Today 3:15-4:15pm. Come in and practice and/or get some extra help from Mrs. Craig. All band students welcome.
from Singapore American School http://ift.tt/1l4eTQZ
Monday, November 30, 2015
MS BAND: After School Help Session
Today 3:15-4:15pm. Come in and practice and/or get some extra help from Mrs. Craig. All band students welcome.
from Singapore American School http://ift.tt/1l4eTQZ
TODAY - One Day Only!!! - Audition Prep for Legally Blonde.
Today: Wednesday: 3:15 to 4:00 in the Mrs. Symes Choir room. (S209) Get help practicing your audition music for the musical. (Optional)
* Reminder that sign up closes Friday for auditions next week. Online & Parent form must be in!from Singapore American School http://ift.tt/1l4eSg5
TODAY - One Day Only!!! - Audition Prep for Legally Blonde.
Today: Wednesday: 3:15 to 4:00 in the Mrs. Symes Choir room. (S209) Get help practicing your audition music for the musical. (Optional)
* Reminder that sign up closes Friday for auditions next week. Online & Parent form must be in!from Singapore American School http://ift.tt/1l4eSg5
Circle with Disney: Easily Take Control with Family Internet
I’m so excited to FINALLY reveal what I wanted to shout from the rooftops! Check out Circle with Disney .
It is the only gift I can basically guarantee won’t give you buyer’s remorse. Yes, it’s that cool.
Every family needs this in their home.
Don’t believe me? Watch this video clip and you’ll be sold too.
(affiliate links that support Kids Activities Blog throughout post)
Best part…
It’s on sale today!
$85.00! (regularly $99)
Are you tired of letting the Internet dictate what your family is exposed to? Not Anymore! With Circle, you are the boss!
4 Awesome things you can EASILY do with Circle:
- Set appropriate filters for EACH DEVICE. Use the pre-designed ones or customize your own.
2. Track where your family is spending their time online.
3. Give your devices a BED TIME!
4. PAUSE the internet! Yes. you. can.
If you are still not convinced, read what these Circle customers are saying about it:
“As the father of four kids from elementary through college age, I am not exaggerating when I say Circle is EXACTLY the device I have been looking for to control the internet in my house. Circle truly is peace of mind in a little white box.” – Wayne Stocks
“Circle has literally changed our lives and how our family spends time on the internet. My worries of what my children could be exposed to online has changed overnight by the use of Circle. I can pause the internet anytime making getting chores or homework done much easier these days.” -Terra Nyce
“Circle makes it easy for me to protect my kids online, monitor usage across all our home’s devices, and create conversations with the entire family. It’s rare that something is simple and effective, but Circle is both.” — Michael Lukaszewski
Get control of the Internet and give your family this gift.
The post Circle with Disney: Easily Take Control with Family Internet appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/1YEGWVo
Circle with Disney: Easily Take Control with Family Internet
I'm so excited to FINALLY reveal what I wanted to shout from the rooftops! Check out Circle with Disney .
It is the only gift I can basically guarantee won't give you buyer's remorse. Yes, it's that cool.
Every family needs this in their home.
Don't believe me? Watch this video clip and you'll be sold too.
(affiliate links that support Kids Activities Blog throughout post)
Best part…
It's on sale today!
$85.00! (regularly $99)
Are you tired of letting the Internet dictate what your family is exposed to? Not Anymore! With Circle, you are the boss!
4 Awesome things you can EASILY do with Circle:
- Set appropriate filters for EACH DEVICE. Use the pre-designed ones or customize your own.
2. Track where your family is spending their time online.
3. Give your devices a BED TIME!
4. PAUSE the internet! Yes. you. can.
If you are still not convinced, read what these Circle customers are saying about it:
"As the father of four kids from elementary through college age, I am not exaggerating when I say Circle is EXACTLY the device I have been looking for to control the internet in my house. Circle truly is peace of mind in a little white box." – Wayne Stocks
"Circle has literally changed our lives and how our family spends time on the internet. My worries of what my children could be exposed to online has changed overnight by the use of Circle. I can pause the internet anytime making getting chores or homework done much easier these days." -Terra Nyce
"Circle makes it easy for me to protect my kids online, monitor usage across all our home's devices, and create conversations with the entire family. It's rare that something is simple and effective, but Circle is both." — Michael Lukaszewski
Get control of the Internet and give your family this gift.
The post Circle with Disney: Easily Take Control with Family Internet appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/1YEGWVo
Snowman Craft from Foam Cups
One of my all time favorite things to make during the winter months are snowman crafts. You can make almost anything into a snowman!
This time I went with foam cups, though I’ve used cardboard tubes, potato chip cans, and even blocks of wood! Pssst…if you have extra plastic spoons, you might want to try these plastic spoon snowmen!
Snowman Craft from Foam Cups
For my snowmen, I used coordinating “outfits”, matching up the colors of the scarves and earmuffs. You can use whatever colors you like!
This is a fun snowy day craft the kids will love. They are easy to make and fun to display.
You will need:
- Foam cups
- Felt
- Medium pom poms
- Pipe cleaners
- White craft glue
- Scissors
- Black marker
Cut a 1-inch wide strip of felt using the full length of the felt sheet. Fringe the ends with scissors by cutting 4 or 5 slits at each end.
Place your foam cup upside down. Glue the scarf around the cup, leaving enough room for a face.
Cut triangles from orange felt and glue them to the face area.
For the earmuffs, cut a pipe cleaner in half. Bend it around the top of the snowman and trim the ends so that they hang over by about 1/2-inch.
Trim one side of a pom pom to make it a little flatter.
Glue to the pipe cleaner on the side of the snowman’s head. Repeat for the other side.
Use a black marker to add eyes. You can add eyebrows if you like as well! I always do because it adds to their cute expressions and gives them character.
If you liked this project, you’ll love Michelle’s foam cup farm animal set! And this is one of my favorite snowman crafts of all time! -> Cardboard Tube Children & Snowmen
Hope you have fun!
The post Snowman Craft from Foam Cups appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/1A8CBPG
Snowman Craft from Foam Cups
One of my all time favorite things to make during the winter months are snowman crafts. You can make almost anything into a snowman!
This time I went with foam cups, though I've used cardboard tubes, potato chip cans, and even blocks of wood! Pssst…if you have extra plastic spoons, you might want to try these plastic spoon snowmen!
Snowman Craft from Foam Cups
For my snowmen, I used coordinating "outfits", matching up the colors of the scarves and earmuffs. You can use whatever colors you like!
This is a fun snowy day craft the kids will love. They are easy to make and fun to display.
You will need:
- Foam cups
- Felt
- Medium pom poms
- Pipe cleaners
- White craft glue
- Scissors
- Black marker
Cut a 1-inch wide strip of felt using the full length of the felt sheet. Fringe the ends with scissors by cutting 4 or 5 slits at each end.
Place your foam cup upside down. Glue the scarf around the cup, leaving enough room for a face.
Cut triangles from orange felt and glue them to the face area.
For the earmuffs, cut a pipe cleaner in half. Bend it around the top of the snowman and trim the ends so that they hang over by about 1/2-inch.
Trim one side of a pom pom to make it a little flatter.
Glue to the pipe cleaner on the side of the snowman's head. Repeat for the other side.
Use a black marker to add eyes. You can add eyebrows if you like as well! I always do because it adds to their cute expressions and gives them character.
If you liked this project, you'll love Michelle's foam cup farm animal set! And this is one of my favorite snowman crafts of all time! -> Cardboard Tube Children & Snowmen
Hope you have fun!
The post Snowman Craft from Foam Cups appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/1A8CBPG
Independence—It’s What Older People Want
We already know what older people want. A study from the National Conference of State Legislatures and AARP, as well as other studies, confirm, time and again, that the vast majority of us want to live in our homes and communities as we age, and, if possible, to avoid dependence on others and institutionalization.
Meeting this deeply personal goal requires that we design and provide good care in our hospitals and clinics, and expand that care beyond traditional boundaries. It requires the involvement of both health care and community-based service providers; a skilled paid workforce; and a well-supported, family-based "care force." It also, of course, requires the correct blend of policies and funding.
This is an increasingly urgent concern. A person turns sixty-five every eight seconds, and according to Census numbers, the population of people age eighty-five and older, which doubled in the past thirty years, is projected to almost triple to more than 14 million people by 2040.
One obstacle we face is that our country spends almost twice as much on health care as on social services. To enable more older people to get the care and the outcomes they seek, we must find ways to balance our investment between these types of services, work together across sectors, and use our resources in forward-looking ways.
A good framework for this approach can be found in the work of the Institute of Medicine's Forum on Aging, Disability, and Independence, which I cochair with Fernando Torres-Gil of the University of California, Los Angeles. A collaboration of the National Academies of Sciences, Engineering, and Medicine, the forum provides a critically needed and neutral venue to bring together aging and disability stakeholders from around the country, accelerate the transfer of research to practice and policy, and identify levers of change.
Supporting this type of transition and building the coalitions to carry it out are, in many ways, the essential role of philanthropy. At the John A. Hartford Foundation, we are committed to promoting better care for older people. To help more of us remain independent, we are supporting research and evidence-based programs in two broad areas: integrating community-based services with traditional health care and providing more coordinated care focused on older people's own goals.
Supporting family and community resources
Our health care system has been developed to perform life-saving and critically needed interventions and procedures, such as stents, transplants, radiation, and chemotherapy. But such high-tech care, while important, is often not well matched with the wants and needs of older adults, particularly those who require help with their personal care and daily activities.
A much more common need for older people and their families is coping with multiple chronic conditions and the complications they can bring. Clinics and hospitals need to be better designed to support this chronic care, but the vast majority of care actually takes place in our homes and communities. To remain at home and successfully manage one's chronic conditions, many more older adults need excellent long-term services and supports—such as transportation, mobility aids, housing modifications, and accessible home care. Without these, they struggle.
Their caregivers need help, as well, and the Institute of Medicine's Study on Family Caregiving for Older Adults, which will be released in spring 2016 with funding from the John A. Hartford Foundation and fourteen other sponsors, should create a blueprint for how we can best support the family and friends who provide unpaid care worth an estimated $470 billion annually. (See list of study sponsors below.)
The Affordable Care Act and the new emphasis on value-based payment to accountable care organizations (ACOs) are changing incentives and placing a new focus on the importance of social services and supports for patients and caregivers alike. But how do we best structure and provide these services?
At the John A. Hartford Foundation, we are supporting work in California by the Partners in Care Foundation, and in Massachusetts by Elder Services of Merrimack Valley and Hebrew SeniorLife, to create more integrated care systems that link community-based, social service agencies to the health care sector.
We are also working with the federal Administration for Community Living, the SCAN Foundation, and the Tufts Health Plan Foundation to help representatives of the aging services network in eleven communities build their business acumen so they can work more effectively with health care providers, fill in service gaps, and meet the needs of older adults.
Reshaping care delivery, promoting teams
Good care must be team care, and good teams don't just happen. Our foundation has a long-standing commitment to improving team care—for example, it has supported a Geriatric Interdisciplinary Team Training program at several universities and team-based practice models in clinic, hospital, and long-term care settings.
Meeting the whole range of health and social needs of frail older adults in each of these settings requires care coordination, reliable communication among team members (who may be in other practices or specialties or outside of the formal health system), and technology that promises to facilitate and monitor care.
The Mobile Acute Care Team (MACT) model is a good example. MACT is a hospital-at-home approach for older adults, where a team of nurses, physicians, social workers, and allied health care professionals provide acute-level care through home visits and monitoring. Studies have found that this approach lowers costs by nearly one-third and reduces infections and other complications. It is highly rated by patients and caregivers alike. Initially developed at Johns Hopkins University with support from the John A. Hartford Foundation, MACT is now being tested at Mount Sinai Medical Center in New York City with a substantial amount of funding from the federal Center for Medicare and Medicaid Innovation.
Making these kinds of services widely available will require significant changes in how care is delivered, and that is not easy. But with older adults becoming an ever-larger part of our population and our health care system continuing to experience rapid change because of market and policy forces, we must focus on delivering care that people actually want. By working together, we can provide services and supports that meet people where they are and honor their goals. That's our definition of better care.
Author's postscript:
The following entities have sponsored the caregiving study mentioned above:
- Alliance for Aging Research
- Alzheimer's Association
- Anonymous Donor
- Archstone Foundation
- California HealthCare Foundation
- Commonwealth Fund
- Fan Fox and Leslie R. Samuels Foundation
- Health Foundation for Western and Central New York
- May and Stanley Smith Charitable Trust
- Retirement Research Foundation
- The Rosalinde and Arthur Gilbert Foundation
- Santa Barbara Foundation
- Tufts Health Plan Foundation
- Veterans Health Administration
from Health Affairs Blog http://ift.tt/1Por6gc
Independence—It’s What Older People Want
We already know what older people want. A study from the National Conference of State Legislatures and AARP, as well as other studies, confirm, time and again, that the vast majority of us want to live in our homes and communities as we age, and, if possible, to avoid dependence on others and institutionalization.
Meeting this deeply personal goal requires that we design and provide good care in our hospitals and clinics, and expand that care beyond traditional boundaries. It requires the involvement of both health care and community-based service providers; a skilled paid workforce; and a well-supported, family-based “care force.” It also, of course, requires the correct blend of policies and funding.
This is an increasingly urgent concern. A person turns sixty-five every eight seconds, and according to Census numbers, the population of people age eighty-five and older, which doubled in the past thirty years, is projected to almost triple to more than 14 million people by 2040.
One obstacle we face is that our country spends almost twice as much on health care as on social services. To enable more older people to get the care and the outcomes they seek, we must find ways to balance our investment between these types of services, work together across sectors, and use our resources in forward-looking ways.
A good framework for this approach can be found in the work of the Institute of Medicine’s Forum on Aging, Disability, and Independence, which I cochair with Fernando Torres-Gil of the University of California, Los Angeles. A collaboration of the National Academies of Sciences, Engineering, and Medicine, the forum provides a critically needed and neutral venue to bring together aging and disability stakeholders from around the country, accelerate the transfer of research to practice and policy, and identify levers of change.
Supporting this type of transition and building the coalitions to carry it out are, in many ways, the essential role of philanthropy. At the John A. Hartford Foundation, we are committed to promoting better care for older people. To help more of us remain independent, we are supporting research and evidence-based programs in two broad areas: integrating community-based services with traditional health care and providing more coordinated care focused on older people’s own goals.
Supporting family and community resources
Our health care system has been developed to perform life-saving and critically needed interventions and procedures, such as stents, transplants, radiation, and chemotherapy. But such high-tech care, while important, is often not well matched with the wants and needs of older adults, particularly those who require help with their personal care and daily activities.
A much more common need for older people and their families is coping with multiple chronic conditions and the complications they can bring. Clinics and hospitals need to be better designed to support this chronic care, but the vast majority of care actually takes place in our homes and communities. To remain at home and successfully manage one’s chronic conditions, many more older adults need excellent long-term services and supports—such as transportation, mobility aids, housing modifications, and accessible home care. Without these, they struggle.
Their caregivers need help, as well, and the Institute of Medicine’s Study on Family Caregiving for Older Adults, which will be released in spring 2016 with funding from the John A. Hartford Foundation and fourteen other sponsors, should create a blueprint for how we can best support the family and friends who provide unpaid care worth an estimated $470 billion annually. (See list of study sponsors below.)
The Affordable Care Act and the new emphasis on value-based payment to accountable care organizations (ACOs) are changing incentives and placing a new focus on the importance of social services and supports for patients and caregivers alike. But how do we best structure and provide these services?
At the John A. Hartford Foundation, we are supporting work in California by the Partners in Care Foundation, and in Massachusetts by Elder Services of Merrimack Valley and Hebrew SeniorLife, to create more integrated care systems that link community-based, social service agencies to the health care sector.
We are also working with the federal Administration for Community Living, the SCAN Foundation, and the Tufts Health Plan Foundation to help representatives of the aging services network in eleven communities build their business acumen so they can work more effectively with health care providers, fill in service gaps, and meet the needs of older adults.
Reshaping care delivery, promoting teams
Good care must be team care, and good teams don’t just happen. Our foundation has a long-standing commitment to improving team care—for example, it has supported a Geriatric Interdisciplinary Team Training program at several universities and team-based practice models in clinic, hospital, and long-term care settings.
Meeting the whole range of health and social needs of frail older adults in each of these settings requires care coordination, reliable communication among team members (who may be in other practices or specialties or outside of the formal health system), and technology that promises to facilitate and monitor care.
The Mobile Acute Care Team (MACT) model is a good example. MACT is a hospital-at-home approach for older adults, where a team of nurses, physicians, social workers, and allied health care professionals provide acute-level care through home visits and monitoring. Studies have found that this approach lowers costs by nearly one-third and reduces infections and other complications. It is highly rated by patients and caregivers alike. Initially developed at Johns Hopkins University with support from the John A. Hartford Foundation, MACT is now being tested at Mount Sinai Medical Center in New York City with a substantial amount of funding from the federal Center for Medicare and Medicaid Innovation.
Making these kinds of services widely available will require significant changes in how care is delivered, and that is not easy. But with older adults becoming an ever-larger part of our population and our health care system continuing to experience rapid change because of market and policy forces, we must focus on delivering care that people actually want. By working together, we can provide services and supports that meet people where they are and honor their goals. That’s our definition of better care.
Author’s postscript:
The following entities have sponsored the caregiving study mentioned above:
- Alliance for Aging Research
- Alzheimer’s Association
- Anonymous Donor
- Archstone Foundation
- California HealthCare Foundation
- Commonwealth Fund
- Fan Fox and Leslie R. Samuels Foundation
- Health Foundation for Western and Central New York
- May and Stanley Smith Charitable Trust
- Retirement Research Foundation
- The Rosalinde and Arthur Gilbert Foundation
- Santa Barbara Foundation
- Tufts Health Plan Foundation
- Veterans Health Administration
from Health Affairs Blog http://ift.tt/1Por6gc
Clinician-Led Stewardship To Curb Medical Excess
In a recent New England Journal of Medicine (NEJM) perspective, Durand and colleagues propose "medical-imaging stewardship." They believe that imaging can be more appropriately used through "provider-led imaging stewardship," based on the model of antimicrobial stewardship.
Antimicrobial stewardship is a hospital program composed of an expert pharmacist and infectious disease physician. Its goal is to improve appropriateness of antimicrobial use through restriction of antibiotics, post-prescription review, and education. Clinician-led stewardship could limit overuse and improve care beyond antimicrobial use or imaging and should be considered for all areas of medicine.
The comparison of imaging to antimicrobials is appropriate. Both imaging and antimicrobials are heavily overused; up to 50 percent of both are unnecessary. Likewise, both have objective harms to patients, with imaging leading to false-positive results such as incidentalomas, contrast, and radiation exposure and antimicrobials increasing risk for Clostridium difficile infection, drug side effects, and promotion of resistance. Both imaging and antimicrobials are often the response to uncertainty in clinical decisions: just to be safe let's get a CT scan; just to be safe, take a week of ciprofloxacin.
Imaging Stewardship
Durand and colleagues imagine an Imaging Steward would (1) implement Choosing Wisely items related to imaging; (2) allocate resources towards information technology such as clinical-decision support systems; (3) intervene to ensure review for appropriateness of image ordering through dialogue with physicians; (4) gather and share data on ordering appropriateness that could show performance by physician; and (5) provide education on imaging knowledge gaps.
Where antimicrobial stewardship has an advantage over imaging is that antimicrobials are costly for hospitals, especially for newer antimicrobials such as daptomycin or linezolid. Antimicrobial stewardship programs have often justified their existence through a business argument that stewardship would lessen inappropriate use of expensive antimicrobials and reduce costs to the system. Imaging, on the other hand, typically generates income for a hospital through direct billing. Antimicrobial stewardship has developed over the past 15 years and now is a key part of the President's National Action Plan for Combating Antimicrobial-Resistant Bacteria and stewardship programs may become a requirement to receive Medicare payments.
Policymakers and The Joint Commission should realize the potential benefit of expert stewardship outside of antimicrobial use. Imaging is a natural place to start, but hardly the only area in which overuse of medical care could be improved. Overuse has been estimated to account for up to 30 percent of all medical care and the majority of patients receive more care than is needed. Such overuse includes inappropriate use of antimicrobials and imaging but also cancer screening tests, diagnostic tests, invasive procedures, major operations, blood transfusions, and medication use. Clinician-led stewardship could intelligently lessen overuse in many environments.
Medical Stewardship Beyond Imaging And Antibiotics
How might this appear? It is easy to imagine having stewards responsible for areas of medicine including antimicrobial use and imaging as well as surgery and procedures that have a great deal of variation in use (and therefore likely overuse). This would include interventional cardiology, orthopedics, vascular surgery, endocrine and cancer surgery, among others. Medical areas such as oncology would be a natural fit. A surfeit of new, highly expensive medications could support a steward focused on appropriate use. Primary care could have stewards look at antimicrobials (for which there is little outpatient stewardship) as well as use of tests and other medications.
In addition to appropriateness criteria, stewardship can incorporate informed patient involvement in decision-making (such as salvage chemotherapy or many forms of knee surgery). A structure for stewardship could be justified as part of patient safety and quality improvement. By improving appropriateness of care, patients would face less risk of medical harm and a lower burden of care (fewer tests and medications to remember).
Policies To Support Medical Stewardship
Whether a system can support multiple experts reviewing appropriateness with primary clinicians is an important question. The potential savings from removing unnecessary care would be greater than the costs of scattered professionals targeting the highest volume, lowest-value care.
However, low-value care is often provided because it is encouraged by our reimbursement systems. Foregoing unnecessary surgery or imaging would have the perverse impact of decreasing revenue under fee-for-service reimbursement. So, beyond the expertise to trim the harmful effects of unnecessary care, we need payment systems that reward providers and hospitals that take the necessary steps to limit overuse. Durand and coauthors point out that alternative models of Medicare payments may change this financial incentive.
The proposal to expand stewardship beyond antimicrobials is astute and should improve the appropriate use of imaging. Clinician-led stewardship efforts in many areas could intelligently limit unnecessary care while assuring provision of effective care. Stewards will need knowledge of evidence-based medicine and support from leadership to be successful. Expansion of stewardship would allow clinicians to lead in high-value care while protecting patients during the inevitable move towards more accountable care.
Author's Note
The author received funding from the US Department of Veterans Affairs, CDC, and AHRQ.
from Health Affairs Blog http://ift.tt/1NiCpzQ
Clinician-Led Stewardship To Curb Medical Excess
In a recent New England Journal of Medicine (NEJM) perspective, Durand and colleagues propose “medical-imaging stewardship.” They believe that imaging can be more appropriately used through “provider-led imaging stewardship,” based on the model of antimicrobial stewardship.
Antimicrobial stewardship is a hospital program composed of an expert pharmacist and infectious disease physician. Its goal is to improve appropriateness of antimicrobial use through restriction of antibiotics, post-prescription review, and education. Clinician-led stewardship could limit overuse and improve care beyond antimicrobial use or imaging and should be considered for all areas of medicine.
The comparison of imaging to antimicrobials is appropriate. Both imaging and antimicrobials are heavily overused; up to 50 percent of both are unnecessary. Likewise, both have objective harms to patients, with imaging leading to false-positive results such as incidentalomas, contrast, and radiation exposure and antimicrobials increasing risk for Clostridium difficile infection, drug side effects, and promotion of resistance. Both imaging and antimicrobials are often the response to uncertainty in clinical decisions: just to be safe let’s get a CT scan; just to be safe, take a week of ciprofloxacin.
Imaging Stewardship
Durand and colleagues imagine an Imaging Steward would (1) implement Choosing Wisely items related to imaging; (2) allocate resources towards information technology such as clinical-decision support systems; (3) intervene to ensure review for appropriateness of image ordering through dialogue with physicians; (4) gather and share data on ordering appropriateness that could show performance by physician; and (5) provide education on imaging knowledge gaps.
Where antimicrobial stewardship has an advantage over imaging is that antimicrobials are costly for hospitals, especially for newer antimicrobials such as daptomycin or linezolid. Antimicrobial stewardship programs have often justified their existence through a business argument that stewardship would lessen inappropriate use of expensive antimicrobials and reduce costs to the system. Imaging, on the other hand, typically generates income for a hospital through direct billing. Antimicrobial stewardship has developed over the past 15 years and now is a key part of the President’s National Action Plan for Combating Antimicrobial-Resistant Bacteria and stewardship programs may become a requirement to receive Medicare payments.
Policymakers and The Joint Commission should realize the potential benefit of expert stewardship outside of antimicrobial use. Imaging is a natural place to start, but hardly the only area in which overuse of medical care could be improved. Overuse has been estimated to account for up to 30 percent of all medical care and the majority of patients receive more care than is needed. Such overuse includes inappropriate use of antimicrobials and imaging but also cancer screening tests, diagnostic tests, invasive procedures, major operations, blood transfusions, and medication use. Clinician-led stewardship could intelligently lessen overuse in many environments.
Medical Stewardship Beyond Imaging And Antibiotics
How might this appear? It is easy to imagine having stewards responsible for areas of medicine including antimicrobial use and imaging as well as surgery and procedures that have a great deal of variation in use (and therefore likely overuse). This would include interventional cardiology, orthopedics, vascular surgery, endocrine and cancer surgery, among others. Medical areas such as oncology would be a natural fit. A surfeit of new, highly expensive medications could support a steward focused on appropriate use. Primary care could have stewards look at antimicrobials (for which there is little outpatient stewardship) as well as use of tests and other medications.
In addition to appropriateness criteria, stewardship can incorporate informed patient involvement in decision-making (such as salvage chemotherapy or many forms of knee surgery). A structure for stewardship could be justified as part of patient safety and quality improvement. By improving appropriateness of care, patients would face less risk of medical harm and a lower burden of care (fewer tests and medications to remember).
Policies To Support Medical Stewardship
Whether a system can support multiple experts reviewing appropriateness with primary clinicians is an important question. The potential savings from removing unnecessary care would be greater than the costs of scattered professionals targeting the highest volume, lowest-value care.
However, low-value care is often provided because it is encouraged by our reimbursement systems. Foregoing unnecessary surgery or imaging would have the perverse impact of decreasing revenue under fee-for-service reimbursement. So, beyond the expertise to trim the harmful effects of unnecessary care, we need payment systems that reward providers and hospitals that take the necessary steps to limit overuse. Durand and coauthors point out that alternative models of Medicare payments may change this financial incentive.
The proposal to expand stewardship beyond antimicrobials is astute and should improve the appropriate use of imaging. Clinician-led stewardship efforts in many areas could intelligently limit unnecessary care while assuring provision of effective care. Stewards will need knowledge of evidence-based medicine and support from leadership to be successful. Expansion of stewardship would allow clinicians to lead in high-value care while protecting patients during the inevitable move towards more accountable care.
Author’s Note
The author received funding from the US Department of Veterans Affairs, CDC, and AHRQ.
from Health Affairs Blog http://ift.tt/1NiCpzQ
Holiday Hack: How To Make Your Christmas Tree Look Fuller
Have you ever brought out the holiday decorations and wished your Christmas tree was fuller? We've got a holiday hack that is SO easy you won't believe it. With this one simple step, your tree will be brighter and more beautiful.
How To Make Your Christmas Tree Look Fuller
The trick is really simple — all you have to do is string two sizes of lights on your tree.
We have a pre-lit tree, so I just added a couple of strands of these large bulbs around the tree and the difference is astounding!
The second set of lights adds dimension to the tree, making it beautiful and bright.
Now it's ready to add all of your homemade ornaments! We added no-mess glitter ornaments to ours — they sparkle and shine in the lights! So beautiful!
The post Holiday Hack: How To Make Your Christmas Tree Look Fuller appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/1MQdGFW
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