The Milliman-Robertson Length of Stay Debate
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Abstract:
To the Editor.
In the HSIM, LOS was consistently presented as “goal LOS,” rather than “average LOS” or “maximum permissible LOS.” The goal LOSs were intended as “ambitious,” and to be applicable only to uncomplicated patients. Many contributors used the notion of goal LOS as analogous in part to the game of golf. If one considers pediatricians to be like golf pros providing professional services to the broad range of golfers, it should not be surprising that many or most receiving professional services (patients) do not achieve par. Less than 5% of the golfing population regularly shoots par on a given hole (G. Norman, personal communications, May 2000). However, I would submit that our problem in pediatrics is not with those who set par at a particular number of strokes for a golf hole or golf course, but rather with those who would set the greens fees (or reimbursement) too low, would ask the golfers to leave the course after 72 strokes, and would hold the golf pros responsible for the diversity in the performance of the golfing population and their routine failure to achieve par. Those actions would be unacceptable in golf, and by analogy, I would suggest that the pediatric community should offer strong and informed resistance to both episodic and systematic misapplications of the “goal of LOS” to their patients.
Pediatric HSIM was developed as a compendium of best practices within the continuum of care for pediatric patients, and was not intended to provide the detailed medical information necessary for diagnosis or for direct patient care. HSIM was not intended as guidelines in the sense of the Institute of Medicine or the Agency for Health Care Policy and Research usage of the term. While generally referred to in the article as “guidelines”, HSIM itself uses the word …Cite
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Seperti pada dewasa, teknik regional anestesi pada pediatrik kini makin popular digunakan oleh ahli anestesikarena keuntungannya. Namun demikian selalu ada risiko dan kemungkinan timbulnya komplikasi dari setiap tindakan yang dilakukan, termasuk tindakan anestesi regional pada pediatrik. Insidensi komplikasi anestesi regional pada pediatrik tidak banyak, dan kalaupun terjadi komplikasi adalah minor. Komplikasi bisa diakibatkan dari identifikasi ruang saraf, alat, obat, teknis tindakan anestesi regionalnya dan komplikasi lainnya.Walaupun tidak banyak kejadian komplikasi regional anestesi yang dilaporkan pada pediatrik, dan bukanlah komplikasi yang fatal, teknik regional anestesi pada pediatrik harus dilakukan dengan lebih hatihati, pertimbangan risiko dan keuntungannya untuk menghindari terjadinya komplikasi, terlebih karena kebanyakan komplikasi dapat dihindari dengan mempelajari teknik yang benar, menggunakan peralatan yang sesuai, dan sangat menerapkan prinsip keamanan pada pasien dengan baik.
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Genentech is partnering with the German cancer company Affimed to develop immunotherapies for multiple kinds of solid and blood cancers. Affimed is developing therapies that engage natural killer cells of the innate immune system to help direct them to attack cancer cells. Genentech will pay Affimed $96 million up front and up to $5 billion more in potential payments.
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Amaç: Konjenital kalp hastalığı için cerrahi uygulanan pediyatrik hastaların incelenmesi amaçlanmıştır
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The nationally-recognized Susquehanna
Chorale will delight audiences of all
ages with a diverse mix of classic and
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music making, successful in their
aim to make the audience feel,
to be moved, to be part of the
performance - and all this while
working at an extremely high
musical level.AÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂA¢AÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂA Experience choral
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