Neonatal intensive care unit (NICU) teams in the US and around the world receive performance reports that locate their particular value for selected process and outcome measures within the range of values from all reporting NICUs. Understandably, many providers focus primarily, if not exclusively, on their particular value. When a value appears undesirable, providers often justify it in an apparent reflex response rather than critically analysing their data. Exceedingly few reflect on the width or implications of the range within which their performance lies. Standard medical education does not include these skills, yet unwarranted practice variation necessarily compromises a population's overall quality of care. Researchers report wide variation in health care resource use with little connection to patient outcomes, challenging the belief that directing incrementally more resources at certain healthcare problems necessarily produces better results. This book provides requisite knowledge to enable readers without research expertise to understand the notion of unwarranted practice variation, how to recognize it, its ubiquity, and why it is generally undesirable - why narrowing is pervasiveness improves quality. The book begins by describing practice variation, its prevalence, and why it matters. Next, it examines alternative conceptualizations of NICU work. One view is task-oriented, while the other is aim-oriented. NICU teams rarely articulate their aims explicitly, so this book offers examples that guide thinking and action. Finally, this book asks, "Which rate is 'right'; what is the performance target?" The answer entails identifying the lowest resource use rate associated with desirable outcomes. This requires data describing efficient and predictably performing provision of current evidence-based care, along with relationships to a variety of outcomes. Provider conceptualization of healthcare quality also is often vague. The challenge lies in defining this notion operationally. This book does precisely that and gives readers tools to think critically about process, outcome, and quality measures, via some understanding of systems, risk-adjustment modelling, and discriminating signal from noise in process data.

Neonatal intensive care unit (NICU) teams in the US and around the world receive performance reports that locate their particular value for selected process and outcome measures within the range of values from all reporting NICUs. Understandably, many providers focus primarily, if not exclusively, on their particular value. When a value appears undesirable, providers often justify it in an apparent reflex response rather than critically analysing their data. Exceedingly few reflect on the width or implications of the range within which their performance lies. Standard medical education does not include these skills, yet unwarranted practice variation necessarily compromises a population’s overall quality of care. Researchers report wide variation in health care resource use with little connection to patient outcomes, challenging the belief that directing incrementally more resources at certain healthcare problems necessarily produces better results. This book provides requisite knowledge to enable readers without research expertise to understand the notion of unwarranted practice variation, how to recognize it, its ubiquity, and why it is generally undesirable – why narrowing is pervasiveness improves quality. The book begins by describing practice variation, its prevalence, and why it matters. Next, it examines alternative conceptualizations of NICU work. One view is task-oriented, while the other is aim-oriented. NICU teams rarely articulate their aims explicitly, so this book offers examples that guide thinking and action. Finally, this book asks, “Which rate is 'right'; what is the performance target?” The answer entails identifying the lowest resource use rate associated with desirable outcomes. This requires data describing efficient and predictably performing provision of current evidence-based care, along with relationships to a variety of outcomes. Provider conceptualization of healthcare quality also is often vague. The challenge lies in defining this notion operationally. This book does precisely that and gives readers tools to think critically about process, outcome, and quality measures, via some understanding of systems, risk-adjustment modelling, and discriminating signal from noise in process data.

This issue of Clinics in Perinatology, guest edited by Drs. Alan Spitzer and Dan Ellsbury, examines Quality Improvement in Neonatal and Perinatal Medicine. The first part of the issue addresses Tools of Quality Improvement and includes articles on The Quality Chasm in Neonatal and Perinatal Medicine; Evaluating the Medical Evidence; The Vermont Oxford Network Database; The Pediatrix Clinical Data Warehouse; Role of Regional Collaboratives: The California Perinatal Quality Care Collaborative Model; A Primer on Quality Improvement Methodology; Using Statistical Process Control Methodology; Human Factors in Quality Improvement, Random Safety Audits, Root Cause Analysis, and Failure Mode and Effects Analysis; Collaboration Between Obstetricians and Neonatologists: Perinatal Safety Programs and Improved Clinical Outcomes; and Pay for Performance: A Business Strategy for Quality Improvement in Neonatal-Perinatal Medicine. The second part of this issue addresses Specific Applications of Documented Quality Improvement Methodology in Neonatal and Perinatal Medicine and includes articles on Delivery Room Intervention-Improving the Outcome, Reducing Retinopathy of Prematurity, Improving Breast Milk Use During and After the NICU Stay, Decreasing Catheter Related Bloodstream Infection, and Decreasing Bronchopulmonary Dysplasia.

Must reading for practitioners of fetal, neonatal, and perinatal medicine

Pediatrics: A Competency-Based Companion, by Maureen C. McMahon, MD and Glenn R. Stryjewski, MD, MPH, is designed to teach you to think like an experienced clinician. The only text written in the framework of the Core Competencies developed by the ACGME, its case-based approach illustrates the thought processes that effective practitioners use to approach and evaluate common pediatric presentations. Learning is easy through an intuitive, practical organization...a concise, high-yield presentation...graphs, tables, and other at-a-glance features, such as Professors’ Pearls" that provide cases with questions and annotated answers...and a framework that allows you to track your progress and that of your patients in relation to ACGME and AAMC expectations. A convenient pocket-sized format enables you to review the material on the go, and online access via Student Consult includes online extras such as "Integration Links" to bonus content in other Student Consult titles, a Competency Self-Assessment Log, Vertical Reads, and much more. Master ACGME Core Competencies with the aid of a color-coded system that helps you to integrate evidence-based medicine, continual self-assessment, and cognizance of interpersonal skills into your daily routine. Access the high-yield core information you need for pediatric rotations in a portable, pocket-sized format that organizes the most common, must-know pediatric signs/symptoms and disorders by patient presentation. Learn to see the "big picture" with the aid of "Teaching Visuals" chapters and "Speaking Intelligently" and "Clinical Thinking" features in clinical chapters. Easily locate more in-depth information on any topic with references to Nelson Essentials of Pediatrics, 6th Edition. Access the complete contents online at www.studentconsult.com, along with "Integration Links" to bonus content in other Student Consult titles...a Competency Self-Assessment Log... "Professors’ Pearls" that provide cases with questions and annotated answers...Vertical Reads...and many other features to enhance learning and retention. Get advice on managing your career, time, and life outside the clinical setting via bonus online appendices.

Written by leading global experts in the field, Principles of Neonatology provides those on the NICU team with clinically focused, evidence-based guidance in an easy-to-access format. Chapters cover the key topics of greatest and most frequent concern to clinicians treating newborns, delivering current, data-driven management and treatment advice in a single source relevant to the seasoned practitioner, fellow, or trainee. - A highly templated format makes it easy to find exactly the information you need. - Lavishly illustrated with photos, radiographs, drawings, and charts and graphs that clarify key concepts in a helpful and accessible way. - Evidence-based focus ensures that only the most reliable treatment protocols and clear-cut, data-driven guidance are included. - Coverage of all relevant topics in the NICU: skin lesions, congenital anomalies, architecture/development of neonatal intensive care units, pain control, anesthesia for newborn infants, and much more. - Ideal for every member of the NICU team: neonatologists, neonatology fellows, residents, and neonatal nurses, as well as all other clinicians working in the NICU, including PAs, occupational therapists, respiratory therapists, and others.

This volume provides a practical overview of the ethical issues arising in pediatric practice. The case-based approach grounds the bioethical concepts in real-life situations, covering a broad range of important and controversial topics, including informed consent, confidentiality, truthfulness and fidelity, ethical issues relating to perinatology and neonatology, end-of-life issues, new technologies, and problems of justice and public health in pediatrics. A dedicated section also addresses the topics of professionalism, including boundary issues, conflicts of interests and relationships with industry, ethical issues arising during training, and dealing with the impaired or unethical colleague. Each chapter contains a summary of the key issues covered and recommendations for approaching similar situations in other contexts. Clinical Ethics in Pediatrics: A Case-Based Textbook is an essential resource for all physicians who care for children, as well as medical educators, residents and scholars in clinical bioethics.

Nursing Ethics and Professional Responsibility in Advanced Practice, Third Edition focuses on the historical background, knowledge and leadership skills necessary to improve the quality of health for both individuals and society.

In this issue of Clinics in Perinatology, guest editors Joseph B. Cantey and Andi Shane bring their considerable expertise to the topic of Perinatal and Neonatal Infections. Provides in-depth, clinical reviews on Perinatal and Neonatal Infections, providing actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field; Authors synthesize and distill the latest research and practice guidelines to create these timely topic-based reviews.

Written by two anaesthetists, one British and one American, this unique book focuses on the transatlantic story of anaesthesia. The authors have both worked at the two hospitals where the first general anaesthetics for surgery were given in 1846, Massachusetts General Hospital in Boston, Massachusetts and University College Hospital, London. Each with more than fifty years' experience of working in anaesthesia, they combine their knowledge and expertise to offer a fresh outlook on the development of anaesthesia through the ages. This highly informative and intriguing text details the origins of anaesthesia, outlines the different techniques of anaesthesia and traces its progress with illuminating and enlightening commentaries. This is a fascinating book which considers the role key figures have played in developing anaesthesia including, Queen Victoria, William Morris, La Condamine, Bjorn Ibsen and Henry Beecher. Broken down into four sections, which are divided into easy-to-read chapters and filled with top quality photographs, this book makes compelling reading. It is recommended to all those interested in the history and development of medicine through the ages, and is of particular interest to anaesthetists. More than just the science of anaesthesia, this is the story about the people and personalities who have made anaesthesia what it is today.