Health Care in the Next Curve: Transforming a Dysfunctional Industry

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Nov 122018
 

Healthcare in the U.S. is a critical juncture. We face a sharp upward rise in the number of people with chronic diseases and disabilities. As demands on our current health system grow, so will costs. But as a society we are approaching the upper limit of how much we are willing (or able) to spend on health care. Health care policy makers know this. That is why major health reform measures are focused on population health and value-based care. These are the so-called second curve objectives. But these initiatives are doomed to failure. We are asking a system to do things that it was not designed to do.

In fact, we don’t have a health care “system” as such. We have a parts bin of disconnected silos. Fragmented delivery systems. Specialized caregivers. Professional groups. Trade associations. All with distinct cultures. Each with their own motivations and agendas.

Our payer and regulatory structures have evolved over the decades in response to political and policy initiatives. However well intentioned (or not), these structures defy logic. They reward and reinforce counter-productive industry behaviors. They pose formidable roadblocks to achieving needed changes.

Current reform initiatives are an implicit recognition that our health model is flawed. The attitude seems to be, “Yes, we know the overall health system is a problem, but we can make failure less severe if we implement these measures.” We are at a critical juncture. We can continue to place additional demands on an industry model that has outlived its functional utility. Or we can take more of a clean slate approach and move toward a model that is in keeping with today’s needs.

The outlook is not good if we stay on the current curve. The demands on resources will continue their upward trajectory. The default scenario will be one of rationing and less to invest in new cures and new technologies. The good news is that we are within sight of a future state of health care that can really work. In this future state, we have gotten rid of the artificial barriers to effective and efficient patient care. Physicians and other health professionals work in a coordinated, inter-disciplinary fashion. They have accountability for the whole care cycle. Caregivers have both the flexibility and encouragement to innovate and come up with optimal delivery approaches. And because they are in a risk-reward relationship with payers, they have the incentives to provide true value. Patients feel intimately connected to a system that is focused on their specific needs.

The key to this future state is good old-fashioned market discipline. Other delivery models must either improve or get out of the way. The market will demand cost-efficiencies and won’t tolerate waste. Much of our regulatory structure will be rendered unnecessary. There will be not rewards for poor performance.

This book takes a unique macro-level perspective of clinical, economic, and regulatory problems and possible solutions. It takes an objective and something scathing look at current industry structure: a silo-driven culture and entrenchment that is driven by self-interest; as well as the complicity of government in preserving the status quo through regulations, licensure, payment systems, etc.

About the Author
John Abendshien is founder and President of Integrated Clinical Solutions, Inc., a national healthcare consulting firm headquartered in Chicago, IL. He has over 40 years of experience providing consulting and advisory services to healthcare organizations in the areas of enterprise strategy, integrated clinical service line development, management/governance organizational design, mergers, and network formation. John has conducted over 400 consulting engagements across the United States and in Canada and UK. His work has encompassed engagements with a broad range of organizations, including community hospitals, healthcare systems, county systems, academic medical centers, physician groups, and professional and trade organizations.

John is a frequent speaker and lecturer on the subject of strategic planning and organizational change management. He is a Past Chair of the American Association of Healthcare Consultants, and has served as a member of the Governance 100. Previously he was a Partner of Ernst & Young and for a number of years served as National Directory of EY’s healthcare strategy practice.

John holds BS in Finance, MBA, and MS Health Services Administration degrees from University of Missouri-Columbia; and completed an administrative residency at University of Washington Medical Center, Seattle

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The Osteoperiosteal Flap: A Simplified Approach to Alveolar Bone Reconstruction

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Nov 102018
 

This elaborately illustrated and concisely written book takes a fresh look at alveolar bone reconstruction, positing that the vitality of the gingiva-alveolus-implant complex is more important than simple implant longevity. With the use of osteoperiosteal flaps, the surgeon manipulates available bone to recover what is missing in a very specific way: endosteally. This relatively closed wound approach seems to spontaneously activate the epigenetic signal within the gingivoalveolar complex, and the augmentation develops in a manner analogous to primordial growth. Soft tissue generally follows suit, and implant therapy can commence, creating a functional gingiva-alveolus-implant matrix. Once mastered, bone flaps can almost entirely eliminate the need for block grafting or guided bone regeneration. The culmination of many years of clinical research independently conducted by experts around the world, this volume presents procedures for various osteoperiosteal flaps that are not only easy to learn but result in significantly fewer complications and a more vital alveolar reconstruction. It is intended for the “wet finger” clinician the private practitioner, who must use techniques that work consistently, minimize morbidity, and are simple and relatively quick to perform. The osteoperiosteal flap, in its various permutations, fulfills these criteria beautifully.ContentsSection I: Biologic Rationale1. Biologic Basis of the Osteoperiosteal Flap2. A New Biologic Classification of Bone AugmentationSection II: Distraction Osteogenesis Techniques3. Alveolar Distraction Osteogenesis4. Supraperiosteal Transport Distraction Osteogenesis5. Rapid Alveolar Expansion of Osteoperiosteal FlapsSection III: Pedicled Segmental Osteotomy Techniques6. Book Bone Flap7. Island Osteoperiosteal Flap8. Internal Alveolar Split Bone Graft9. Sandwich Osteotomy Bone Graft in the Anterior Maxilla10. Sandwich Osteotomy Combined with Extraction Socket Bone Graft11. Sandwich Osteotomy Bone Graft in the Anterior Mandible12. Smile Osteotomy13. Sinus Graft Combined with Osteoperiosteal Flaps14. Maxillary Alveolar Split Horseshoe Osteotomy15. Sinus Floor Intrusion as a Vascularized Osteoperiosteal FlapSection IV: Restorative Techniques16. Alveolar Design by Stereolithography17. Esthetically Driven Prosthetic Management of Osteoperiosteal Flaps18. Esthetically Driven Surgical and Prosthetic Management of Alveolar Distraction Osteogenesis19. Recombinant Protein Application for Bony and Periodontal Augmentation20. Dental Implant Repositioning by Osteotomy in the Esthetic ZoneSection V: Developing Technologies21. Osteoperiosteal Tissue-Engineered Injectable Bone22. De Novo Tooth Engineering to Replace Lost Teeth
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Frozen Section Library: Breast

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Nov 082018
 

The Frozen Section Library series provides concise, user-friendly, site specific handbooks that are well illustrated and highlight the pitfalls, artifacts and differential diagnosis issues that arise in the hurried frozen section scenario.

Frozen Section Library: Breast provides an easy reference and pocket book about the nuances of adequately handling breast specimens in a fashion that meets the increasingly complex environment of breast pathology. The pros and cons of frozen section versus use of touch imprint as well as related quality assurance requirements are addressed. Other less common uses of intraoperative evaluation, such as diagnosis and margin evaluation are described. The volume includes recommended guidelines for evaluation and documentation of specific gross pathologic features, in conjunction with radiological imaging. Techniques and protocols for such examinations are illustrated. The volume closes with an overview of the newly published guidelines for handling a variety of breast specimens, which are intended to be used for assessment of predictive factors. Syed K. Mohsin, M.D. is the Head of Breast Pathology and Medical Director, Immunohistochemistry, Riverside Methodist Hospital, Columbus, OH

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Foundations of nursing: an integrated approach

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Nov 062018
 

Combines anatomy and physiology with principles of nursing practice to present an approach to patient care and the nurse’s role. This title introduces the role of the nurse and the scope of practice (accountability, EBP, EBL etc). It then looks at each body system in turn.
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Otolaryngology Board Review (3rd Edition)

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Nov 012018
 

This quick-hit question and answer review for the Otolaryngology in-service and board exams provides intense, streamlined review and is a comprehensive last minute review.

Pearls of Wisdom: Otolaryngology Board Review, 3rd edition is a quick-hit question and answer review for the otolaryngology boards.The unique question and correct-answer-only format eliminates the guesswork associated with traditional multiple-choice Q&A reviews and eliminates the possibility of an incorrect answer staying in your mind.

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Hemodiafiltration: Theory, Technology and Clinical Practice

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Oct 222018
 

This book gives a complete description of online hemodiafiltration, in five sections. It is unique in the systematic and complete way in which hemodiafiltration is described. Each chapter is completed by a point-to-point summary of essential information, in a separate text box. Part of the book is dedicated to the theoretical background of convective clearance. In this part, safety issues and quality control is reviewed (especially on the quality of water for dialysis and substitution fluid), as well as equipment (both dialyzers and machines) with which this treatment can be performed. As recently the results of several randomized controlled trials were available, the effect of hemodiafiltration on hard clinical end points (mortality and morbidity) is discussed in detail. This has not been done before, as the most recent book/journal on hemodiafiltration was published in 2011, before the results of the 3 randomized controlled trials were published. Furthermore, the methodological quality of the trials is discussed by an expert, in order to help the readers in their judgment of the trials Part of the book concentrates on the effect of the treatment on several biomarkers and uremic toxins. Several clinically relevant issues is discussed separately, such as the prescription of anticoagulation during the treatment, drug prescription and clearance for patients treated with hemodiafiltration, and hemodynamic stability. Finally, a practical guide on how to perform the treatment is provided. In this unique section, seemingly simple but important details of hemodiafiltration-treatment is discussed, such as the importance of needle size for blood flow rates, the difference between filtration fraction and substitution ratio, the different targets that can be set and how to reach them. As most literature is mainly focused on theoretical issues, this unique feature really will help the field to perform hemodiafiltration, and answer practical questions

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Chronic obstructive lung diseases 2

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Oct 212018
 

This clinical reference for practitioners offers a new and comprehensive look at chronic obstructive lung disease. Global in scale and importance, it is an important cause of morbidity and mortality. Bringing together a roster of internationally renowned contributors from the front lines of pulmonary medicine and research, this book is aimed at practitioners in pulmonary medicine, pathology, thoracic radiology and epidemiology. Its focus is on the pathobiology of chronic obstructive pathology disease and emphysema and its exacerbation of chronic obstructive pulmonary disease and on treatment options.

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The Greenberg Rapid Review: A Companion to the 8th Edition

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Oct 202018
 

Written by an esteemed educator and founder of the renowned Chicago Review Course in Neurological Surgery™, this updated review reflects substantive content additions to the 8th edition. The two prior editions of the Rapid Review were must-have companions that fully leveraged the vast knowledge contained within Greenberg’s legendary tome.

Through repetition and spot-on questions, this book brings clarity to a specialty whose sheer depth and breadth presents comprehension and retention challenges. This book helps readers determine if they are retaining key data and information, thereby providing a robust self-assessment study tool for ABNS certification.

The 7th companion generated glowing reviews, such as: “A wonderful example of how to turn the classic Greenberg text into a study guide rather than an encyclopedic reference to a young neurosurgeon” -AANS Young Neurosurgeons News

Key Highlights:

Question formats include fill in the blank, open-ended questions, true/false, matching, and identification of various elements in diagrams/figures
Mnemonic devices, helpful hints, clinical pearls, and study charts aid in comprehension and long-term retention
Greenberg chapter headings are used (e.g. 4.2.3), thereby providing clear-cut Handbook references
This book is designed to help neurosurgical residents prepare for the ABNS primary examination and/or rounds. It will enable practicing neurosurgeons, neurologists, neuroradiologists, and neuropathologists to develop a storehouse of knowledge required to efficaciously examine, analyze, diagnose, and treat neurosurgical patients.

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Aging and Aging-Related Diseases: Mechanisms and Interventions

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Oct 202018
 

This book provides an overview of recent advances in the study of aging and aging related diseases, discussing the topics at individual, organ, tissue, cell, and molecular levels. It also presents studies on the biomarkers of aging and anti-aging interventions.
Aging has been becoming a global health problem. However it was not possible to determine aging as we usually diagnose a disease because there are few biomarkers for age estimation. Since ancient times, people have been seeking anti-aging substances and methods for achieving immortality, while the scientific study of aging has only existed for 100 years. This book appeals to researchers both in institutes and in pharmaceutical companies interested in further studies in this field.

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My Imaginary Illness: A Journey into Uncertainty and Prejudice in Medical Diagnosis

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Oct 182018
 

At age twenty-one, Chloë Atkins began suffering from a mysterious illness, the symptoms of which rapidly worsened. Paralyzed for months at a time, she frequently required intubation and life support. She eventually became quadriplegic, dependent both on a wheelchair and on health professionals who refused to believe there was anything physically wrong with her. When test after test returned inconclusive results, Atkins’s doctors pronounced her symptoms psychosomatic. Atkins was told not only that she was going to die but also that this was her own fault; they concluded she was so emotionally deranged that she was willing her own death.

My Imaginary Illness is the compelling story of Atkins’s decades-long battle with a disease deemed imaginary, her frustration with a succession of doctors and diagnoses, her immersion in the world of psychotherapy, and her excruciating physical and emotional journey back to wellness. As both a political theorist and patient, Atkins provides a narrative critique of contemporary medicine and its problematic handling of uncertainty and of symptoms that are not easily diagnosed or known. She convincingly illustrates that medicine’s belief in evidence-based practice does not mean that individual doctors are capable of objectivity, nor that the presence of biomedical ethics invokes ethical practices in hospitals and clinics.

A foreword by Bonnie Blair O’Connor, who teaches medical students how to listen to patients, and a clinical commentary by Dr. Brian David Hodges, a professor of psychiatry, enrich the book’s narrative with practical guidance for medical practitioners and patients alike.

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