VoicesVolume 7, Issue 1 p. 15-15 Guidelines for AFA Book Reviews Suzanne Baker, Suzanne Baker (suzbaker@twmi.rr.com)Search for more papers by this author Suzanne Baker, Suzanne Baker (suzbaker@twmi.rr.com)Search for more papers by this author First published: 23 February 2010 https://doi.org/10.1111/j.1548-7423.2005.tb00024.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume7, Issue1April 2005Pages 15-15 RelatedInformation

BACKGROUND:The influence of an opinion leader intervention on adherence to Unstable Angina (UA) guidelines compared with a traditional quality improvement model was investigated.RESEARCH DESIGN:A group-randomized controlled trial with 2210 patients from 21 hospitals was designed. There were three intervention arms: (1) no intervention (NI); (2) a traditional Health Care Quality Improvement Program (HCQIP); and (3) a physician opinion leader in addition to the HCQIP model (OL). Quality indicators included: electrocardiogram within 20 minutes, antiplatelet therapy within 24 hours and at discharge, and heparin and beta-blockers during hospitalization. Hospitals could determine the specific indicators they wished to target. Potential cases of UA were identified from Medicare claims data. UA confirmation was determined by a clinical algorithm based on data abstracted from medical records. Data analyses included both hospital level analysis (analysis of variance) and patient level analysis (generalized linear models).RESULTS:The only statistically significant postintervention difference in percentage compliant was greater improvement for the OL group in the use of antiplatelet therapy at 24 hours in both hospital level (P = 0.01) and patient level analyses (P <0.05) compared with the HCQIP and NI groups. When analyses were confined to hospitals that targeted specific indicators, compared with the HCQIP hospitals, the OL hospitals showed significantly greater change in percentage compliant postintervention in both antiplatelet therapy during the first 24 hours (20.2% vs. -3.9%, P = 0.02) and heparin (31.0% vs.9.1%, P = 0.05).CONCLUSIONS:The influence of physician opinion leaders was unequivocally positive for only one of five quality indicators. To maximize adherence to best practices through physician opinion leaders, more research on how these physicians influence health care delivery in their organizations will be required.

CONTEXT:Antenatal corticosteroids for fetal maturation have been underused, despite evidence for their benefits in cases of preterm birth.OBJECTIVE:To evaluate dissemination strategies aimed at increasing appropriate use of this therapy.DESIGN AND SETTING:Twenty-seven tertiary care institutions were randomly assigned to either usual dissemination of practice recommendations (n = 14) or usual dissemination plus an active, focused dissemination effort (n = 13).SUBJECTS:Obstetricians and their preterm delivery cases at participating hospitals.INTERVENTION:Recommendations by a National Institutes of Health (NIH) Consensus Conference held in late February-early March 1994 were disseminated in early May 1994. Usual dissemination was publication of the recommendations and endorsement by the American College of Obstetricians and Gynecologists. Active dissemination was a year-long educational effort led by an influential physician and a nurse coordinator at each facility, consisting of grand rounds, a chart reminder system, group discussion of case scenarios, monitoring, and feedback.MAIN OUTCOME MEASURE:Use or nonuse of antenatal corticosteroids was abstracted from medical records of eligible women delivering at the participating hospitals in the 12 months immediately prior to release of the NIH recommendations (average number of records abstracted, 130) and in the 12 months following their release (average number of records abstracted, 122).RESULTS:Active dissemination significantly increased the odds of corticosteroid use after the conference. Use increased from 33.0% of eligible patients receiving corticosteroids to 57.6%, or by 75% over baseline, in usual dissemination hospitals. Use increased from 32.9% to 68.3%, oran 108% increase, in active dissemination hospitals. Gestational age and maternal diagnosis affected use of the therapy in complex ways.CONCLUSION:An active, focused dissemination effort increased the effectiveness of usual dissemination methods when combined with key principles to change physician practices.

Benchmarking is generally considered to be an important tool for quality improvement. Traditional approaches to benchmarking have relied on subjective identification of 'leaders in the field'. We derive an objective, reproducible and attainable Achievable Benchmark of Care (ABC) by measuring and analysing performance on process-of-care indicators. Three characteristics of the ABC that we deem essential are: (1) benchmarks represent a measurable level of excellence; (2) benchmarks are demonstrably attainable; (3) benchmarks are derived from data in an objective, reproducible and predetermined fashion. From these characteristics it follows that (4) providers with high performance are selected to define a level of excellence in a predetermined fashion, but (5) providers with high performance on small numbers of cases do not influence unduly benchmark levels. We use the 'pared mean' to operationalize the ABC. Roughly, the pared mean summarizes the performance of top-ranked providers whereby at least 10% of the patient pool across all providers is included. Bayesian estimators for adjustment of performance of providers with small sample sizes are used to rank providers. Randomized controlled trials to assess the independent effect of the ABC in quality improvement projects are under way. We have developed a methodology objectively and reproducibly to derive a level of excellent, attainable performance, based on measured performance by a group of providers. The ABC can be applied to groups of providers in communities, to institutions and departments within them, or to individual practitioners.

APRETERM BIRTH OCCURS IN 10% of all live births and is a major cause of neonatal mortality and morbidity. In preterm infants, survival is strongly related to gestational age (GA). Antenatal corticosteroid therapy for fetal maturation is one of the most effective ways to improve the outcomes of preterm births. Randomized controlled trials conducted between 1972 and the early 1990s confirm benefit in most populations. Antenatal corticosteroid therapy reduces the risk of infant mortality by approximately 30%, of neonatal respiratory distress syndrome by approximately 50%, and of both intracranial hemorrhage and periventricular leukomalacia by approximately 70%. The latter 2 conditions are among the best predictors of long-term neurodevelopmental injury, including cerebral palsy. Net economic benefits are estimated at more than $3000 per treated neonate. Despite evidence of its effectiveness, use of corticosteroid therapy in eligible infants remained relatively low through the 1990s. Of particular importance, the therapy was used less often when GA was less than 28 weeks, compared with GA between 28 and 34 weeks. Yet these very low-GA infants were precisely the group that would most likely benefit from antenatal corticosteroids. Because of these discrepancies, the National Institutes of Health (NIH) with its affiliate, the National Institute of Child Health and Human Development (NICHD), convened a consensus panel in February 1994 to develop practice recommendations for antenatal corticosteroid therapy. The panel concluded that nearly all women who are between 24 and 34 weeks of their pregnancies and are likely to deliver preterm are candidates for the therapy. In this article, we report results of a randomized controlled trial comparing changes in the use of antenatal cortico-

Numerous changes in higher education (e.g., the demand for accountability, threats to tenure, new modes of instruction) and discontent with narrow definitions of scholarship have created the need for a broader and more precise definition of the nature of scholarship in psychology. The 5-part definition that we propose includes (a) original research (creation of knowledge), (b) integration of knowledge (synthesis and reorganization), (c) application of knowledge, (d) the scholarship of pedagogy, and (e) the scholarship of teaching in psychology. Scholarly activities require high levels of discipline-specific expertise, are innovative, can be replicated are documented can be subject to peer review and have significance. This broader conceptualization of scholarship will benefit all stakeholders in higher education-students, faculty: colleges and universities the community, and society at large.

One of the major challenges in modern obstetrics is the prevention of preterm birth, especially the birth of a very preterm infant. Preterm birth is associated with most of all neonatal deaths and is a major cause of infant morbidity. To date little evidence exists that obstetric care is effective in reducing the preterm delivery rate.(1) In fact recent data indicate that from 1981 to 1991 a small increase occurred in preterm births, especially among African-American women.(2) Better women. management of preterm labor and delivery and advances in neonatal medicine have contributed to the increased survival of preterm infants. Although most survive, many of these very preterm babies end up with serious long-term complications as a result of prematurity-related conditions such as respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Therefore more attention is being given to secondary prevention strategies that may reduce these negative outcomes. One of the few interventions available to obstetricians that has been demonstrated to be effective in reducing the negative sequelae associated with preterm birth is the antenatal administration of corticosteroids. In 1972 Liggins and Howie(3) introduced this therapy as a means of enhancing fetal lung maturity. Since then, numerous clinical trials have demonstrated the benefits of corticosteroid therapy in reducing neonatal morbidity and mortality. In 1990 Crowley et al.,(4) published a metaanalysis of 12 of these clinical trials and found that corticosteroids are effective not only in reducing the occurrence of RDS overall but also in many of the subgroups studied in the trials. They also found that corticosteroid use was associated with a reduction in the incidence of IVH, NEC, and neonatal death. They did not find evidence of any adverse effects of corticosteroids on the mother or the baby. Despite the strength of the evidence regarding the effectiveness of antenatal corticosteroids in reducing the rate and severity of RDS in premature infants, corticosteroids are given to a relatively small number of women who deliver prematurely, Evidence from several sources indicates that only about 20% of mothers who deliver preterm newborns receive corticosteroids.(5) The purpose of this study was to better understand why antenatal corticosteroid therapy is used so rarely. To this end, the investigators sought in-depth information about the variations in obstetrician opinions and practice patterns that might encourage or hinder appropriate corticosteroid use.