Department of Cardiovascular Surgery, Mayo Clinic, Rochester Minnesota.
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Ann Thorac Surg. 2019 Apr;107(4):1267-1274. doi: 10.1016/j.athoracsur.2018.10.022. Epub 2018 Nov 22.
The appropriate implementation of new technology, root cause analysis of "imperfect" outcomes, and the continuous reappraisal of postgraduate training are needed to improve the care of tomorrow's patients. Healthcare delivery remains one of the most expensive sectors in the United States, and the application of new and expensive technology that is necessary for the advancement of this complex specialty must be aligned with providing the best care for our patients. There are a several pathways to innovation: One is partnering with industry and the other is the investigational laboratory. Innovation and the funding thereof come from both the public and private sector. Most new trials that are likely to impact cardiothoracic surgery are industry-sponsored trials to meet the requirements necessary for regulatory approval. Cost considerations are paramount when considering integration of innovative technology and treatments into a clinical cardiothoracic surgical practice. The value of any new innovation is determined by the quality divided by the cost, and lean initiatives maximize this equation. The importance and implications of conflict of interest have been a concern for physicians, particularly when new technology or procedures are incorporated into clinical practice, and full disclosures by medical professionals and others involved are essential. Our societies and associations provide a platform for presentation and peer-reviewed discussion of new procedures, innovations, and trials and provide a venue for the sharing of knowledge on the highest quality patient care through education and research.
需要适当实施新技术、对“不完善”结果进行根本原因分析，以及对研究生培训进行持续评估，以改善未来患者的护理。医疗保健服务仍然是美国最昂贵的部门之一，为推进这一复杂专业而应用必要的新技术和昂贵技术，必须与为患者提供最佳护理相一致。创新有几种途径：一种是与行业合作，另一种是研究实验室。创新及其资金来源既有公共部门也有私营部门。最有可能影响心胸外科的新试验是行业赞助的试验，以满足监管批准所需的要求。在考虑将创新技术和治疗方法纳入临床心胸外科实践时，成本考虑至关重要。任何新创新的价值都由质量除以成本来决定，而精益计划则使这个等式最大化。利益冲突的重要性和影响一直是医生关注的问题，尤其是当新技术或程序被纳入临床实践时，医疗专业人员和其他相关人员的充分披露至关重要。我们的学会和协会为新程序、创新和试验的展示和同行评审讨论提供了一个平台，并通过教育和研究为分享最高质量患者护理的知识提供了一个场所。
