scholarly journals A preliminary assessment of guideline adherence and clinical variation in oral cancer treatment: a MarketScan database study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Antoine Eskander ◽  
Axel Sahovaler ◽  
Jennifer Shin ◽  
Konrado Deutsch ◽  
Matthew Crowson ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Radiation Treatment ◽  
Tube Placement ◽  
Adjuvant Chemoradiotherapy ◽  
Research Database ◽  
Chest Imaging ◽  
Geographical Differences ◽  
Processes Of Care ◽  
North East ◽  
Multidisciplinary Consultation

Abstract Background To assess variations in adherence to guideline-recommended processes of care for oral cavity cancer patients. Methods Retrospective study using a U.S. healthcare research database (MarketScan). Index diagnoses were considered from 2010 to 2012 with follow-up from 2013 to 2014. Diagnostic and procedure codes were utilized to identify oral cavity patients with a defined treatment modality. Compliance with guideline-recommended processes of care, which included pre-treatment imaging, thyroid-function testing (TFTs), multidisciplinary consultation and gastrostomy-tube insertion rates, were assessed. Results A total of 2752 patients were identified. Surgery alone was the most common treatment (60.8%), followed by surgery with adjuvant chemoradiotherapy (20.4%) and surgery with adjuvant radiotherapy (18.8%). Head/neck and chest imaging were obtained in 60% and 62.5% of patients respectively. Significant geographical differences in head and neck imaging were observed between North-central (64%), South (58.4%) and West (56.1%) regions (p = 0.026). Differences in chest imaging were also present between North-east (65%) and West (56.8%; p = 0.007). TFTs were obtained in 54.4% of the patients after radiation treatment, and 18.6% of patients had multidisciplinary consultation during the 6 months before and 3 months after initiation of treatment. During the year after treatment initiation, 21.2% of patients underwent G-tube placement, with significantly higher rates in patients receiving triple modality treatment (58%) when compared to surgery plus radiation (27%) and surgery alone (15%; p < 0.01). Conclusion Adherence to evidence-based practices was low based on the database coding. These data suggest a potential to improve adherence and increase the routine use of practices delineated in national clinical practice guidelines. Clinical relevance This study reflects a suboptimal adherence to guidelines based on the database employed. This study should be considered by healthcare providers and efforts should be maximized to follow the processes of care which have proven to impact on patient's outcomes.

scholarly journals National Trends in Cycling in Light of the Norwegian Bike Traffic Index

2021 ◽  
Vol 18 (12) ◽  
pp. 6198
Author(s):  
Solveig Nordengen ◽  
Lars Bo Andersen ◽  
Amund Riiser ◽  
Ane K. Solbraa
Keyword(s):  
Urban Areas ◽  
Active Transportation ◽  
Monitoring Systems ◽  
Geographical Differences ◽  
Southern Norway ◽  
Associated Risk Factors ◽  
National Trends ◽  
International Strategies ◽  
Nonsignificant Decrease ◽  
Walking For Transportation

National and international strategies and recommendations are intended to increase physical activity in the general population. Active transportation is included in interdisciplinary strategies to meet these recommendations. Cycling seems to be more health enhancing than walking for transportation since cycling seems to reduce the risk of cardiovascular disease and associated risk factors. Furthermore, the health benefits of cycling are proven to outrun the risk of injuries and mortality. Politicians seem to approve costly infrastructure strategies to increase the amount of cycling in the population to improve public health and shift to more sustainable travel habits. A linear relationship between cycle-friendly infrastructure and the amount of commuter cycling has been demonstrated. However, in Norway and on a global level, there is a lack of robust evaluations of actions and sensitive monitoring systems to observe possible change. Therefore, we aimed to develop the Norwegian bike traffic index and describe the national, regional, and local trends in counted cycle trips. We used a transparent methodology so that the index can be used, developed, and adapted in other countries. We included 89 stationary counters from the whole country. Counters monitored cycling from 2018 onward. The index is organized at local, regional, and national levels. Furthermore, the index is adjusted for population density at the counter level and presented as ratio of counted cycle trips, comparing 2018 to subsequent years. The index is presented as a percentage change with 95% confidence intervals. In Norway, counted cycle trips increased by 11% from 2018 (100, 100–100) to 2020 (111.0, 106.2–115.1), with large geographical differences. In Southern Norway, there was a significant increase of 23%, and in Northern Norway, there was a nonsignificant decrease by 8% from 2018 to 2020. The indices may indicate possible related effects of local to national cycling strategies and how the COVID-19 pandemic has affected Norwegian travel habits in urban areas.

Isolated meniscus injuries in skeletally immature children and adolescents: state of the art

2021 ◽  
pp. jisakos-2020-000496
Author(s):  
Gustavo Vinagre ◽  
Flávio Cruz ◽  
Khalid Alkhelaifi ◽  
Pieter D'Hooghe
Keyword(s):  
Children And Adolescents ◽  
State Of The Art ◽  
Surgical Techniques ◽  
Meniscal Repair ◽  
Management Plan ◽  
Anatomical Location ◽  
Return To Sports ◽  
Meniscal Tears ◽  
Geographical Differences ◽  
Meniscal Healing

The prevalence of isolated meniscal injuries in children and adolescents is low; however, we see an increase mainly due to intensified sports-related activities at an early age. A meniscal repair should be attempted whenever possible as children present with increased meniscal healing potential. The diagnosis and management of meniscal tears involve both patient factors and tear characteristics: size, anatomical location and associated injuries. Special attention should be given to the feature of discoid menisci and related tears as they require a specific management plan. This state-of-the-art review highlights the most recent studies on clinical evaluation, surgical techniques, tips and tricks, pitfalls, outcomes, return-to-sports, geographical differences and future perspectives related to meniscal injuries in children and adolescents.

scholarly journals Issues Related to Late-Life Sexuality: Sex in Long-Term Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 602-602
Author(s):  
Rachael Spalding ◽  
Peter Lichtenberg
Keyword(s):  
Best Practice ◽  
Long Term Care ◽  
Social Stigma ◽  
Late Life ◽  
Assessment Tools ◽  
Geographical Differences ◽  
Term Care ◽  
Practical Applications ◽  
Ethical And Legal Issues

Abstract Despite surrounding social stigma and stereotypes of the “asexual older adult,” older adults, including those residing in long-term care facilities, indicate that expressing their sexuality continues to be important to them (Doll, 2013). This presentation will feature presentations regarding recent research and perspectives relevant to late-life sexuality with a focus on how issues of sexual expression may particularly emerge in long-term care settings. Dr. Maggie Syme will present findings from mixed-methods, consumer-based approaches that elucidate how current and future long-term care residents view late-life sexuality, with a focus on the practical applications of these findings to inform facility administration and policies. Ethical and legal issues surrounding sexuality in long-term care will be discussed by Dr. Pamela Teaster, who will present ethical models that can translate into potential best-practice recommendations and strategies. Rachael Spalding will discuss the paucity of psychometrically sound assessment tools for measuring attitudes towards late-life sexuality and discuss their development of such a measure. Finally, Dr. Lilanta Bradley and Dr. Pamela Payne-Foster will present a framework for sexual agency in late-life and identify relevant gaps in the literature regarding gender, ethnicity/race, and geographical differences. Ultimately, this presentation will offer a forum for lively discussion among attendees regarding these pertinent topics.

scholarly journals How well did Norwegian general practice prepare to address the COVID-19 pandemic?

2020 ◽  
Vol 8 (4) ◽  
pp. e000512
Author(s):  
Ingvild Vatten Alsnes ◽  
Morten Munkvik ◽  
W Dana Flanders ◽  
Nicolas Øyane
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
General Practitioners ◽  
Home Page ◽  
Quality Improvements ◽  
Geographical Differences ◽  
Home Office ◽  
Isolation Room ◽  
Improvement Measures ◽  
The Mean

ObjectivesWe aimed to describe the quality improvement measures made by Norwegian general practice (GP) during the COVID-19 pandemic, evaluate the differences in quality improvements based on region and assess the combinations of actions taken.DesignDescriptive study.SettingParticipants were included after taking part in an online quality improvement COVID-19 course for Norwegian GPs in April 2020. The participants reported whether internal and external measures were in place: COVID-19 sign on entrance, updated home page, access to video consultations and/or electronic written consultations, home office solutions, separate working teams, preparedness for home visits, isolation rooms, knowledge on decontamination, access to sufficient supplies of personal protective equipment (PPE) and COVID-19 clinics.ParticipantsOne hundred GP offices were included. The mean number of general practitioners per office was 5.63.ResultsMore than 80% of practices had the following preparedness measures: COVID-19 sign on entrance, updated home page, COVID-19 clinic in the municipality, video and written electronic consultations, knowledge on how to use PPE, and home office solutions for general practitioners. Less than 50% had both PPE and knowledge of decontamination. Lack of PPE was reported by 37%, and 34% reported neither sufficient PPE nor a dedicated COVID-19 clinic. 15% reported that they had an isolation room, but not enough PPE. There were no geographical differences.ConclusionsNorwegian GPs in this study implemented many quality improvements to adapt to the COVID-19 pandemic. Overall, the largest potentials for improvement seem to be securing sufficient supply of PPE and establishing an isolation room at their practices.

scholarly journals Telemedicine in Spine Surgery: Global Perspectives and Practices

2021 ◽  
pp. 219256822110223
Author(s):  
Grant Riew ◽  
Francis Lovecchio ◽  
Dino Samartzis ◽  
Philip K. Louie ◽  
Niccole Germscheid ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Descriptive Statistics ◽  
South American ◽  
Geographical Differences ◽  
Cross Sectional ◽  
Global Perspectives ◽  
Phone Calls ◽  
Initial Appointment ◽  
Almost All

Study Design: Cross-sectional, anonymous, international survey. Objectives: The COVID-19 pandemic has resulted in the rapid adoption of telemedicine in spine surgery. This study sought to determine the extent of adoption and global perspectives on telemedicine in spine surgery. Methods: All members of AO Spine International were emailed an anonymous survey covering the participant’s experiences with and perceptions of telemedicine. Descriptive statistics were used to depict responses. Responses were compared among regions. Results: 485 spine surgeons participated in the survey. Telemedicine usage rose from <10.0% to >39.0% of all visits. A majority of providers (60.5%) performed at least one telemedicine visit. The format of “telemedicine” varied widely by region: European (50.0%) and African (45.2%) surgeons were more likely to use phone calls, whereas North (66.7%) and South American (77.0%) surgeons more commonly used video ( P < 0.001). North American providers used telemedicine the most during COVID-19 (>60.0% of all visits). 81.9% of all providers “agreed/strongly agreed” telemedicine was easy to use. Respondents tended to “agree” that imaging review, the initial appointment, and postoperative care could be performed using telemedicine. Almost all (95.4%) surgeons preferred at least one in-person visit prior to the day of surgery. Conclusion: Our study noted significant geographical differences in the rate of telemedicine adoption and the platform of telemedicine utilized. The results suggest a significant increase in telemedicine utilization, particularly in North America. Spine surgeons found telemedicine feasible for imaging review, initial visits, and follow-up visits although the vast majority still preferred at least one in-person preoperative visit.

scholarly journals Otolaryngology activity in two hospitals in northern and central Italy differently affected by COVID-19 pandemic

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042199848
Author(s):  
Antonio Minni ◽  
Francesco Pilolli ◽  
Massimo Ralli ◽  
Niccolò Mevio ◽  
Luca Roncoroni ◽  
...  
Keyword(s):  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Intensive Care Units ◽  
Healthcare System ◽  
Central Italy ◽  
Northern Italy ◽  
Public Hospitals ◽  
Geographical Differences ◽  
Italian Regions

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic had a significant impact on the Italian healthcare system, although geographical differences were present; regions in northern Italy have been the most severely affected while regions in the south of the country were relatively spared. Otolaryngologists were actively involved in the management of the pandemic. In this work, we analyzed and compared the otolaryngology surgical activity performed during the pandemic in two large public hospitals located in different Italian regions. In northern Italy, otolaryngologists were mainly involved in performing surgical tracheotomies in COVID-19 positive patients and contributed to the management of these patients in intensive care units. In central Italy, where the burden of the infection was significantly lower, otolaryngologists focused on diagnosis and treatment of emergency and oncology patients. This analysis confirms the important role of the otolaryngology specialists during the pandemic, but also highlights specific differences between two large hospitals in different Italian regions.

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