435 results on '"Brownlee, Shannon"'
Search Results
402. National Partnership for Maternal Safety: Consensus Bundle on Venous Thromboembolism.
- Author
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Urato, Adam C., Abi-Jaoude, Elia, Abramson, John, Alter, Harrison, Andrew, Louise B., Antonuccio, David, Bero, Lisa, Biron, Pierre, Boylan, Laura S., Braillon, Alain, Brophy, James M., Brownlee, Shannon, Cassels, Alan, Cook-Deegan, Robert, Cosgrove, Lisa, De Fiore, Luca, Deyo, Richard A., Elshaug, Adam, Farquhar, Cindy, and Fatovich, Daniel M.
- Published
- 2019
- Full Text
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403. The Clinton rally.
- Author
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Walsh, Kenneth T., Lavelle, Marianne, Streisand, Betsy, Lord, Mary, Ackerman, Elise, Brownlee, Shannon, Vest, Jason, and Cohen, Warren
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PRESIDENTS , *POLITICAL ethics , *HUMAN sexuality - Abstract
Discusses how United States President Bill Clinton remained positive during the week prior to February 9, 1998, despite the allegations that he had a sexual relationship with White House intern Monica Lewinsky. Clinton's high approval ratings; The evidence that the public is processing the scandal very differently from way the press is; The issuance of blunt denials by first lady Hillary Rodham Clinton.
- Published
- 1998
404. Overtreatment in the United States.
- Author
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Lyu, Heather, Xu, Tim, Brotman, Daniel, Mayer-Blackwell, Brandan, Cooper, Michol, Daniel, Michael, Wick, Elizabeth C., Saini, Vikas, Brownlee, Shannon, and Makary, Martin A.
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OVERTREATMENT , *MEDICAL care , *PHYSICIANS , *MEDICAL malpractice , *INTERPOLATION - Abstract
Background: Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, and implications of overtreatment. Methods: 2,106 physicians from an online community composed of doctors from the American Medical Association (AMA) masterfile participated in a survey. The survey inquired about the extent of overutilization, as well as causes, solutions, and implications for health care. Main outcome measures included: percentage of unnecessary medical care, most commonly cited reasons of overtreatment, potential solutions, and responses regarding association of profit and overtreatment. Findings: The response rate was 70.1%. Physicians reported that an interpolated median of 20.6% of overall medical care was unnecessary, including 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures. The most common cited reasons for overtreatment were fear of malpractice (84.7%), patient pressure/request (59.0%), and difficulty accessing medical records (38.2%). Potential solutions identified were training residents on appropriateness criteria (55.2%), easy access to outside health records (52.0%), and more practice guidelines (51.5%). Most respondents (70.8%) believed that physicians are more likely to perform unnecessary procedures when they profit from them. Most respondents believed that de-emphasizing fee-for-service physician compensation would reduce health care utilization and costs. Conclusion: From the physician perspective, overtreatment is common. Efforts to address the problem should consider the causes and solutions offered by physicians. [ABSTRACT FROM AUTHOR]
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- 2017
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405. Levers for addressing medical underuse and overuse: achieving high-value health care.
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Elshaug, Adam G., Rosenthal, Meredith B., Lavis, John N., Brownlee, Shannon, Schmidt, Harald, Nagpal, Somil, Littlejohns, Peter, Srivastava, Divya, Tunis, Sean, and Saini, Vikas
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MEDICAL care , *HEALTH services accessibility , *PUBLIC health , *WELL-being , *MEDICAL quality control , *COST effectiveness - Abstract
The preceding papers in this Series have outlined how underuse and overuse of health-care services occur within a complex system of health-care production, with a multiplicity of causes. Because poor care is ubiquitous and has considerable consequences for the health and wellbeing of billions of people around the world, remedying this problem is a morally and politically urgent task. Universal health coverage is a key step towards achieving the right care. Therefore, full consideration of potential levers of change must include an upstream perspective-ie, an understanding of the system-level factors that drive overuse and underuse, as well as the various incentives at work during a clinical encounter. One example of a system-level factor is the allocation of resources (eg, hospital beds and clinicians) to meet the needs of a local population to minimise underuse or overuse. Another example is priority setting using tools such as health technology assessment to guide the optimum diffusion of safe, effective, and cost-effective health-care services. In this Series paper we investigate a range of levers for eliminating medical underuse and overuse. Some levers could operate effectively (and be politically viable) across many different health and political systems (eg, increase patient activation with decision support) whereas other levers must be tailored to local contexts (eg, basing coverage decisions on a particular cost-effectiveness ratio). Ideally, policies must move beyond the purely incremental; that is, policies that merely tinker at the policy edges after underuse or overuse arises. In this regard, efforts to increase public awareness, mobilisation, and empowerment hold promise as universal methods to reset all other contexts and thereby enhance all other efforts to promote the right care. [ABSTRACT FROM AUTHOR]
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- 2017
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406. Drivers of poor medical care.
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Saini, Vikas, Garcia-Armesto, Sandra, Klemperer, David, Paris, Valerie, Elshaug, Adam G., Brownlee, Shannon, Ioannidis, John P. A., and Fisher, Elliott S.
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MEDICAL quality control , *MEDICAL care financing , *MEDICAL care , *MEDICAL ethics , *POWER (Social sciences) , *MEDICAL economics , *MEDICAL care standards , *ATTITUDE (Psychology) , *BIOLOGICAL models , *HEALTH attitudes , *HEALTH behavior , *MEDICAL personnel , *PHYSICIAN-patient relations - Abstract
The global ubiquity of overuse and underuse of health-care resources and the gravity of resulting harms necessitate an investigation of drivers to inform potential solutions. We describe the network of influences that contribute to poor care and suggest that it is driven by factors that fall into three domains: money and finance; knowledge, bias, and uncertainty; and power and human relationships. In each domain the drivers operate at the global, national, regional, and individual level, and are modulated by the specific contexts within which they act. We discuss in detail drivers of poor care in each domain. [ABSTRACT FROM AUTHOR]
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- 2017
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407. Statins for people at low risk of cardiovascular disease.
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Newman, David H., Saini, Vikas, Brody, Howard, Brownlee, Shannon, Hoffman, Jerome R., Redbe, Rita F., Roberts, Barbara H., Donzelli, Alberto, Battaggia, Alessandro, Font, Maria, Simpson, William G., Ray, Kausik K., Redberg, Rita F., Mascitelli, Luca, Goldstein, Mark R., Zomer, Ella, Owen, Alice J. Owe, Magliano, Dianna J., Reid, Christopher M., and Mihaylova, Borislava
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LETTERS to the editor , *PHYSIOLOGICAL effects of cholesterol - Abstract
Sevral letters to the editor is presented in response to the article "Cholesterol Treatment Trialists (CTT) Collaborators. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials," published in a previous issue of the periodical.
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- 2012
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408. Year in Ideas.
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Mihm, Stephen, Tough, Paul, Bowe, John, Fortini, Amanda, Johnson, Nathanael, Lowenstein, Roger, Thompson, Clive, Stevenson, Seth, Chandler, Michael, Ballard, Chris, Shea, Christopher, Koerner, Brendan J., Bigge, Ryan, Pink, Daniel H., Aurthur, Kate, Brownlee, Shannon, Max, D. T., Dominus, Susan, Bai, Matt, and Donadio, Rachel
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CONCEPTS , *ENCYCLOPEDIAS & dictionaries , *KEYBOARDS (Musical instruments) , *RACIAL identity of Black people , *BAR codes , *AUTOMOBILES , *CONCRETE , *SEX crimes , *COLLEGE students , *JEWELRY , *EYE , *WATER waves - Abstract
Presents a mini-encyclopedia of the most noteworthy ideas of the previous 12 months. Acoustic keyboard eavesdropping; "Acting White" myth; Augmented bar codes; Cars that emote; Concrete you can see through; Criminalizing reckless sex; Employable liberal arts majors; Eyeball jewelry; Giga-waves; Others.
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- 2004
409. How can routine colorectal cancer screening in the USA be considered low value in other countries?
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Chalmers K, Brownlee S, and Saini V
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- Humans, Mass Screening, Early Detection of Cancer, Colorectal Neoplasms diagnosis, Colorectal Neoplasms prevention & control
- Abstract
Competing Interests: Competing interests: None declared.
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- 2023
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410. An Estimate of Severe Harms Due to Screening Colonoscopy: A Systematic Review.
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Huffstetler AN, Fraiman J, Brownlee S, Stoto MA, and Lin KW
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- Humans, United States, Early Detection of Cancer adverse effects, Early Detection of Cancer methods, Colonoscopy adverse effects, Mass Screening adverse effects
- Abstract
Objective: This study aims to comprehensively assess the direct, severe harms of screening colonoscopy in the United States. Whereas other investigators have completed systematic reviews estimating the harms of all types of colonoscopy, this analysis focuses on screening colonoscopies that had adequate follow up to avoid undercounting delayed harms., Data Sources: PubMed and Embase were queried for relevant studies on screening colonoscopy harms published between January 1, 2002, and April 1, 2022., Study Selection: English-language studies of screening colonoscopy for average risk patients were included. Studies must have followed patients for adequate time post procedure, defined as 30 days after colonoscopy., Main Outcomes: The primary outcome was the number of severe bleeding events and gastrointestinal (GI) perforations within 30 days of screening colonoscopy., Results: A total of 1951 studies were reviewed for inclusion; 94 were reviewed in full text. Of those reviewed in full, 6 studies, including a total of 467,139 colonoscopies, met our inclusion criteria and were included in our analysis of harms related to screening colonoscopies. The rate of severe bleeding ranged credibly from 16.4 to 36.18 per 10,000 colonoscopies; the rate of perforation ranged credibly from 7.62 to 8.50 per 10,000 colonoscopies., Conclusions: This study is the first to estimate direct harms from screening colonoscopy, including harms that occur up to 30 days after the procedure. The risk of harm subsequent to screening colonoscopy is higher than previously reported and should be discussed with patients when engaging in shared decision making., Competing Interests: Conflict of interest: None., (© Copyright by the American Board of Family Medicine.)
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- 2023
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411. An Estimate of the US Rate of Overuse of Screening Colonoscopy: a Systematic Review.
- Author
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Fraiman J, Brownlee S, Stoto MA, Lin KW, and Huffstetler AN
- Subjects
- Humans, United States, Colonoscopy statistics & numerical data, Medical Overuse statistics & numerical data
- Abstract
Background: This study aims to assess the rate at which screening colonoscopy is performed on patients younger or older than the age range specified in national guidelines, or at shorter intervals than recommended. Such non-indicated use of the procedure is considered low-value care, or overuse. This study is the first systematic review of the rate of non-indicated completed screening colonoscopy in the USA., Methods: PubMed and Embase were queried for relevant studies on overuse of screening colonoscopy published from January 1, 2002, until January 23, 2019. English-language studies that were conducted for screening colonoscopy after 2001 for average-risk patients were included. Studies must have followed national guidelines for detecting rates of overuse. We followed methods outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the reporting recommendations of the Meta-analysis of Observational Studies in Epidemiology group (MOOSE)., Results: A total of 772 papers were reviewed for inclusion; 42 were reviewed in full text. Of those reviewed, six studies met eligibility criteria, including a total of 459,503 colonoscopies of which 242,756 were screening colonoscopies. The rate of overuse ranged credibly from 17 to 25.7%., Discussion: This study demonstrates that screening colonoscopy is regularly performed in the USA more often, and in populations older or younger, than recommended by national guidelines. Such overuse wastes resources and places patients at unnecessary risk of harm. Efforts to reduce non-indicated screening colonoscopy are needed., (© 2021. The Author(s) under exclusive licence to Society of General Internal Medicine.)
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- 2022
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412. Should regulatory authorities approve drugs based on surrogate endpoints?
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Lenzer J and Brownlee S
- Abstract
Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare. Provenance and peer review: Commissioned; externally peer reviewed.
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- 2021
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413. Adverse Events and Hospital-Acquired Conditions Associated With Potential Low-Value Care in Medicare Beneficiaries.
- Author
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Chalmers K, Gopinath V, Brownlee S, Saini V, and Elshaug AG
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- Aged, Cross-Sectional Studies, Female, Humans, Iatrogenic Disease epidemiology, Low-Value Care, Retrospective Studies, United States epidemiology, Medicare, Percutaneous Coronary Intervention
- Abstract
Importance: There has been insufficient research on the patient harms and costs associated with potential low-value procedures in the US Medicare population., Objective: To report the prevalence of adverse events associated with potential low-value procedures and the additional hospital length of stay (LOS) and costs., Design Setting and Participants: This is a retrospective cohort study using Medicare fee-for-service claims between January 2016 to December 2018. Participants were aged 65 years or older. Procedures were selected if they had previously published indicators of low-value care, including knee arthroscopy, spinal fusion, vertebroplasty, percutaneous coronary intervention (PCI), carotid endarterectomy, renal stenting, and hysterectomy for benign conditions. Analysis was conducted from July to December, 2020., Main Outcomes and Measures: For inpatient procedures, the number and rate of admissions with a hospital-acquired condition (HAC) or patient safety indicator event (PSIs), as well as the unadjusted and adjusted difference in mean LOS and Medicare costs between admissions with and without a HAC/PSI. For outpatient procedures, we report the number of claims where the beneficiary had an unplanned hospital admission within seven days and the number of these admissions with a HAC/PSI., Results: There were 573 351 patients included in the study, with 617 264 procedures; the mean (SD) age was 74.2 (6.7) years, with 320 637 women (55.9%), and mostly White patients (520 735; 90.8%). Among the 197 755 claims for the inpatient procedures, 231 had an HAC and 1764 had a PSI. Spinal fusion was associated with the most HACs (123 admissions) and PSIs (1015 admissions). Overall, HACs during a PCI admission were associated with the highest adjusted additional mean LOS (17.5 days; 95% CI, 10.3-23.6), with also the highest adjusted additional mean cost ($22 000; 95% CI, $9100-$32 600). There were 419 509 included outpatient procedures, and 7514 (1.8%) had an unplanned admission within 7 days. A total of 17 HACs and PSIs occurred in these admissions., Conclusions and Relevance: In this cross-sectional cohort study of Medicare fee-for-service claims, patients receiving potential low-value care were exposed to risk of unnecessary harm associated with higher cost and LOS., Competing Interests: Conflict of Interest Disclosures: Dr Chalmers reports receiving personal fees from the Australian state government health departments–Victoria, Queensland, South Australia, as well as the Australian Department of Veterans Affairs, and Private Healthcare Australia. Dr Elshaug reports receiving personal fees from the Australian state government health departments–Victoria, Queensland, South Australia, as well as the Australian Department of Veterans Affairs, Medibank Ltd, Private Healthcare Australia, and the Australian Defence Force Joint Health Command, for low-value care analytics and advice, and grants from the National Health and Medical Research Council outside the submitted work., (Copyright 2021 Chalmers K et al. JAMA Health Forum.)
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- 2021
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414. Assessment of Overuse of Medical Tests and Treatments at US Hospitals Using Medicare Claims.
- Author
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Chalmers K, Smith P, Garber J, Gopinath V, Brownlee S, Schwartz AL, Elshaug AG, and Saini V
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- Aged, Aged, 80 and over, Cross-Sectional Studies, Fee-for-Service Plans, Female, Hospital Bed Capacity statistics & numerical data, Hospitals statistics & numerical data, Hospitals, Rural statistics & numerical data, Hospitals, Urban statistics & numerical data, Hospitals, Voluntary statistics & numerical data, Humans, Male, Medicare, Midwestern United States, New England, Northwestern United States, Retrospective Studies, Safety-net Providers statistics & numerical data, Southeastern United States, Southwestern United States, United States, Hospitals, Proprietary statistics & numerical data, Hospitals, Teaching statistics & numerical data, Medical Overuse statistics & numerical data
- Abstract
Importance: Overuse of health care services exposes patients to unnecessary risk of harm and costs. Distinguishing patterns of overuse among hospitals requires hospital-level measures across multiple services., Objective: To describe characteristics of hospitals associated with overuse of health care services in the US., Design, Setting, and Participants: This retrospective cross-sectional analysis used Medicare fee-for-service claims data for beneficiaries older than 65 years from January 1, 2015, to December 31, 2017, with a lookback of 1 year. Inpatient and outpatient services were included, and services offered at specialty and federal hospitals were excluded. Patients were from hospitals with the capacity (based on a claims filter developed for this study) to perform at least 7 of 12 investigated services. Statistical analyses were performed from July 1, 2020, to December 20, 2020., Main Outcomes and Measures: Outcomes of interest were a composite overuse score ranging from 0 (no overuse of services) to 1 (relatively high overuse of services) and characteristics of hospitals clustered by overuse rates. Twelve published low-value service algorithms were applied to the data to find overuse rates for each hospital, normalized and aggregated to a composite score and then compared across 6 hospital characteristics using multivariable regression. A k-means cluster analysis was used on normalized overuse rates to identify hospital clusters., Results: The primary analysis was performed on 2415 cohort A hospitals (ie, hospitals with capacity for 7 or more services), which included 1 263 592 patients (mean [SD] age, 72.4 [14] years; 678 549 women [53.7%]; 101 017 191 White patients [80.5%]). Head imaging for syncope was the highest-volume low-value service (377 745 patients [29.9%]), followed by coronary artery stenting for stable coronary disease (199 579 [15.8%]). The mean (SD) composite overuse score was 0.40 (0.10) points. Southern hospitals had a higher mean score than midwestern (difference in means: 0.06 [95% CI, 0.05-0.07] points; P < .001), northeast (0.08 [95% CI, 0.06-0.09] points; P < .001), and western hospitals (0.08 [95% CI, 0.07-0.10] points; P < .001). Nonprofit hospitals had a lower adjusted mean score than for-profit hospitals (-0.03 [95% CI, -0.04 to -0.02] points; P < .001). Major teaching hospitals had significantly lower adjusted mean overuse scores vs minor teaching hospitals (difference in means, -0.07 [95% CI, -0.08 to -0.06] points; P < .001) and nonteaching hospitals (-0.10 [95% CI, -0.12 to -0.09] points; P < .001). Of the 4 clusters identified, 1 was characterized by its low counts of overuse in all services except for spinal fusion; the majority of major teaching hospitals were in this cluster (164 of 223 major teaching hospitals [73.5%])., Conclusions and Relevance: This cross-sectional study used a novel measurement of hospital-associated overuse; results showed that the highest scores in this Medicare population were associated with nonteaching and for-profit hospitals, particularly in the South.
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- 2021
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415. Better understanding the downsides of low value healthcare could reduce harm.
- Author
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Brownlee SM and Korenstein D
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- Health Care Costs statistics & numerical data, Health Policy, Humans, Medical Errors economics, Medical Errors prevention & control, Medical Errors statistics & numerical data, Medical Overuse economics, Medical Overuse statistics & numerical data, United States, Medical Errors adverse effects, Medical Overuse prevention & control, Quality of Health Care economics, Quality of Health Care statistics & numerical data
- Abstract
Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests. SB has no interests to declare. DK reports that her spouse serves on the scientific advisory board and has equity interest in Vedanta Biosciences and serves on the scientific advisory board of Opentrons.
- Published
- 2021
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416. The endurance of medication overload: Rethinking the medication review process.
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McCormack JP, Brownlee S, Garber J, and Devlin JW
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Competing Interests: CONFLICT OF INTEREST The authors declare no conflicts of interest.
- Published
- 2020
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417. Addressing overuse and underuse around the world.
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Saini V, Brownlee S, Elshaug AG, Glasziou P, and Heath I
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- 2017
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418. Evidence for overuse of medical services around the world.
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Brownlee S, Chalkidou K, Doust J, Elshaug AG, Glasziou P, Heath I, Nagpal S, Saini V, Srivastava D, Chalmers K, and Korenstein D
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- Diagnostic Tests, Routine statistics & numerical data, Drug Utilization statistics & numerical data, Evidence-Based Medicine, Health Services Misuse trends, Health Services Research, Humans, Mass Screening statistics & numerical data, Terminology as Topic, Global Health statistics & numerical data, Health Services Misuse statistics & numerical data
- Abstract
Overuse, which is defined as the provision of medical services that are more likely to cause harm than good, is a pervasive problem. Direct measurement of overuse through documentation of delivery of inappropriate services is challenging given the difficulty of defining appropriate care for patients with individual preferences and needs; overuse can also be measured indirectly through examination of unwarranted geographical variations in prevalence of procedures and care intensity. Despite the challenges, the high prevalence of overuse is well documented in high-income countries across a wide range of services and is increasingly recognised in low-income countries. Overuse of unneeded services can harm patients physically and psychologically, and can harm health systems by wasting resources and deflecting investments in both public health and social spending, which is known to contribute to health. Although harms from overuse have not been well quantified and trends have not been well described, overuse is likely to be increasing worldwide., (Copyright © 2017 Elsevier Ltd. All rights reserved.)
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- 2017
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419. Patient Decision Aids: A Case for Certification at the National Level in the United States.
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Poddar U, Brownlee S, Stacey D, Volk RJ, Williams JW, and Elwyn G
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- Certification, Humans, Malpractice legislation & jurisprudence, Patient Protection and Affordable Care Act, Patient Safety, United States, Clinical Decision-Making ethics, Clinical Decision-Making methods, Conflict of Interest, Decision Making, Decision Support Techniques, Informed Consent ethics, Patient Participation trends
- Abstract
Patient decision aids enable patients to be better informed about the potential benefits and harms of their healthcare options. Certification of patient decision aids at the national level in the United States is a critical step towards responsible governance-primarily as a quality measure that increases patients' safety, as mandated in the U.S. Patient Protection and Affordable Care Act (PPACA). Certification would provide a verification process to identify conflicts of interest that may otherwise bias the scientific evidence presented in decision aids. Certification also benefits clinicians who may otherwise face malpractice claims based on harm to patients caused by possible reliance on patient decision aids that are inaccurate, incomplete, or presented in a manner that biases the patient's decision. Existing work by the International Patient Decision Aid Standards Collaboration could guide the establishment of a certification process within the U.S. This article argues for national certification of patient decision aids and discusses how that may be achieved., (Copyright 2015 The Journal of Clinical Ethics. All rights reserved.)
- Published
- 2015
420. Setting a research agenda for medical overuse.
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Morgan DJ, Brownlee S, Leppin AL, Kressin N, Dhruva SS, Levin L, Landon BE, Zezza MA, Schmidt H, Saini V, and Elshaug AG
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- Humans, Health Services Misuse, Research, Unnecessary Procedures
- Published
- 2015
- Full Text
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421. Diverting attention from financial conflicts of interest.
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Lenzer J and Brownlee S
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- Humans, Biomedical Research economics, Conflict of Interest economics, Industry economics, Research Support as Topic
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- 2015
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422. Undoing Racism Through Genesee County's REACH Infant Mortality Reduction Initiative.
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Kruger DJ, Carty DC, Turbeville AR, French-Turner TM, and Brownlee S
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- Health Promotion, Health Status Disparities, Humans, Infant, Michigan, Black or African American, Community Networks, Infant Mortality, Racism prevention & control
- Abstract
Background: Genesee County Racial and Ethnic Approaches to Community Health Program (REACH) is a Community-Based Public Health partnership for reducing African American infant mortality rates that hosts the Undoing Racism Workshop (URW)., Objectives: Assess the URW's effectiveness in promoting an understanding of racism, institutional racism, and how issues related to race/ethnicity can affect maternal and infant health., Methods: Recent URW participants (n=84) completed brief preassessment and postassessment forms; participants (n=101) also completed an on-line, long-term assessment (LTA)., Results: URWs promoted understanding of racism and institutional racism, although they were less effective in addressing racism as related to maternal and infant health., Conclusions: The URWs were most effective in the domains related to their standard content. Additional effort is necessary to customize URWs when utilized for activities beyond their original purpose of community mobilization.
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- 2015
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423. Genesee County REACH Windshield Tours: enhancing health professionals understanding of community conditions that influence infant mortality.
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Kruger DJ, French-Turner T, and Brownlee S
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- Black or African American statistics & numerical data, Community-Based Participatory Research methods, Data Collection, Health Knowledge, Attitudes, Practice, Health Personnel, Humans, Infant, Michigan epidemiology, Program Evaluation, Residence Characteristics statistics & numerical data, Vulnerable Populations statistics & numerical data, Health Promotion methods, Infant Mortality
- Abstract
The Genesee County Racial and Ethnic Approaches to Community Health (REACH) program is a community-based program designed to reduce African American infant mortality rates in Flint, Michigan. Genesee County REACH activities address three core themes: fostering community mobilization, reducing racism, and enhancing the maternal-infant health care system. The REACH Community Action Plan was generated using a community-based participatory approach, and is based on a socio-ecological model with interventions focused at the individual, organizational, health system, and community levels. Genesee County REACH's Community Windshield Tours were developed to raise awareness of social and environmental barriers to health promotion among health care system staff in Flint, Michigan. These tours provide a close-up examination of the community's environmental conditions and the experiences of mothers, children, and families at risk for poor birth outcomes. In this article, we report our findings from pre-/post-tour surveys, as well as long-term follow-up surveys, to assess the impact of this REACH activity on participants' knowledge and beliefs about Genesee County residents, and to determine any resultant individual, policy, system, or environmental changes. We used t tests to compare participants' responses before and after the tours. We found that several individual- and systems-level changes have resulted from these tours, reflecting greater cultural sensitivity and increased understanding of patients' circumstances. African American infant mortality rates in Genesee County declined to a historic low in 2005, and they remain lower than in previous years. Although REACH coalition partners recognize that this reduction cannot be attributed to a single intervention or activity, REACH activities such as the Community Windshield Tours addressing multiple levels of the socio-ecological model may have had a synergistic effect.
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- 2013
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424. US expert panel recommends against prostate cancer screening.
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Lenzer J and Brownlee S
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- Advisory Committees, Humans, Male, United States, Early Detection of Cancer standards, Prostate-Specific Antigen blood, Prostatic Neoplasms diagnosis
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- 2011
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425. Why the FDA can't protect the public.
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Lenzer J and Brownlee S
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- Databases, Factual, Equipment Safety, Humans, United States, Device Approval, Electric Stimulation Therapy instrumentation, Epilepsy prevention & control, Product Surveillance, Postmarketing, United States Food and Drug Administration
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- 2010
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426. Naming names: is there an (unbiased) doctor in the house?
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Lenzer J and Brownlee S
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- Leadership, United States, Conflict of Interest, Drug Industry ethics, Psychiatry ethics, Societies, Scientific ethics
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- 2008
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427. Knowing me, knowing you.
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Lenzer J and Brownlee S
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- Biomedical Research, Commerce, Consumer Health Information legislation & jurisprudence, Consumer Health Information methods, Genetic Testing economics, Genetic Testing legislation & jurisprudence, Genome, Human, Genomics, Humans, Internet, Risk Assessment, Consumer Health Information economics, Genetic Testing supply & distribution
- Published
- 2008
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428. An untold story?
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Lenzer J and Brownlee S
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- Adult, Drug Industry, Humans, Publication Bias, Antidepressive Agents therapeutic use, Depressive Disorder drug therapy
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- 2008
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429. Doctor takes "march of shame" to atone for drug company payments.
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Lenzer J and Brownlee S
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- Education, Medical ethics, History, 20th Century, History, 21st Century, Research Support as Topic ethics, United States, Drug Industry economics, Education, Medical economics, Interprofessional Relations ethics, Physicians ethics, Research Support as Topic economics
- Published
- 2008
- Full Text
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430. Doing better for less: the case for organized group practices.
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Brownlee S
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- Cost Control trends, Delivery of Health Care trends, Efficiency, Organizational trends, Group Practice trends, United States, Cost Control methods, Delivery of Health Care economics, Efficiency, Organizational economics, Group Practice economics, Health Care Costs trends
- Published
- 2008
431. Putting consumers in the driver's seat?
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Brownlee S
- Subjects
- Centers for Medicare and Medicaid Services, U.S., Health Education, Health Services standards, Health Services Misuse, Health Services Needs and Demand, Humans, Information Dissemination, Practice Patterns, Physicians', United States, Consumer Behavior, Health Services statistics & numerical data, Quality Assurance, Health Care
- Published
- 2005
432. Staying healthy. Too heavy, too young.
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Brownlee S
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- Adolescent, Child, Child, Preschool, Health Behavior, Humans, Life Style, Obesity complications, Parenting, Diet, Exercise, Obesity prevention & control, Primary Prevention
- Published
- 2002
433. The king of the apes.
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Brownlee S
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- Academies and Institutes, Animals, Federal Government, Financing, Government, Government, Government Regulation, Humans, Laboratories, Malpractice, National Institutes of Health (U.S.), Reference Standards, Social Control, Formal, United States, Universities, Animal Experimentation, Animal Welfare, Primates, Research Personnel, Scientific Misconduct
- Published
- 1995
434. Tinkering with destiny: genes and cancer.
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Brownlee S, Cook GG, and Hardigg V
- Subjects
- Adult, Breast Neoplasms, Child, Cognition, Comprehension, Diagnosis, Eugenics, Federal Government, Genetic Counseling, Genetic Diseases, Inborn, Genetic Engineering, Genetic Enhancement, Government, Government Regulation, Human Experimentation, Human Genome Project, Humans, Industry, Laboratories, Pharmaceutical Preparations, Physicians, Prenatal Diagnosis, Preventive Medicine, Probability, Research Personnel, Risk, Social Control, Formal, Stress, Psychological, Uncertainty, United States, Genetic Predisposition to Disease, Genetic Testing, Neoplasms
- Published
- 1994
435. Send in the clones.
- Author
-
Brownlee S
- Subjects
- Fertilization in Vitro, Humans, United States, Cloning, Organism, Embryo Research, Embryo, Mammalian, Research
- Published
- 1993
Catalog
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