Palliative Care in Nephrology: The Work and the Workforce

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Preparing for an Era of Episode-Based Care in Total Joint Arthroplasty

With a history of steadily rising healthcare costs, the United States faces an unprecedented set of health and financial challenges. The COVID-19 pandemic will only exacerbate these challenges, and it is of paramount importance to reform and refine health systems to maximize the value of care delivered to the patient. Recent developments related to value improvement in total joint arthroplasty suggest that episode-based payment is likely to become standard practice given the current healthcare environment. Consequently, developing episode-based care models for total joint arthroplasty is in the best interests of surgeons, health systems, and patients. In this article, we review important developments related to value-based care in total joint arthroplasty and present an episode-based framework for delivering high-value, patient-centric care. We examine each phase of a total joint arthroplasty episode—preoperative, acute, post-acute, and follow up—and present several ideas with developing bodies of evidence that can improve the value of care delivered to the patient.     

Care of the critically ill patient

In this article we aim to describe some of the key principles of this relatively new speciality. Intensive care medicine has become an essential and integral part of hospital medicine which uses a system-based approach to the care of a patient, underpinned by detailed understanding of physiology and pharmacology. Modern critical care embraces multi disciplinary team work in all aspects of patient care from admission through to discharge (including end-of-life care and organ donation).