Sláintecare implementation status in 2020: Limited progress with entitlement expansion

The Sláintecare report developed by political consensus sets out a ten year plan for achieving Universal Health Care (UHC) in Ireland. This paper evaluates the design and progress of the report to mid 2020, but with some reflection on the new COVID 19 era, particularly as it relates to the expansion of entitlements to achieve UHC. The authors explore how close Sláintecare is to the UHC ideal. They also review the phased strategy of implementation in Sláintecare that utilises a systems-thinking approach with interlinkages between entitlements, funding, capacity and implementation. Finally the authors review the Sláintecare milestones against the reality of implementation since the publication of the report in 2017, cognisant of government policy and practice. Some of the initial assumptions around the context of Sláintecare were not realised and there has been limited progress made toward expanding entitlements, and certainly short of the original plan. Nevertheless there have been positive developments in that there is evidence that Government’s Implementation Strategy and Action Plans are focussing on reforming a complex adaptive system rather than implementing a blueprint with such initiatives as integrated care pilots and citizen engagement. The authors find that this may help the system change but it risks losing some of the essential elements of entitlement expansion in favour of organisational change.     

A National Analysis of Minimally Invasive Vs Open Segmentectomy for Stage IA Non–Small-Cell Lung Cancer

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Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020

Health and logistical needs in emergencies have been well recognised. The last 7 years has witnessed improved professionalisation and standardisation of care for disaster affected communities – led in part by the World Health Organisation Emergency Medical Team (EMT) initiative.Mass casualty incidents (MCIs) resulting in burn injuries present unique challenges. Burn management benefits from specialist skills, expert knowledge, and timely availability of specialist resources. With burn MCIs occurring globally, and wide variance in existing burn care capacity, the need to strengthen burn care capability is evident. Although some high-income countries have well-established disaster management plans, including burn specific plans, many do not – the majority of countries where burn mass casualty events occur are without such established plans. Developing globally relevant recommendations is a first step in addressing this deficit and increasing preparedness to deal with such disasters.Global burn experts were invited to a succession of Technical Working Group on burns (TWGB) meetings to:1) review literature on burn care in MCIs; and2) define and agree on recommendations for burn care in MCIs.The resulting 22 recommendations provide a framework to guide national and international specialist burn teams and health facilities to support delivery of safe care and improved outcomes to burn patients in MCIs.     

Are Medicare's Nursing Home Compare Ratings Accurate Predictors of 90-Day Complications,Readmission, and Bundle Cost for Patients Undergoing Primary Total Joint Arthroplasty?

Background

Nursing Home Compare (NHC) ratings, created and maintained by Medicare, are used by both hospitals and consumers to aid in the skilled nursing facility (SNF) selection process. To date, no studies have linked NHC ratings to actual episode-based outcomes. The purpose of this study was to evaluate whether NHC ratings are valid predictors of 90-day complications, readmission, and bundle costs for patients discharged to an SNF after primary total joint arthroplasty (TJA).

Defining the learning curve in robot-assisted thoracoscopic lobectomy

Background

Robot-assisted thoracoscopic lobectomy has been shown to be a safe approach to pulmonary lobectomy. This study sought to define, mathematically, the learning curve for RATS lobectomy.

Evaluation of a Fluorescence-aided Identification Technique (FIT) to assist clean-up after orthodontic bracket debonding

Objectives:To compare a fluorescence-aided identification technique (FIT) with a conventional light source (CLS) for removing composite during debonding of brackets with respect to time needed, composite remnants, and tooth substance loss.Materials and Methods:Twelve maxillary models with 10 bovine teeth each were digitally surface-scanned and metal brackets were bonded on each tooth with Opal Seal and Opal Bond. Two operators: an experienced orthodontist (A) and an undergraduate student (B) received six models each and were asked to remove the composite remnants with a tungsten carbide bur and Sof-Lex discs by both a conventional light source (CLS group, n = 3), and fluorescent inducing light (FIT group, n = 3). The time taken was recorded, and a postoperative scan was digitally superimposed on the preoperative scan to quantify number of teeth with composite remnants and volume and thickness of enamel loss and composite remnants. Chi-square test and independent t-tests were performed to compare methods with a significance level of 5%.Results:Compared to CLS, both operators needed significantly less time when using the FIT method and degree of enamel loss, height, and volume of composite remnants and total remaining composite remnants were significantly reduced. By FIT, the volume of enamel loss was significantly reduced for operator A only. Operator B removed the same enamel volume with either method.Conclusions:Cleanup after orthodontic debonding with the FIT was superior regarding time needed and removal of composite remnants. Total enamel loss reduction was operator-dependent.     

Interhemispheric communication and the preference for attitude consistent information

The current study investigated the role of interhemispheric communication in selective exposure to information. Participants (N?=?241) reported their attitude and attitude strength toward a controversial social topic, engaged in a selective exposure task, and completed the Poffenberger paradigm. As expected, participants demonstrated a moderate (d?=?0.50) preference for attitude consistent information on the selective exposure task and attitude strength was a significant predictor of participants’ information search tendencies. Furthermore, faster right-to-left interhemispheric transfer was also significantly associated with an increased preference for attitude consistent information. These findings highlight the potential role of the right hemispheric processes in the detection of cognitive inconsistency and in the implementation of dissonance reduction strategies.     

Anticoagulation in the cardiac patient: A concise review

Anticoagulation has multiple roles in the treatment of cardiovascular disease, including in management of acute myocardial infarction, during percutaneous coronary intervention, as stroke prophylaxis in patients with atrial arrhythmias, and in patients with mechanical heart valves. Clinical anticoagulation choices in the aforementioned diseases vary widely, due to conflicting data to support established agents and the rapid evolution of evidence‐based practice that parallels more widespread use of novel oral anticoagulants. This review concisely summarizes evidence‐based guidelines for anticoagulant use in cardiovascular disease, and highlights new data specific to direct oral anticoagulants.