The surgeon of the future will be required (expected) to engage in leading high performance teams that integrate surgical and nonsurgical skills; he or she will be integral to the evolving systems of health care. Practice will be based on evidence and measured by outcomes that will include some aspect of public reporting. Continuous professional development will be based upon recertification that is founded on practice and objective learning criteria. The processes and goals of CER are of the highest priority and remain in line with the surgeons' practice and professionalism. As we guide the evolution of the health care of the future, our professionalism will be increasingly focused upon accountability. We, as surgeons, must assume this challenge as our legacy, which includes a 100-year history that provides inspiring quality with development of higher standards and improved outcomes for the surgery patient.
[Show abstract][Hide abstract] ABSTRACT: Vesicoureteral reflux (VUR) is present in approximately 1% of children in North America and Europe and is associated with an increased risk of pyelonephritis and renal scarring. Despite its prevalence and potential morbidity, however, many aspects of VUR management are controversial.
Review the evidence surrounding current controversies in VUR diagnosis, screening, and treatment.
A systematic review was performed of Medline, Embase, Prospero, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, clinicaltrials.gov, and the most recent guidelines of relevant medical specialty organizations.
We objectively assessed and summarized the published data, focusing on recent areas of controversy relating to VUR screening, diagnosis, and treatment.
The evidence base for many current management patterns in VUR is limited. Areas that could significantly benefit from additional future research include improved identification of children who are at risk for VUR-related renal morbidity, improved stratification tools for determining which children would benefit most from which VUR treatment option, and improved reporting of long-term outcomes of VUR treatments.
European Urology 04/2012; 61(4):773-82. DOI:10.1016/j.eururo.2012.01.002 · 13.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Containing growth in health care expenditures is considered to be essential to improving both the long-term fiscal outlook of the federal government and the future affordability of health care in the US. As health care expenditures have increased, so too have concerns about the quality of health care. Better information on the clinical effectiveness of alternative treatments and other interventions is needed to improve the quality of care and restrain growth in expenditures. This article explains the key role played by the federal government in defining the context and process of comparative effectiveness research as well as its funding. Subsequently, the article explores the mission, priorities, and research agenda of the Patient-Centered Outcomes Research Institute, which is an independent, nonprofit corporation established in 2010 by the Patient Protection and Affordable Care Act.
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