|Although surgery often is intended to be curative, it may sometimes be used to assuage pain or dysfunction. This type of surgery, called palliative surgery, can remove an intestinal obstruction or remove masses that are causing pain or disfigurement. Palliative surgery is typically defined as any procedure performed to reduce symptoms or improve quality of life in a patient with an advanced malignancy, excluding operations for potential cure. Increasingly, health care systems are requiring quality standards to be analyzed in order to justify surgical interventions. One contemporary movement that has drive hospitals to address issues of safety, quality, and affordability is The Leapfrog Group. The three original Ã¢â¬ÅleapsÃ¢â¬Â in quality included computerized prescriber order entry, intensive care unit (ICU) physician staffing, and evidence-based hospital referral. A 2008 update on improvements resulting from the adoption of Leapfrog safety and quality standards showed that adoption of all three leaps at an urban hospital could save a total of 12.04 billion dollars and 57,903 lives per year. As surgical palliation becomes an increasingly larger component of comprehensive cancer care, the same standards of excellence will need to be set by evidence-based studies. Establishing this foundation is crucial for ensuring patient safety, optimizing quality of care, setting expectations for families, aiding surgeons in complicated clinical decisions, and supporting the use of healthcare resources.
Open access to the scientific literature means the removal of barriers (including price barriers) from accessing scholarly work. There are two parallel âroadsâ towards open access: Open Access articles and self-archiving. Open Access articles are immediately, freely available on their Web site, a model mostly funded by charges paid by the author (usually through a research grant). The alternative for a researcher is âself-archivingâ (i.e., to publish in a traditional journal, where only subscribers have immediate access, but to make the article available on their personal and/or institutional Web sites (including so-called repositories or archives)), which is a practice allowed by many scholarly journals.
Open Access raises practical and policy questions for scholars, publishers, funders, and policymakers alike, including what the return on investment is when paying an article processing fee to publish in an Open Access articles, or whether investments into institutional repositories should be made and whether self-archiving should be made mandatory, as contemplated by some funders.