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BIBLIOGRAPHY Carrol Gamble, P., Ashma Krishan, B., Deborah Stocken, P., Steff Lewis, P., & Edmund Juszczak, M. (2018). Guidelines for the Content of Statistical Analysis Plans. JAMA | Special Communication, 23, 2337-2343. doi:10.1001/jama.2017.18556
Daniel J. Morgan, M. M., Sanket S. Dhruva, M., Eric R. Coon, M., ScottM.Wright, M., & Deborah Korenstein, M. (2018). 2017 Update onMedical Overuse. JAMA Internal Medicine, 1(178), 110-115. doi:10.1001/jamainternmed.2017.4361
Lindsay R. Pool, P., Sarah A. Burgard, P., Belinda L. Needham, P., & Michael R. Elliott, P. (2018). Association of a NegativeWealth Shock With All-Cause. JAMA, 13, 1341-1350. doi:10.1001/jama.2018.2055
Susan Haas, M. M. (2018). The Risks to Patient Safety. JAMA, 1-2. doi:10.1001/jama.2018.2074
Victor J. Dzau, M., Mark B. McClellan, M. P., J. Michael McGinnis, M. M., & Sheila P. Burke, M. R. (2017). Vital Directions for Health and Health Care. JAMA, 14, 1461-1470. doi:10.1001/jama.2017.1964

The author said that it is important to focus on health conditions of all populations or members in the world mostly, taking in consideration of the poor and low level people. In this paper, Affordable Care Act (ACA) replacement and repeal fractions had been discussed. In near future the United States has to face problems on health care and health which exceed the provisions of ACA with higher attention. To obtain healthier life in lowest price, initiatives has focused on infrastructure priorities and certain strategic. The article also shows the information on absence of supervision in statistical analysis plans (SAPs) content and principles for clinical trials to support reproducibility and transparency. Minimum groups of items should be kept in SAPs in clinical trials, funders, previous guideline authors and regulators are key reference to upgrade the system, as stated in article. It is also required to set up statistical analysis, protocols and trails registration which are analytically prominent to report the clinical trials in appropriate way. In paper, the United States health care system undertaking through single service agreement to institutional affiliations rather than from acquisitions and merge as like substantial consolidation. Some more how there has been risk in the system evaluation to the patients. To observe the risk on patient safety, Harvard-affiliated institutions are taken in consideration to carry on the experiment namely health systems research (Ariadne Labs) and medical liability insurer (CRICO/ Risk management Foundation). The process they adopted in journal to account the patient risk level in both national and local standard were leaders conveying systems and interviewing clinicians. It is observed that the three types of important safety risks has been created by system expansion related to changing clinical practice settings, patient populations and infrastructure which are often unaddressed and unrecognized. The article also described the health related expenses in United States affected by the negative shock of wealth which reflects a sudden loss of wealth for instance property loss by fire, robbery, and natural calamities etc. might leads towards significant ring of major mental health problems and too left less financialpropertiesuseful to expense on healthier life. It is said that with limited time to regain the loss property in older age there will be long lasting negative shocks in wealth. The article associates the negative shocks with mortality, to find out the all causes of mortality on follow-up 20 years period. Some articles shows that maximum use of medical care is also a significant problem in health care. The most often these problems were found in adulthood. The author gone through the evaluation of use of medicine by the adults.
The article argues qualitative analysis with secondary data from nineteen National Academy of Medicine along with primary data from analysis of publicly available data, commissioned white papers, and published research findings and with supplemental review. According to survey, Dataencountered during major challenges in US health system were $3.2 trillion cost were spent in health care annually which remains the highest cost out of which 30% of an estimated amount is on inefficiencies and waste. In addition, the families and communities are facing the financial burdens of disability and chronic illness and the health and excessive prices are in health inequalities which are worsening and persistent. The findings shows that four essential infrastructure needs and four action priorities were identified as eight crosscutting policy directions which were important to fiscal future and nation’s health. It is to be taken in account that action priorities on basis of pay should be given to activate communities, value, empower people and care connected. The articles also suggest for better, equitable, efficient community and patient focused health system by advancing the strategic opportunities. Furthermore, to ensure progress the most commonly cited foundational elements as the essential infrastructures are modernize skill, advance science, accelerate real world evidences and knowing what matters most. Across the income distribution longer life expectancy is directly related with higher income. The article is particularly based on health care system in US considering 20 million people which were newly assured during last six years gap but the coverage provision of ACA spans far beyond the range of health care challenges and health. The articles describe the burdens on clinical, entire communities, employers and individuals imposed by payments hardship, structural inefficiencies, proliferating administrative requirements, unparrel health care and fragmented care delivery.
To overcome with such issue the employee should act as a partner with the patient in order to improve their trust and ensure privacy. Families should be allowed to enhance support their patient with sharing and love. The health care center should be able to support the patient driven and additive regulatory framework which requires involvement of patient mostly. Along with, the employee should be provided with trainings pathways and new education workforce to cope with situations easily.

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Furthermore, the author has conducted the quantitative survey with primary data collection on different sector to identify the existing guidance in SAPs. For instance, to establish consensus on SPAs a Delphi survey was conducted with invited participants of 73 in numbers. The papers says that under going through different surveys no any existence guidance was identified. It is also said by author that 63 items were agreed by the expert panel which can be included in guidance. Along with it there were 17 items which are additionally importantly identified which can be referenced anywhere. The article on the aim that among broad range of stake holder’s harmony should be established. Regarding guidance, piloting and critical review were carried out with aim to confirmed the usefulness of guidance whether it is fit for the purpose or not, finding out if any items there still requiring clarification and so on. SAPs availability should be public. As it has way to facilitate the detection and reduce the occurrence of unfairness commonly in reporting and analyzing the selective relation. The author describe that the safety of patient and care in clinical were adversely effected by the system expansions particularly on infrastructure, setting in practice and population of patient.
For that the paper suggested the working staff who commonly interact with the patient in health care center, hospital should provide with latest develop knowledge and skills, ability to recognize the symptoms and supply the medicine, support and some others practice pattern which helps in retaining for a long period of time in hospital. Also, social to the patient and proper communication with non-speaking English patient accordingly is needed too to take care of them. The lack of proper specialized needs attentions may cause seriousness in timely care and safety of ill person. The analytical health care institutions survey of quantitative analysis shows that around 90% institutions physicians to move to unknown practice site, in which most common being the surgeons, specialists, obstetricians analysis, oncologist. The paper said that with the absence of guidance the physicians used to face the new circumstances with trial and error method which risk the patient life. In the journal the physicians said that they know the symptoms and diseases of patient and right care to provide to them but most often they pretend themselves unknowingly about the delivery of care and how to handle patient efficiently. The risk to patient rise at very severe end until and unless the responsibility and goals for quality and safety remains unclear. As toolkit is bring in use for patient to overcome the risks which is very helpful in increasing patient safety along provides a way of checklist in order to established a joint integration clinical council. To upgrade with the new care system research is necessary which integrate the level of safety margin. In addition, secondary quantitative data was collected from RAND HRS file to understand the health conditions of US old age people and their retirements. The article shows that the mortality rate is directly influence by the loss in wealth during middle and old age period. The study specified the rate of mortality on the basis of negative wealth shock but varies on the way the shock occurred. The research shows that maximum US old people experienced negative wealth shock followed by the long term poverty asset during period of study. Furthermore the women were more likely to be suffer from negative wealth shock as compared to positive wealth without shock. In the asset poverty group the health conditions were very serious to those who were not working and are unmarried.
The article used the qualitative secondary data to show up the overuse of medicine. The study shows that with over use and under use of D-dimer testing and over use of CTPA, for PE there was varying application of the diagnosticalgorithm which has been suggested. The problems such as higher cost, patient harm and delays are cause of inappropriate testing. In order to reduce the dose of medicine the physicians should prescribe the fewer antibiotics as compared to their peers which reduces the risk of clostridium difficile infection, adverse drug events and resistant bacteria with benefits.
It is important to encourage the people of overuse literature rapidly and it seems to be exciting too. In order to optimize the value and also to decrease unwanted care, couple should understand the appropriate way to reduce the overdosing and identified the over used services. As, in US among the adults aged 51 years or older were related with an increased hazard of all causing death due to loss of wealth over two years. It would be good to do research further in order to understand properly the mechanisms thinkable for this associations. Also, to conclude the targeted inventions with potential value. In addition, in case of patient safety and clinical care, system expansion may have substantial effects mainly when the changes occurred in infrastructure or practice setting or patient population of clinicians. For that, institutions must actively involve for the joint patient population in planning for monitoring and managing the risk that comes as a result of comprehensive strategy including sharing oversight of care and sharing data on quality and safety. The key factor that governed whole internal system is working staff. They should be provided with adequate facilities, appropriate training, rewards, polite communication and helpful environment to understand the patient easily resulting less risk factors in health sector. The proper recruitment of worker is must in order to increase work efficiency of health care center, make them to live for longer period of time in service as well as they should feel their working areas as their own work which they have to do sincerely and punctually. Clinical trials should include and addressed recommendation for minimum sets of items. It is also important to ensure the appropriate reporting of clinical trials regarding statistical analysis, trail registration and protocols. In general, the article supports to bring up the care givers and supervisors with development of knowledge and training. The higher the involvement of the people in their care process better will be the community. The United State nation has wide range of amount spent on the health safety of population but they are also located with improvement in outcomes and values through knowledge. Therefore, strategic investments and strong leadership are the potential program which is essential to explore in proper management of health and well-being. Along, create public and private programs, implement precompetitive collaborations, ensure research funding in basis and applied sciences.

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