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Procedure volume is potentially important for physicians learning a new procedure and for practicing physicians to maintain proficiency. Volume standards for training are largely based on opinion. In contrast, there are substantia...
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Procedure volume is potentially important for physicians learning a new procedure and for practicing physicians to maintain proficiency. Volume standards for training are largely based on opinion. In contrast, there are substantial data showing that the volume of procedures performed by a hospital or physician in practice has an inverse relationship with clinical outcomes: higher volumes are associated with better outcomes. Increased procedure volume for implantable defibrillators has been associated with lower short-term complication rates. The controversial policy implications of these observations are discussed.
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This paper examines attempts by members of a remote Aboriginal community in the Northern Territory (NT), Australia, to control alcohol use, and the impact of policy decisions taken by national, territory and local governments on t...
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This paper examines attempts by members of a remote Aboriginal community in the Northern Territory (NT), Australia, to control alcohol use, and the impact of policy decisions taken by national, territory and local governments on those attempts between 2007 and 2017. The Australian Government's main policy instrument for reducing alcohol-related harms from 2010 was the Alcohol Management Plan (AMP), officially defined as a plan, negotiated at a local community level with a high level of community input, for the effective management of alcohol use by the local community.
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Governments and international organizations increasingly pursue the development of integrated policy strategies to govern persistent societal problems that crosscut the boundaries of traditional jurisdictions. In spite of the risi...
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Governments and international organizations increasingly pursue the development of integrated policy strategies to govern persistent societal problems that crosscut the boundaries of traditional jurisdictions. In spite of the rising popularity of such integrated strategies, little is known about their effects. Although it is generally assumed that integrated strategies result in better outcomes, the evidence base to support this claim is sparse. This is not to say that no attempts to study the relationship between integrated strategies and policy outcomes have been undertaken at all; this paper presents a research synthesis of the fragmented evidence base. Eligible studies are interpreted and discussed by using a heuristic that distinguishes between programmatic and political success and failure. Apart from synthesizing the impacts that integrated strategies have had, the paper reflects on associated explanatory conditions and methodological approaches that have been used. The review almost exclusively finds reports of failure and constraining conditions. At the same time, methodological approaches are found to be largely unconvincing and considerable research gaps remain. The paper, therefore, ends with a nuanced answer to the question of whether integrated strategies are worth pursuing and sets out various avenues for further research.
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This paper provides a survey of policy process theories and their usefulness in transitions research. Some research has already used such theories, but often in an ad hoc and relatively cursory way and with little attention to pot...
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This paper provides a survey of policy process theories and their usefulness in transitions research. Some research has already used such theories, but often in an ad hoc and relatively cursory way and with little attention to potential alternatives. However, it has been argued that transition scholars need to pay more attention to the politics of policy processes. We argue that a critical stocktaking of policy process theories is a prerequisite for future transition studies that more systematically respond to these challenges. Therefore, we review five prominent policy process theories and their applicability in transition studies. We point to two weaknesses of empirical applications of these approaches that are of particular relevance for transitions research: their focus on single instruments or policy packages, and their neglect of policy outcomes. We conclude by suggesting avenues for research on the linkages between policy processes, policy mixes, and socio-technical change.
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Abstract Omega‐3 fatty acids are a group of polyunsaturated fatty acids that play a critical role in the human body. The three main types of omega‐3 fatty acids are alpha‐linolenic acid, eicosapentaenoic acid and docosahexaenoi...
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Abstract Omega‐3 fatty acids are a group of polyunsaturated fatty acids that play a critical role in the human body. The three main types of omega‐3 fatty acids are alpha‐linolenic acid, eicosapentaenoic acid and docosahexaenoic acid. This review describes characteristics of omega‐3 fatty acids and their ability to reduce blood pressure and improve cardiovascular health.
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The initial policy response to the COVID-19 pandemic has differed widely across countries. Such variability in government interventions has made it difficult for policymakers and health research systems to compare what has happene...
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The initial policy response to the COVID-19 pandemic has differed widely across countries. Such variability in government interventions has made it difficult for policymakers and health research systems to compare what has happened and the effectiveness of interventions across nations. Timely information and analysis are crucial to addressing the lag between the pandemic and government responses to implement targeted interventions to alleviate the impact of the pandemic.To examine the effect government interventions and technological responses have on epidemiological and economic outcomes, this policy paper proposes a conceptual framework that provides a qualitative taxonomy of government policy directives implemented in the immediate aftermath of a pandemic announcement and before vaccines are implementable. This framework assigns a gradient indicating the intensity and extent of the policy measures and applies the gradient to four countries that share similar institutional features but different COVID-19 experiences: Italy, New Zealand, the United Kingdom and the United States of America.Using the categorisation framework allows qualitative information to be presented, and more specifically the gradient can show the dynamic impact of policy interventions on specific outcomes. We have observed that the policy categorisation described here can be used by decision-makers to examine the impacts of major viral outbreaks such as SARS-CoV-2 on health and economic outcomes over time. The framework allows for a visualisation of the frequency and comparison of dominant policies and provides a conceptual tool to assess how dominant interventions (and innovations) affect different sets of health and non-health related outcomes during the response phase to the pandemic.Policymakers and health researchers should converge toward an optimal set of policy interventions to minimize the costs of the pandemic (i.e., health and economic), and facilitate coordination across governance levels before effective vaccines are produced. The proposed framework provides a useful tool to direct health research system resources and build a policy benchmark for future viral outbreaks where vaccines are not readily available.
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After successfully improving access to education in the early 1990s through virtually universal primary school completion and similar positive trends at the senior secondary level in 2005, Indonesia began investing heavily in impr...
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After successfully improving access to education in the early 1990s through virtually universal primary school completion and similar positive trends at the senior secondary level in 2005, Indonesia began investing heavily in improving learning outcomes. For almost a decade, the country has been spending about a fifth of its public funds on education. In particular, teachers have received significant salary increases through a certification programme. This paper provides a long-run overview of numeracy and literacy among fifteen-year-old Indonesians using an international test, spanning from 2003 until 2015. It is found that improvements in learning levels are too small to justify the substantial investments that the country has undertaken. The government's major education policies have not produced the expected results. It is argued that without adding accountability measures that focus on learning outcomes, there is little chance for the investments to provide noteworthy returns in the form of remarkably improved learning outcomes.
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BACKGROUND & AIMS: Colonoscopy is a common procedure, yet little is known about variations in colonoscopy quality among outpatient facilities. We developed an outcome measure to profile outpatient facilities by estimating risk-standardized rates of unplanned hospital visits within 7 days of colonoscopy. METHODS: We used a 20% sample of 2010 Medicare outpatient colonoscopy claims (331,880 colonoscopies performed at 8140 facilities) from patients >= 65 years or older, and developed a patient-level logistic regression model to estimate the risk of unplanned hospital visits (ie, emergency department visits, observation stays, and inpatient admissions) within 7 days of colonoscopy. We then used the patient-level risk model variables and hierarchical logistic regression to estimate facility rates of risk-standardized unplanned hospital visits using data from the Healthcare Cost and Utilization Project (325,811 colonoscopies at 992 facilities), from 4 states containing 100% of colonoscopies per facility. RESULTS: Outpatient colonoscopies were followed by 5412 unplanned hospital visits within 7 days (16.3/1000 colonoscopies). Hemorrhage, abdominal pain, and perforation were the most common causes of unplanned hospital visits. Fifteen variables were independently associated with unplanned hospital visits (c = 0.67). A history of fluid and electrolyte imbalance (odds ratio [OR] = 1.43; 95% confidence interval [CI]: 1.29-1.58), psychiatric disorders (OR = 1.34; 95% CI: 1.22-1.46), and, in the absence of prior arrhythmia, increasing age past 65 years (aged >85 years vs 65-69 years: OR = 1.87; 95% CI: ...
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BACKGROUND & AIMS: Colonoscopy is a common procedure, yet little is known about variations in colonoscopy quality among outpatient facilities. We developed an outcome measure to profile outpatient facilities by estimating risk-standardized rates of unplanned hospital visits within 7 days of colonoscopy. METHODS: We used a 20% sample of 2010 Medicare outpatient colonoscopy claims (331,880 colonoscopies performed at 8140 facilities) from patients >= 65 years or older, and developed a patient-level logistic regression model to estimate the risk of unplanned hospital visits (ie, emergency department visits, observation stays, and inpatient admissions) within 7 days of colonoscopy. We then used the patient-level risk model variables and hierarchical logistic regression to estimate facility rates of risk-standardized unplanned hospital visits using data from the Healthcare Cost and Utilization Project (325,811 colonoscopies at 992 facilities), from 4 states containing 100% of colonoscopies per facility. RESULTS: Outpatient colonoscopies were followed by 5412 unplanned hospital visits within 7 days (16.3/1000 colonoscopies). Hemorrhage, abdominal pain, and perforation were the most common causes of unplanned hospital visits. Fifteen variables were independently associated with unplanned hospital visits (c = 0.67). A history of fluid and electrolyte imbalance (odds ratio [OR] = 1.43; 95% confidence interval [CI]: 1.29-1.58), psychiatric disorders (OR = 1.34; 95% CI: 1.22-1.46), and, in the absence of prior arrhythmia, increasing age past 65 years (aged >85 years vs 65-69 years: OR = 1.87; 95% CI: 1.54-2.28) were most strongly associated. The facility risk-standardized unplanned hospital visits calculated using Healthcare Cost and Utilization Project data showed significant variation (median 12.3/1000; 5th-95th percentile, 10.5-14.6/1000). Median risk-standardized unplanned hospital visits were comparable between ambulatory surgery centers and hospital outpatient departments (each was 10.2/1000), and ranged from 16.1/1000 in the Northeast to 17.2/1000 in the Midwest. CONCLUSIONS: We calculated a risk-adjusted measure of outpatient colonoscopy quality, which shows important variation in quality among outpatient facilities. This measure can make transparent the extent to which patients require follow-up hospital care, help inform patient choices, and assist in quality-improvement efforts.
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Individuals who spent time in foster care as children fare on average worse than non-placed peers in early adult life. Recent research on the effect of foster care placement on early adult life outcomes provides mixed evidence. So...
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Individuals who spent time in foster care as children fare on average worse than non-placed peers in early adult life. Recent research on the effect of foster care placement on early adult life outcomes provides mixed evidence. Some studies suggest negative effects of foster care placement on early adult outcomes, others find null effects. This study shows that differences in the average duration of foster care stays explain parts of these discordant findings and then test how foster care duration shapes later life outcomes using administrative data on 7220 children. The children experienced different average durations of foster care because of differences in exposure to a reform. Later born cohorts spent on average 3 months longer in foster care than earlier born cohorts. Isolating exogenous variation in duration of foster care, the study finds positive effects of increased duration of foster care on income and labor market participation.
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During the 20th century, dramatic changes in the manner and location of care for the dying resulted in the conception and birth of the American hospice movement. Idealistic nurses, social workers, clergy, and others concerned abou...
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During the 20th century, dramatic changes in the manner and location of care for the dying resulted in the conception and birth of the American hospice movement. Idealistic nurses, social workers, clergy, and others concerned about the plight of terminally ill cancer patients launched hospice as a necessary healthcare reform. As new hospice programs opened across the country, the idealism of the early leaders gave way to more pragmatic issues such as program viability. As hospice was studied and integrated into the healthcare system, it came to be redefined by the politics of health policy and the healthcare industry. As a result, there is a disarticulation between the needs of seriously ill persons and their families and the healthcare that is available to them. Important lessons can be learned from the history of the Medicare hospice benefit to help guide current palliative care policy initiatives. While formalized reimbursement for hospice enhanced organizational sustainability, many critical issues remain.
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