vcu.edu/etd/2996

Chicago Manual of Style (16^th Edition):

Lucas, D Pulane. “Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital.” 2013. Doctoral Dissertation, Virginia Commonwealth University. Accessed February 27, 2021. https://doi.org/10.25772/X2DF-RY91 ; https://scholarscompass.vcu.edu/etd/2996.

MLA Handbook (7^th Edition):

Lucas, D Pulane. “Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital.” 2013. Web. 27 Feb 2021.

Vancouver:

Lucas DP. Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital. [Internet] [Doctoral dissertation]. Virginia Commonwealth University; 2013. [cited 2021 Feb 27]. Available from: https://doi.org/10.25772/X2DF-RY91 ; https://scholarscompass.vcu.edu/etd/2996.

Council of Science Editors:

Lucas DP. Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital. [Doctoral Dissertation]. Virginia Commonwealth University; 2013. Available from: https://doi.org/10.25772/X2DF-RY91 ; https://scholarscompass.vcu.edu/etd/2996

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