30 years of data: impact of the United States in vitro fertilization data registry on advancing fertility care.

OBJECTIVE: To summarize and assess the impact of key research generated through the Society of Assisted Reproductive Technology (SART)-initiated United States IVF registry and annual reporting system. DESIGN: Review. SETTING: Eligible studies included those that analyzed data generated by the National IVF data collection program (through SART or Centers for Disease Control and Prevention). PATIENT(S): Not applicable. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Summarize and report outcomes of research using National IVF registry data. RESULT(S): The Society of Assisted Reproductive Technology was founded in 1985 and published the first annual US IVF data report 30 years ago in 1988 in Fertility and Sterility. In 1995, the Centers for Disease Control and Prevention subsequently began collecting data from IVF programs and published their first report in 1997. This annual National IVF data collection and reporting is a significant responsibility and effort for IVF programs. Using these data sources, 199 articles have been published by clinicians and researchers from across the country. This research has guided the development of evidence-based assisted reproductive technology (ART) practice guidelines during the past 30 years, which have ultimately led to improved quality and patient care. CONCLUSION(S): Since the first SART National IVF data report publication 30 years ago, SART has achieved its original goals of creating a national IVF registry that successfully assesses clinical effectiveness, quality of care, and safety.

Ernest Amory Codman and the End-result System.

Ernest Amory Codman had an early penchant fondness for recording surgical complications and analyzing these recordings to determine a surgeon's ability along with a hospital's efficiency. This idea and the actions that followed suit in his career were not well received by his fellow colleagues. However, Codman's influence and spirit remained and helped shape important institutions in American medicine such as the The Joint Commission on Accreditation of Healthcare Organizations.

The outcome problem in psychotherapy revisited. 1963.

This reprinted article originally appeared in Psychotherapy: Theory, Research, & Practice, 1963, 1 (1), 1-13. (The following abstract of the original article appeared in record 1965-15636-001) "… the therapeutic situation itself should be used to a much greater extent than has heretofore been the case to generate and develop criteria of outcome… . no-where else do we have an opportunity to make as penetrating, intensive, systematic, and undistorted observations as in the therapeutic situation… . transference is the most faithful replica of the patients' capacity for intimate interpersonal relatedness." Researchers should systematize and objectify intratherapeutic observations and where possible relate them to the patients' interpersonal performances outside therapy. There is a class association between quality of patients' relationship to the therapist and the quality of his relationship with others, including his adaptation to reality. Difficulties encountered in using the therapeutic situation as a criterion-generating situation are "(1) the problem of conceptualizing, specifying, and quantifying the multidimensional observations made in therapy; (2) the therapists reliability as on O (by which is meant more than countertransference); and (3) limitations inherent in the 2-person setting, which provide representative, but incomplete, data about the patients' interactions with others".

The outcome problem in psychotherapy: a reply.

This reprinted article originally appeared in Psychotherapy: Theory, Research, & Practice, 1964(MONTH), 1(3), 97-100. (The following abstract of the original article appeared in record 1966-01631-001). Comments on the original article by H. H. Strupp (see record 1965-15636-001). In his recent article in this journal, Strupp (1963) has this to say in relation to the outcome problem in psychotherapy: "A brief review of Eysenck's (1952) widely quoted survey, which capitalized upon and added considerably to the existing confusion may be instructive." In reply I would like to suggest that Strupp's review is, in the lawyer's phrase, irrelevant, incompetent and immaterial. Fortunately, the points I wish to make are so simple that they will not take up much space.

The good, the bad, and the ugly: a 50-year perspective on the outcome problem.

In the middle of the 20th century, Hans Eysenck reviewed studies of psychotherapy, which consisted primarily of psychoanalytic, psychodynamic, and eclectic treatments, and concluded that psychotherapy (as opposed to behavior therapy) was not effective and was possibly harmful. In the inaugural article in Psychotherapy, Hans Strupp challenged Eysenck's conclusions and discussed how psychotherapy research should progress. Eysenck criticized Strupp's conjectures and Strupp responded. In this article, I discuss progress in psychotherapy research by examining "the good, the bad, and the ugly" aspects of the Eysenck and Strupp interchange. Essentially, Eysenck and Strupp motivated researchers to pursue, with increased sophistication, process and outcome research, but each was defending a theoretical position (behavior therapy and psychodynamic therapy, respectively). Despite the progress, the conjecture at issue continues to be debated today.

You can't step into the same river twice, but you can stub your toes on the same rock: psychotherapy outcome from a 50-year perspective.

H.H. Strupp's 1963 article, The Outcome Problem in Psychotherapy Revisited, and the exchange between Eysenck and Strupp that followed the article were reexamined to answer the question: What, if anything, has changed in the world of psychotherapy research over half a century since the article was originally published? Many of the issues that provided the impetus for the article and the focal point of the passionate debate between Strupp and Eysenck have been long put to rest. Much has been accomplished: Debates in the literature have became more civil, generic factors such as the therapy relationship have received strong empirical support, and researchers' attention has shifted from the broad question whether psychotherapy offers real benefits to patients to providing empirical support for closely prescribed treatments for specific disorders. However, some of the core issues raised in the article concerning how to measure and meaningfully appraise the benefits of psychotherapy are still a challenge today. Some possible avenues for future developments are explored.

The variables problem and progress in psychotherapy research.

In this journal's first article, Strupp (1963) pointed to problems specifying independent and dependent variables as a source of slow progress in psychotherapy outcome research. This commentary agrees, shows how the concept of variable loses its meaning in psychotherapy research because of participants' responsiveness, and notes an alternative research strategy that does not depend on variables.

Outcome in psychotherapy: the past and important advances.

Fifty years after the 1963 debate between Strupp and Eysenck, as recorded in their articles in Psychotherapy, it is clear that Eysenck overstated the case against psychoanalysis and dynamic psychotherapy (Bergin, 1971), while inflating the magnitude of improvement in untreated individuals (Lambert, 1976). Eysenck was probably correct about the beneficial effects of behavior therapies, but did not foresee that behavior therapy would be supplanted by cognitive behavior therapies (CBT) and eclectic mixtures of CBT that incorporate elements of eastern religion, humanistic interventions, and psychodynamic constructs. Fortunately, most of the treatments that have been tested in rigorous investigations have been found to be effective, but few have distinguished themselves as uniquely superior. Many of the problems of how to measure the effects of treatment have been solved and suggest that about two thirds of treated individuals improve or recover. This leaves a sizable portion of nonresponding individuals, but emerging methods involving in tracking treatment response are being used to decrease deterioration and enhance positive outcomes.

Revisiting and reenvisioning the outcome problem in psychotherapy: an argument to include individualized and qualitative measurement.

We review the historical debate about the assessment of psychotherapy outcome, along with the current status of outcome research. Although strides in statistical techniques have allowed us to conclude that psychotherapy is effective, we argue that typical statistical measurement does not allow researchers to demonstrate the complexity of change for individuals. We thus recommend that researchers include individualized and qualitative approaches in their assessments of psychotherapy outcome.

Eysenck, Strupp, and 50 years of psychotherapy research: a personal perspective.

In this article, we review the status of psychotherapy research at the time of the founding of the journal Psychotherapy, and trace its history over the past 50 years, spanning the career of the first author. We trace this history in the context of the development of treatments for panic disorder and agoraphobia emanating from our research program. In so doing, we discuss the early visions of Strupp and Eysenck and the realization of many of their own goals for psychotherapy research. We conclude with a view toward the future based on cumulative knowledge of psychotherapy and psychopathology and, in the context of that knowledge, the type of ideal research programs that will be required.

The New York State cardiac registries: history, contributions, limitations, and lessons for future efforts to assess and publicly report healthcare outcomes.

In 1988, the New York State Health Commissioner was confronted with hospital-level data demonstrating very large, multiple-year, interhospital variations in short-term mortality and complications for cardiac surgery. The concern with the extent to which these differences were due to variations in patients' pre-surgical severity of illness versus hospitals' quality of care led to the development of clinical registries for cardiac surgery in 1989 and for percutaneous coronary interventions in 1992 in New York. In 1990, the Department of Health released hospitals' risk-adjusted cardiac surgery mortality rates for the first time, and shortly thereafter, similar data were released for hospitals and physicians for percutaneous coronary interventions, cardiac valve surgery, and pediatric cardiac surgery (only hospital data). This practice is still ongoing. The purpose of this communication is to relate the history of this initiative, including changes or purported changes that have occurred since the public release of cardiac data. These changes include decreases in risk-adjusted mortality, cessation of cardiac surgery in New York by low-volume and high-mortality surgeons, out-of-state referral or avoidance of cardiac surgery/angioplasty for high-risk patients, alteration of contracting choices by insurance companies, and modifications in market share of cardiac hospitals. Evidence related to these impacts is reviewed and critiqued. This communication also includes a summary of numerous studies that used New York's cardiac registries to examine a variety of policy issues regarding the choice and use of cardiac procedures, the comparative effectiveness of competing treatment options, and the examination of the relationship among processes, structures, and outcomes of cardiac care.

Systems of care for ST-segment elevation myocardial infarction: impact of different models on clinical outcomes.

ST-segment elevation myocardial infarction (STEMI) is one of the greatest medical emergencies, for which organization of care has a determinant impact on patient outcomes. The purpose of this paper is to review systems of care for STEMI patients. Although primary percutaneous coronary intervention (PCI) is the preferred option for patients with STEMI, offering easy and emergent access to this procedure often remains difficult because of geographic and diverse structural difficulties. intravenous fibrinolysis, especially when administered early after symptom onset and as part of a pharmacoinvasive strategy (i.e., followed by rapid coronary angiography with PCI when necessary), offers a reasonable therapeutic option in selected cases and has yielded satisfactory clinical results. Network organization is central for optimizing patient care at the acute stage of myocardial infarction. This review describes different clinical experiences with network implementation both in Europe and in North America. In all instances, early recognition of STEMI and, particularly in the pre-hospital setting, shortening time delays is central for the achievement of optimal clinical results. Overall, the encouraging results described in the models presented here, as diverse as they might be, should be an encouragement to promote and implement regional protocols according to the specific local constraints and to monitor their effectiveness by recording simple quality indicators in ongoing registries.

Cancer and leukemia group B cancer control and health outcomes committee: origins and accomplishments.

Cancer and Leukemia Group B (CALGB) has conducted protocols in cancer prevention and control, psycho-oncology, and health services for many years. Significant findings from the studies have emerged and have helped shape the practice of medicine and the direction of future research in these areas. This article describes the origins of the Cancer Control and Health Outcomes Committee within CALGB and briefly describes significant findings and future work. The success CALGB has had with psycho-oncology and health services research has paved the way for other cooperative groups to develop these modalities. Cancer control research is growing and continues to gather momentum. This type of research is integral to providing quality care to patients and healthy populations.