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\"Bell and Cortese clearly articulate the central importance of leadership to achieving high value, patient-centric health and wellness . . . compelling.\"—William B. Rouse, PhD, author of Understanding and Managing the Complexity of Healthcare   Healthcare in America is wildly inconsistent and uncomfortably close to bankruptcy, and the only way it can be rescued is with leaders in all the different areas of healthcare stepping up with the right kind of leadership. The problem is that they don't realize the importance of their leadership, and even when they do, they don't know how to lead. Rescuing Healthcare shows them (and the rest of us) why it's so important that they do step up, and—the critical ingredient—it shows them how to exercise the right kind of leadership—whatever their role or contribution. And for the rest of us as consumers, it shows us what we should be expecting . . . and demanding. The goal of this book, then, is nothing less than the salvation and transformation of healthcare.   \"One of America's most eminent medical executives and a highly-regarded thought leader in leadership have given us a masterful overview of healthcare leadership and how to improve it. Rescuing Healthcare gets straight to the point, with a sharp diagnosis of our ills and a clear vision of where healthcare needs to go. Drawing on a lifetime of experience, Dr. Cortese and Antony Bell offer a detailed strategy to unite your organization around a common purpose, improve patient care, and succeed in a value-based environment.\" —Toby Cosgrove, MD, CEO and President, Cleveland Clinic

Conflict of interest, even the appearance of potential conflict, has long been a concern for physicians and scientists. Conflict of interest arises when an activity is accompanied by a divergence between personal or institutional benefit when compared to the responsibilities to patients and to society; it arises in the context of research, purchasing, leadership, and investments. Conflict of interest is of concern because it compromises the trust of the patient and of society in the individual physician or the medical center.

To study the effectiveness of photodynamic therapy (PDT) as a therapeutic strategy in roentgenographically occult squamous cell carcinoma of the lung. A carefully selected group of 21 patients (with 23 cancers) who had early stage squamous cell carcinoma of the lung and were eligible for surgical treatment were offered PDT as an alternative to resection. Patients underwent close follow-up with bronchoscopic surveillance and were offered resection if cancer persisted after no more than two sessions of PDT. A complete response was identified in 15 patients (16 cancers) after an initial PDT session. A complete response that lasted longer than 12 months was noted in 11 patients (52%). After PDT, the minimal follow-up period was 24 months. A subsequent primary lung cancer developed in 5 of the 21 patients (24%). Ten patients ultimately had surgical treatment, in 3 (30%) of whom N1 disease was identified at the time of resection. Two patients refused a surgical procedure and received alternative therapy. Therefore, nine patients (43%) were spared an operation (95% confidence interval, 21.8 to 66.6%). The mean duration of follow-up for these nine patients was 68 months (range, 24 to 116). On the basis of this investigation, we can conclude with 95% confidence that at least 22% of patients with early stage squamous cell lung cancer who are candidates for PDT can be spared surgical resection.

Dr. Denis Cortese and Jeffrey Korsmo write that we must hold physicians and other providers accountable for providing high-value health care, defined in terms of both quality and cost. They propose that we create a value score for each medical institution and make it publicly available. Americans do not consistently receive high-value health care. Collectively, our country spends more on health care than any other nation, but our people do not receive the best outcomes, safety, service, or access in return. Although some organizations, regions, and states deliver high-quality, affordable care, many do not. It's time to make high-value health care the norm in the United States. To reach that goal, we must hold physicians and other providers accountable for providing high-value health care, defined in terms of both quality and cost: value=quality÷cost. In this equation, quality includes clinical outcomes, safety, and patient-reported satisfaction, and cost . . .

An occurrence of multiple chronic lung abscesses managed bylobectomy is described. These abscesses were present for 13 years inthe patient, a nonimmunocompromised wood pulp worker. The patient hadhemoptysis at presentation. The organism isolated was Ochroconisgallopavum, a dematiaceous fungus known to cause disease inimmunocompromised patients and epidemic encephalitis in poultry. Thefungus is typically found in warm environments and in decaying compost;for this reason, we postulate that his illness was occupationallyacquired.

To study the effectiveness of photody-namic therapy (PDT) as a therapeutic strategy in roentgenographically occult squamous cell carcinoma of the lung. A carefully selected group of 21 patients (with 23 cancers) who had early stage squamous cell carcinoma of the lung and were eligible for surgical treatment were offered PDT as an alternative to resection. Patients underwent close follow-up with bronchoscopic surveillance and were offered resection if cancer persisted after no more than two sessions of PDT. A complete response was identified in 15 patients (16 cancers) after an initial PDT session. A complete response that lasted longer than 12 months was noted in 11 patients (52%). After PDT, the minimal follow-up period was 24 months. A subsequent primary lung cancer developed in 5 of the 21 patients (24%). Ten patients ultimately had surgical treatment, in 3 (30%) of whom Nl disease was identified at the time of resection. Two patients refused a surgical procedure and received alternative therapy. Therefore, nine patients (43%) were spared an operation (95% confidence interval, 21.8 to 66.6%). The mean duration of follow-up for these nine patients was 68 months (range, 24 to 116). On the basis of this investigation, we can conclude with 95% confidence that at least 22% of patients with early stage squamous cell lung cancer who are candidates for PDT can be spared surgical resection.