This is a list of all the articles and potential quotes I could have used in the AP. I made this list as I did my specific research after I figured out the outline and direction I wanted to take my paper. I used this quite a bit when I was writing my paper. I would create a second copy of this document and then go through and take out all the quotes that did not fit in the paragraph I was currently writing and then look at what was left. I then select from the remaining quotes to write my paragraph. I would repeat this process through out the whole paper, except I would refrain from using the same quotes again.

 

The Strategy that will Fix Health Care – Thomas H. Lee 

Lee, Thomas H. "The strategy that will fix health care." (2014).

• Insurance Reform
• Payment Reform
• Delivery System Reform

• Challenges:

• Too many people involved, too much to do, no one with all info, no one with accountability
• Gaps in quality and safety, inefficiency

• Make patient oriented:
  • Focus on patients with similar needs
  • Not money oriented
    • Not have fee for service or capitalization drive improvement
    • Different programs to help pay for cost of certain medical procedures
      • Ie transplant programs, walmart cardiac and spine surgery program
    • Integrate care across system
      • Consolidate care where it can be done at highest value

Health Care Reform and the Primary Care Workforce Bottleneck – Mark D. Schwartz

Schwartz, Mark D. "Health care reform and the primary care workforce bottleneck." Journal of general internal medicine 27.4 (2012): 469-472.

• the United States is heading towards a severe primary care workforce bottleneck due to ballooning demand and vanishing supply (469)
• The primary care workforce is declining because of decreased production and accelerated attrition. To mitigate the looming primary care bottleneck, even bolder policies will be needed to attract, train, and sustain a sufficient number of primary care professionals (469)
• I f the United States (US) does not fundamentally strengthen its primary care workforce it will not achieve the dramatically enhanced access, improved quality, and cost containment envisioned by the Affordable Care Act (ACA) (469)
• a serious healthcare workforce bottleneck, a severe shortage of primary care providers due to mounting patient demand and diminishing supply. (469)
• Healthcare systems based on a robust primary care workforce produce better health care quality and outcomes at lower costs than systems with a less adequate primary care supply (469)
• For each incremental primary care physician per 10,000 population (a 12.6% increase over average supply in 2000), there were 49 fewer deaths per 100,000 persons per year (a 5.3% decrease). (469)
• This association suggests that more than 120,000 deaths per year could be averted through a modest increase in the number of primary care physicians. Further, patients with a regular primary care physician have lower overall health care costs than those without one. (469)
• Only 32% of all 800,000 US physicians practice primary care ( 469)
• The number of US medical students matching into primary care residency positions declined 24% between 1985 and 2011, and the proportion of internal medicine (IM) residents practicing general internal medicine after residency dropped from 54% in 1999 to 20% in 2003. ( 469)
• Fewer than 18% of current graduating medical students are expected to ultimately practice primary care (469)
• As a result, by 2016 the number of adult primary care physicians leaving practice will exceed the number entering (469)
• Medicare provided $9.5 billion to approximately 1,100 teaching hospitals in 2009 to subsidize the cost of GME, with $3 billion in Direct GME subsidizing residency program costs, and $6.5 billion in indirect medical rducation (IME) added to Medicare case payments to teaching hospitals. (470)
• MedPAC recommends that Congress redirect the “extra” estimated $3.5 billion towards incentive payments to teaching institutions that achieve desired educational outcomes (470)
• Policy options to increase the percentage of physician trainees practicing primary care from 18% to 40% include: a) increasing the direct GME per resident amount (PRA) for trainees in primary care programs and decreasing the PRA for all other residents; b) providing bonus payments to hospitals for graduating residents that practice primary care after training; c) expanding loan repayment programs for residents that practice primary care; d) increasing salaries of primary care residents; and e) raising the cap for funded GME positions by 3,000 positions annually for 5 years, allocating at least 80% of these new slots for primary care training programs. (470) 

We have to Operate, but Let’s Play First – Michel Marriott

Marriott, Michel. "We Have to Operate, but Let's Play First." The New York Times. N.p., 24 Feb. 2005. Web. 2 Feb. 2016.

• Dr, James Clarence Rosser Jr., operates at Beth Israel Medical Center in New York
• Pefers laparoscopic surgery, a technique that relies on an ultrasmall video camera to help him manipulate long, slender instruments inserted into patients through small incisions.
• He is using video games to help develop and train a new generation of surgeons who may have unwittingly acquired an aptitude for laparoscopic surgery while willing away thousands of hours playing Mortal Kombat, BloodRayne and the like.
• "I could come in, sit down and put this in my hand," Dr. Rosser said, referring to his instruments with touch-sensitive handles that resemble triggers, "and not find it foreign to look on that screen and do something with my hands."
• Rosser, 50, practices what he preaches. He keeps an Xbox, along with PlayStation 2 and GameCube consoles, just a few strides from the operating room so he can warm up with a favorite, Super Monkey Ball, just before surgery.
• Last year Dr. Rosser was a co-author of a study that concluded that surgeons who played video games for at least three hours a week were 27 percent faster and made 37 percent fewer mistakes than surgeons who did not play video games.
• And as Dr. Rosser conducts his Rosser Top Gun Laparoscopic Skills and Suturing Program, which, among other things, introduces video games to medical trainin
• Precisely measuring how surgeons work and then using training tools, like video games, to help impart those skills is vitally important to the medical profession, said Anthony C. Antonacci, Beth Israel's chairman of the department of surgery.
• Many medical simulators are almost prohibitively expensive, he suggested. He said he had been using one, "but that thing was costing $200,000 -- how many people are going to have one of those?"
• Recently, Dr. Rosser has been working with Hollywood visual effects experts to help apply motion-capture technologies -- used in creating lifelike virtual characters in movies and video games -- to produce new types of surgical training techniques and devices.

Health Care in the 21^st Century – William H. Frist

Frist, William H. "Health care in the 21st century." New England Journal of Medicine 352.3 (2005): 267-272.

Pg 267

• These changes resulted in dramatic improvements to the U.S. health care system — lower costs, higher quality, greater efficiency, and better access to care.
• Because of the widespread availability and use of reliable information, which has generated increased provider-level competition, the cost of health care has stabilized and in some cases has actually fallen, whereas quality and efficiency have risen.1
• Rodney periodically accesses his multidisciplinary primary medical team using e-mail, video conferencing, and home blood monitoring. He owns his privacy-protected, electronic medical record. He also chose to have a tiny, radio-frequency computer chip implanted in his abdomen that monitors his blood chemistries and blood pressure.
• The emergency room physician quickly accesses all of Rodney’s up-to-date medical information.
• Thanks to interoperability standards adopted by the federal government in 2008, nearly every emergency room in the United States can access Rodney’s health history, with his permission

Pg 268 

• Today, however, we are saddled with glaring inefficiencies, high and rapidly rising health care costs, growing ranks of the uninsured, chasms in quality, and health care disparities. Health care spending in the United States is the highest of any industrialized country,4,5 making up nearly 15 percent of our gross domestic product
• Today’s average premium for an insurance policy for a family — $9,086 a year and rising — represents 21 percent of the national median household income of $42,409.7 We spend approximately $5,540 per person per year on health care in the United States
• Life expectancy has increased from 47 to 77 years of age during the past 100 years
• Yet there are troubling signs that we are not getting a good return on our investment
• We have uneven access to care, with the number of uninsured people climbing annually, most recently to about 45 million
• receive only about 55 percent of the recommended care for a variety of common conditions
• Although we have made massive investments in medical research, we clearly have underinvested in the research and infrastructure necessary to translate basic research into results
• For example, it takes our physicians an average of 17 years to adopt widely the findings from basic research
• First, we must agree on a guiding principle: all Americans deserve the security of lifelong, affordable access to high-quality health care.
• we must acknowledge as a society that the current health care sectors cannot meet the needs of 21st-century America without a true transformation on the scale of what most of America’s other industries sustained in the 1980s and 1990s as they retooled to become among the most competitive and successful in the world
• will need to make these changes, we must adjust our policies for a patient-centered, consumer-driven, and provider-friendly health care system
• The focus of the 21st-century health care system must be the patient. Such a system will ensure that patients have access to the safest and highest-quality care
• responsive primarily to individual consumers, rather than to third-party payers
• health care today is paid for and controlled by third parties,

pg 269

• empower all people — if they so choose — to make decisions that will directly affect the most fundamental and intimate aspect of their life — their own health
• In a transformed health care system, we must reestablish and promote the value of the doctor–patient relationship
• We must recognize that empowered providers, competing and retooling to provide the highest possible level of care for patients, are the cornerstones of this new vision
• This patient-centered, consumer-driven, provider-friendly model will be energized and driven by three fundamental forces: information, choice, and control.
• Increased access to more accurate information about care and pricing will make possible the rest of the transformation of the health care system.
• Informed consumers must have the opportunity to choose. Whether selecting their physician, hospital, or health plan, consumers must be able to choose what best meets their needs
• Consumers and patients must be in control. Sophisticated, empowered consumers — as Americans are in almost every other aspect of their lives — will make the best decisions both for themselves and, collectively, for the health care economy and society itself.
• Providers also must have sufficient control to compete, take risks, and innovate to provide higher-quality, more efficient clinical care.
• Government should provide people with adequate resources and promote the development of better information so that consumers can make informed choices
• It must also provide a sturdy safety net with basic protections and additional assistance for the physically, mentally, or financially vulnerable
• A 21st-century health care system requires electronic health records
• Electronic health records must contain all necessary health information, from medical histories to billing information; must be accessible from any Internet portal; must be capable of seamless use among all hospitals, doctors’ offices, and clinics; and must be protected by strong, national privacy laws from inappropriate, unethical, or unauthorized use.
• Widespread adoption of electronic health records will reduce errors, improve quality, eliminate paperwork, and improve efficiency. Once fully implemented, electronic records will dramatically reduce cost and improve quality
• Providers should be encouraged, with the use of payment incentives, to deploy electronic health records rapidly

Pg 270

• Affordable health coverage for all americans
• We should also take steps to make insurance more affordable and more consumer-friendly, particularly for individual consumers and small businesses
• Third, we must pass medical litigation reform and patient safety legislation to stop the litigation lottery, curb frivolous lawsuits, and reduce medical errors. I
• It is estimated that malpractice costs, including defensive medicine, account for at least $100 billion a year in health care costs
• 4 Moreover, a liability system intended to promote the highest standards of care, reduce errors, and punish negligence is having the opposite effect

An Introduction to Medical Malpractice in the US – B. Sonny Bal

Bal, B. Sonny. "An introduction to medical malpractice in the United States."Clinical orthopaedics and related research 467.2 (2009): 339-347.

• Medical malpractice is defined as any act or omission by a physician during treatment of a patient that deviates from accepted norms of practice in the medical community and causes an injury to the patient. (340)

Anesthesiologist trashes sedated patient – ends up costing her – Tom Jackman

Jackman, Tom. "Anesthesiologist Trashes Sedated Patient - and It Ends up Costing Her." Washington Post. The Washington Post, 23 June 2015. Web. 29 Feb. 2016.

https://www.washingtonpost.com/local/anesthesiologist-trashes-sedated-patient-jury-orders-her-to-pay-500000/2015/06/23/cae05c00-18f3-11e5-ab92-c75ae6ab94b5_story.html

• , a Vienna man prepared for his colonoscopy by pressing record on his smartphone, to capture the instructions his doctor would give him after the procedure.
• mocked and insulted him as soon as he drifted off to sleep.
• doctors discussed avoiding the man after the colonoscopy, instructing an assistant to lie to him, and then placed a false diagnosis on his chart.
• So the man sued the two doctors and their practices for defamation and medical malpractice and, last week, after a three-day trial, a Fairfax County jury ordered the anesthesiologist and her practice to pay him $500,000
• Name = B.
• Tiffany M. Ingham, 42
• Ingham worked out of the Aisthesis anesthesia practice in Bethesda, Md., which the jury ruled should pay $50,000 of the $200,000 in punitive damages it awarded
• Soloman Shah, 48, was dismissed from the case
• Shah was recorded saying during the rash discussion — and did not discourage Ingham from her comments or actions, which included writing on the man’s chart that he had hemorrhoids, when he did not.
• “I’ve never heard of a case like this,” said Lee Berlik, a Reston lawyer who specializes in defamation law. He said comments between doctors typically would be privileged, but the Vienna man claimed his recording showed that there was at least one and as many as three other people in the room during the procedure and that they were discussing matters beyond the scope of the colonoscopy.
• e colonoscopy took place in Shah’s surgical suite on April 18, 2013
• Ingham suggested Shah receive an urgent “fake page” and said, “I’ve done the fake page before,” the complaint states
• Then the anesthesiologist said, “I’m going to mark ‘hemorrhoids’ even though we don’t see them and probably won’t,” and did write a diagnosis of hemorrhoids on the man’s chart, which the lawsuit said was a falsification of medical records.

Challenges to improving patient safety in the NHS – Daljit Kaur Hothi

Kaur Hothi, Daljit. "Challenges to improving patient safety in the NHS."Clinical Governance: An International Journal 9.3 (2004): 143-146.

• Faced with errors, doctors have traditionally relied on the “shame and blame” approach (Sharpe, 2000), but psychologists believe this to be counterproductive, making an individual feel exposed and defensive (Eisenberg, 2000) (144)
• The systems approach to errors is based on the supposition that honest human error is inevitable, and that through the production of a “system” errors can be reduced. (144)
• Studies have shown that patients who are well informed are more likely to adhere to treatment and have better health outcomes (145)
• Patient-centred care is driving quality improvement (145)
• The results are often immediate, but are expensive with respect to time and staffing. To make an informed decision, patients require access to up to date information and time for discussion (145)

Are Video Games Training Gains specific or general? – Adam C. Oei and Michael D. Patterson

Oei, Adam C., and Michael D. Patterson. "Are videogame training gains specific or general." Frontiers in systems neuroscience 8.54 (2014): 1-9.

• With a few exceptions (e.g., Boot et al., 2008; Irons et al., 2011), results from independent laboratories have shown experienced AVG(Action Video Game) players outperforming non-players in a variety of cognitive and perceptual task (1)
• In other words, AVG trainees become better able to use evidence from repeated presentations of a task to guide their decision-making and allocation of cognitive resources (Green et al., 2010b; Bavelier et al., 2012b) (2)
• Hence, AVG experience may enhance a general capacity to control top-down attention and learning of a new task, which in turn translates to improvement across many different tasks (2)
• First, it is unclear whether this transfer to a general statistical learning ability applies only to AVG or whether it can also be used to explain transfer effects from other videogames (2)
• this hypothesis is too general such that it is not clear which tasks AVG training can and cannot transfer to (2)
• although it has been demonstrated that AVG trainees do indeed improve probabilistic inference in a visual perceptual task (Green et al., 2010b), empirical evidence is currently lacking to show that this can also account for transfer to the other tasks seen in the AVG literature. (2)
• An important aspect of visual perception that is enhanced by AVG playing is the ability to detect subtle contrast differences. (2)
• AVGs make good candidates for training peripheral vision because of their heavy emphasis on detecting targets across different central and peripheral areas (2)
• First, AVG players searched faster and more efficiently overall (HubertWallander et al., 2011) without sacrificing accuracy (Castel et al., 2005). Additionally, AVG players searched more accurately and faster in demanding conjunction conditions (Wu and Spence, 2013). Finally, AVG players were able to search more accurately when distracting objects were in close proximity to the target (Green and Bavelier, 2007), a condition known as crowding (Toet and Levi, 1992; Intriligator and Cavanagh, 2001). (4)
• expert AVG players will exhibit superior ability to detect visual anomalies when they are focused on other features in their visual field (4)
• AVG, especially those with a first-person perspective, should be good training tools for some spatial skills due to navigation and rotation demands in 3D space (Spence and Feng, 2010; Sanchez, 2012 (5)

Simulation in Neurosurgery – A Brief Review and Commentary – Mary In-Ping Huang

Cobb, Mary In-Ping Huang, et al. "Simulation in Neurosurgery—A Brief Review and Commentary." World neurosurgery (2015) 

• More than 75% of neurosurgical errors are deemed as preventable and technical in nature. Yet in a specialty that requires such high level of technical expertise, with large consequences for error, there are even fewer opportunities for residents in training to practice on the most complicated cases (1)
• Surgeons who played video games well in the past and those who currently enjoy it may happen to develop laparoscopic training skills more quickly than video game novices (3)
• The current Donkey Kong world record holder is a plastic surgeon from New York City, who states that mastering the video game is more difficult than the surgeries he performs (3)
• free online interactive virtual surgical gaming websites, developed for surgeons in non-neurosurgery specialties, patients, and the general gamer consumer. (3)
• For example, www.surgerysquad. com is a website that offers free surgical simulators in procedures in general surgery, obstetrics/gynecology, plastics, and dentistry. The closest application to neurosurgery is their module on carpal tunnel release. The website www. mydoctorgames.com has several “brain surgery” games that set up the scenario, requires the user to select the appropriate instrument, and move that instrument to a specific location on the patient. (3)
• GestSure (Cambridge, Massachusetts, USA) has applied the X-Box Kinect technology to the operating room, allowing surgeons to manipulate computed tomography/magnetic resonance imaging through use of hand gestures in a sterile manner during surgery(3)
• TedCas (Navarra, Spain) has developed a similar technology, like GestSure, that allows surgeons to manipulate images through hand gestures in a sterile manner during surgery. Developers are moving forward with programming applications that have allowed control of alaparoscopic robotic arm with no need for hardware, for example (https://www.youtube.com/watch?v¼JLqLm vL75B0#t¼34).(3)

Crowned New King of Kong – Corey Kilgannon

Kilgannon, Corey. "Crowned New King of Kong." The New York Times. The New York Times, 07 Jan. 2012. Web. 07 Mar. 2016.

• Chien specializes in reshaping his patients’ eyes to create a crease in the upper eyelid.
• “For both gaming and surgery, you have to have a focused personality and be very precise,” he said. “They both take foresight and good reflexes, and a lot of strategy and planning and timing.”
• Hank Chien

Play to Become a Surgeon: Impact of Nintendo Wii Training on Laparoscopic Skills –

Giannotti, Domenico, et al. "Play to become a surgeon: impact of Nintendo Wii training on laparoscopic skills." PLoS One 8.2 (2013): e57372.

• All participants were tested in the first session on our validated laparoscopic simulator (Lap MentorTM, SimbionixTM) and then randomized to group 1 (Controls, no training with the NintendoH WiiTM), and group 2 (training with the NintendoH WiiTM) with 21 subjects in each group, according to a computer-generated list. e57372 (1)
• Between the two sessions, subjects in group 1 (control) were instructed not to play video-games while group 2 underwent a systematic NintendoH WiiTM training for 60 minutes a day, five days a week, for four weeks | e57372 (2)
• Probably in both areas the same process of ‘‘perceptual learning’’ is involved. (3)
• Video-games may be a cheap and widely available product, helping to develop cognitive skills that, apparently, can be transferred in improved surgical performance (3)
• Rosemberg et al. evaluated 11 medical students playing a selection of video-games and performing laparoscopic tasks in a swine model. As reported in other studies they found a correlation between video-game play and the completion time of simple laparoscopic tasks, such as object translocation, while no advantages were identified in more complex tasks (3)
• In our study, the NintendoH WiiTM proved its validity in improving both the basic laparoscopic skills and complete simulated procedures of cholecystectomy. (6)
• In full procedures, the training reduced the complication rate and the unsafe cautery rate, which are probably the most frequent avoidable incidents for novice laparoscopists.
• ( 6)

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0057372 

The Impact of Video Games on Training Surgeons in the 21^st century – James C. Rosser

Rosser, James C., et al. "The impact of video games on training surgeons in the 21st century." Archives of surgery 142.2 (2007): 181-186. 

• Past video game play in excess of 3 h/wk correlated with 37% fewer errors (P<.02) and 27% faster completion (P<.03). (181)
• Current video game players made 32% fewer errors (P=.04), performed 24% faster (P<.04), and scored 26% better overall (time and errors) (P<.005) than their nonplaying colleagues. (181)
• Video game skill correlates with laparoscopic surgical skills. Training curricula that include video games may help thin the technical interface between surgeons and screen-mediated applications, such as laparoscopic surgery. Video games may be a practical teaching tool to help train surgeons. (181)
• A positive correlation was found between video gaming and visual attention processing, and a correlation with competence in analogous tasks was suggested. (182)
• The participants were divided into 5 groups (after controlling for visual imagery abilities): 1 control group, 2 learning groups (with the intent to improve in actual putting), and 2 enjoyment groups (with the intent to simply enjoy the game). The results indicated that the 2 learning groups showed the most improvement in golf putting. All 4 of the experimental groups improved their posttest scores, demonstrating that video games can be an effective skill transfer tool, even without haptic references, particularly if a user is engaged in a skill-learning strategy (182)
• Over-the-counter video games may constitute a training resource, not as simulation but as a gradual path of analogous or parallel skill acquisition. (182)

Systemic Review of serious games for medical education and surgical skills training –

Graafland, Maurits, J. M. Schraagen, and Marlies P. Schijven. "Systematic review of serious games for medical education and surgical skills training."British journal of surgery 99.10 (2012): 1322-1330. 

• Patient safety concerns call for the need to train medical personnel in simulated settings to reduce cost and patient morbidity. (1322)
• Although game-based learning is becoming a new form of education throughout healthcare, scientific research on its effectiveness is rather limited. (1323)
• If training and testing of healthcare professionals such as surgical trainees is to be carried out in digital game-based environments, strict requirements should be met. Use of these games and interpretation of the underlying game-metrics must be reliable, valid and cause-specific. Thorough scientific research on validity testing is mandatory before serious games can be applied to surgical training curricula in a valid manner. (1323)
• A majority felt immersed in the virtual world, felt the game improved their confidence

and believed the cases were useful in learning clinical skill management, proving face validity. (1325)

• The search identified 17 serious games designed specifically for educational use in medicine, of which several were of specific interest to surgical practice. Other games were not linked directly to surgical practice, but could be viewed as generally interesting because of methods of education. Further research should define valid performance parameters and complete formal validation programmes, before serious games can be seen as fully fledged teaching instruments for professionals in the medical and surgical field. (1327)
• Video games have been shown to increase visuospatial and attention skills. Furthermore, visuospatial abilities and human visual working memory have been associated with laparoscopic handling performance (1328)
• Serious games allow multiple professionals to train simultaneously on one case (teamwork) and allow one professional to train multiple cases simultaneously (1328)
• Serious games allow multiple professionals to train simultaneously on one case (teamwork) and allow one professional to train multiple cases simultaneously (1328)
• Serious games allow such training in a relatively cheap, readily available environment with a large variety of cases, providing an alternative to expensive high-fidelity simulators (1328)