scholarly journals Laser access and utilization preferences for pediatric ureteroscopy: A survey of the Societies of Pediatric Urology

2021 ◽  
Vol 16 (3) ◽  
Author(s):  
Raymond Yong ◽  
Gregory E. Tasian ◽  
Kate H. Kraft ◽  
William W. Roberts ◽  
Adam Maxwell ◽  
...  
Keyword(s):  
Treatment Options ◽  
Hybrid Approach ◽  
Pediatric Urology ◽  
Treatment Preferences ◽  
Free Standing ◽  
Future Technology ◽  
Practice Variability ◽  
After Hours ◽  
Improve Patient ◽  
Question Survey

Introduction: We sought to evaluate laser access and practice variability for pediatric ureteroscopy (URS) across the Societies of Pediatric Urology (SPU) to identify opportunities and barriers for future technology promulgation and evidence dissemination. Methods: A 25-question survey was sent electronically to members of the SPU. The questionnaire assessed surgeon and hospital characteristics, treatment preferences based on an index case, and information about available laser units. Descriptive and comparative statistical analyses were performed to assess patterns of care and laser accessibility across the SPU. Results: A total of 105 of 711 (15%) recipients responded. Seventy-seven respondents (73%) reported laser ownership, which was associated with greater after-hours laser access (87% vs. 13%, p<0.01). Fifty-eight individuals provided additional laser specifications, of whom 21 (36%) used a high-power laser unit (>60 W). Standard-power lasers were used more frequently in free-standing children’s hospitals, as compared to those working within a larger hospital complex (75% vs. 50%, p=0.049). Variation existed in treatment preferences with respect to dusting (33, 34%), fragmentation (18, 19%), or a hybrid approach (46 respondents, 48%). Stone clearance was the most important consideration irrespective of treatment choice. Conclusions: Variability in surgical preferences and accessibility to laser units exist across pediatric urologists who performing URS. Laser ownership and access to newer technologies vary across practices and may influence treatment options. Understanding access to laser technology will be important when considering opportunities for surgical optimization to improve patient outcomes through future studies.

The impact of a physician’s recommendation and gender on informed decision making: A randomized controlled study in a simulated decision situation

2020 ◽  
Author(s):  
Marie Eggeling ◽  
Anna Meinhardt ◽  
Ulrike Cress ◽  
Joachim Kimmerle ◽  
Martina Bientzle
Keyword(s):  
Decision Making ◽  
Cruciate Ligament ◽  
Treatment Options ◽  
General Information ◽  
Treatment Preference ◽  
Controlled Study ◽  
Treatment Preferences ◽  
Hypothetical Scenario ◽  
And Gender ◽  
The Impact

Objective: This study examined the influence of physicians’ recommendations and gender on the decision-making process in a preference-sensitive situation. Methods: N = 201 participants were put in a hypothetical scenario in which they suffered from a rupture of the anterior cruciate ligament (ACL). They received general information on two equally successful treatment options for this injury (surgery vs. physiotherapy) and answered questions regarding their treatment preference, certainty and satisfaction regarding their decision, and attitude toward the treatment options. Then participants watched a video that differed regarding physician’s recommendation (surgery vs. physiotherapy) and physician’s gender (female vs. male voice and picture). Afterward, they indicated again their treatment preference, certainty, satisfaction, and attitude, as well as the physician’s professional and social competence.Results: Participants changed their treatment preferences in the direction of the physician’s recommendation (P&lt;.001). Decision certainty (P&lt;.001) and satisfaction (P&lt;.001) increased more strongly if the physician’s recommendation was congruent with the participant’s prior attitude than if the recommendation was contrary to the participant’s prior attitude. Finally, participants’ attitudes toward the recommended treatment became more positive (surgery recommendation: P&lt;.001; physiotherapy recommendation: P&lt;.001). We found no influence of the physician’s gender on participants’ decisions, attitudes, or competence assessments.Conclusion: This research indicates that physicians should be careful with recommendations when aiming for shared decisions, as they might influence patients even if the patients have been made aware that they should take their personal preferences into account. This could be particularly problematic if the recommendation is not in line with the patient’s preferences.

scholarly journals Variation in treatment preferences of pulmonary exacerbations among Australian and New Zealand cystic fibrosis physicians

2021 ◽  
Vol 8 (1) ◽  
pp. e000956
Author(s):  
Grace Currie ◽  
Anna Tai ◽  
Tom Snelling ◽  
André Schultz
Keyword(s):  
Cystic Fibrosis ◽  
Clinical Trials ◽  
New Zealand ◽  
Treatment Options ◽  
Early Response ◽  
Treatment Preferences ◽  
Dornase Alfa ◽  
Clinical Scenarios ◽  
Professional Opinion ◽  
Pulmonary Exacerbations

BackgroundDespite advances in cystic fibrosis (CF) management and survival, the optimal treatment of pulmonary exacerbations remains unclear. Understanding the variability in treatment approaches among physicians might help prioritise clinical uncertainties to address through clinical trials.MethodsPhysicians from Australia and New Zealand who care for people with CF were invited to participate in a web survey of treatment preferences for CF pulmonary exacerbations. Six typical clinical scenarios were presented; three to paediatric and another three to adult physicians. For each scenario, physicians were asked to choose treatment options and provide reasons for their choices.ResultsForty-nine CF physicians (31 paediatric and 18 adult medicine) participated; more than half reported 10+ years of experience. There was considerable variation in primary antibiotic selection; none was preferred by more than half of respondents in any scenario. For secondary antibiotic therapy, respondents consistently preferred intravenous tobramycin and a third antibiotic was rarely prescribed, except in one scenario describing an adult patient. Hypertonic saline nebulisation and twice daily chest physiotherapy was preferred in most scenarios while dornase alfa use was more variable. Most CF physicians (>80%) preferred to change therapy if there was no early response. Professional opinion was the most common reason for antibiotic choice.ConclusionsVariation exists among CF physicians in their preferred choice of primary antibiotic and use of dornase alfa. These preferences are driven by professional opinion, possibly reflecting a lack of evidence to base policy recommendations. Evidence from high-quality clinical trials is needed to inform physician decision making.

scholarly journals POS1097 TREATMENT KNOWLEDGE AND PREFERENCES FOR BLACK PEOPLE WITH HIP AND KNEE OSTEOARTHRITIS: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 828.2-829
Author(s):  
C. Brantner ◽  
D. Pearce-Fisher ◽  
C. Moezinia ◽  
H. Tornberg ◽  
J. Fitzgerald ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Racial Differences ◽  
Black People ◽  
Meta Analysis ◽  
Treatment Options ◽  
Cochrane Library ◽  
Treatment Preferences ◽  
White People ◽  
Narcotic Analgesics ◽  
Accessible Information

Background:Black people are less likely to undergo total joint arthroplasties, despite reporting more severe symptoms. (1) While racial disparities exist in treatment utilization for osteoarthritis, comprehensive studies of the treatment preferences of Black people have not been conducted.Objectives:The purpose of this manuscript is to systematically review the literature and identify Black osteoarthritis patients’ treatment preferences to understand how they may contribute to racial differences in the utilization of different treatment options.Methods:Searches ran on April 8, 2019 and April 7, 2020 in the following databases: Ovid MEDLINE (ALL - 1946 to Present); Ovid EMBASE (1974 to present); and The Cochrane Library (Wiley). Using the Patient/Population-Intervention-Comparison/Comparator-Outcome (PICO) format, our population of interest was Black people with hip and/or knee osteoarthritis, our intervention was preferences and opinions about treatment options for osteoarthritis, our comparator was white people with hip and/or knee osteoarthritis, and our outcome was preferences of osteoarthritis therapies. The protocol was registered under the PROSPERO international register, and the Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed.Results:Searches across the chosen databases retrieved 10,894 studies after de-duplication, 182 full text, and 31 selected for inclusion in this review. Black people were less likely to use NSAIDs or narcotic analgesics compared to white people. (Figure 1) Black people were more likely than white people to use spirituality and prayer, as well as topical treatments. Utilization of meditation, supplement/vitamin use, and hot/cold treatments was not significantly different between groups. Black people were less willing than white people to consider or undergo joint replacements, even if the procedure was needed and recommended by a physician.Conclusion:Racial differences persist in OA care across the spectrum of options. Future interventions should focus on providing accessible information surrounding treatment options and targeting perceptions of the importance of joint health.References:[1]Suarez-Almazor ME, Souchek J, Kelly PA, et al. Ethnic Variation in Knee Replacement: Patient Preferences or Uninformed Disparity? Arch Intern Med. 2005;165(10):1117-1124. doi:10.1001/archinte.165.10.1117Figure 1.Meta-analysis describing the odds ratios of Black people using NSAIDs and Narcotic Analgesics compared to white peopleDisclosure of Interests:Collin Brantner: None declared, Diyu Pearce-Fisher: None declared, Carine Moezinia: None declared, Haley Tornberg: None declared, John FitzGerald: None declared, Michael Parks Consultant of: Zimmer Biomet, Peter Sculco Consultant of: EOS Imaging, Intellijoint Surgical, DePuy Synthes, Lima Corporate, Cynthia Kahlenberg: None declared, Curtis Mensah: None declared, Ajay Premkuar: None declared, Nicholas Williams: None declared, Michelle Demetres: None declared, Susan Goodman Consultant of: UCB, Grant/research support from: Novartis, Horizon Therapeutics.

scholarly journals Successful Treatment of Vaccine-Induced Immune Thrombotic Thrombocytopenia in a 26-Year-Old Female Patient

2021 ◽  
pp. 1-4
Author(s):  
Marcel Kemper ◽  
Georg Lenz ◽  
Rolf Michael Mesters
Keyword(s):  
Female Patient ◽  
Treatment Options ◽  
Anticoagulation Therapy ◽  
Intravenous Immunoglobulins ◽  
High Dose ◽  
Severe Thrombocytopenia ◽  
Vein Thrombosis ◽  
Medical Facilities ◽  
Deep Vein ◽  
Improve Patient

Vaccine-induced immune thrombotic thrombocytopenia (VITT) has already been described after vaccination with ChAdOx2 nCov-19 (AstraZeneca) and Ad26.COV2.S (Johnson &amp; Johnson/Janssen). However, less knowledge so far has been gained about optimal therapeutic regimens in VITT-suspected patients. Here, we report the case of a 26-year-old female patient, who developed bilateral deep vein thrombosis in the lower legs and severe thrombocytopenia after ChAdOx2 nCov-19 vaccination. After initial anticoagulation therapy regimens including fondaparinux, apixaban, and danaparoid failed, the patient was successfully treated with high-dose intravenous immunoglobulins in combination with parental anticoagulation therapy with argatroban. As vaccination against severe acute respiratory syndrome coronavirus 2 affects billions of people worldwide, medical facilities and hospitals have to be prepared and provide effective treatment options in VITT-suspected patients, including rapid application of high-dose intravenous immunoglobulins, to improve patient outcomes.

PP20 UK Ambulance Service resuscitation management of pulseless electrical activity: a systematic review of text and opinion

2021 ◽  
Vol 38 (9) ◽  
pp. A9.2-A9
Author(s):  
Ali Coppola ◽  
Michael A Smyth ◽  
Sasha Johnston ◽  
Sarah Black ◽  
Ruth Endacott
Keyword(s):  
Electrical Activity ◽  
Early Identification ◽  
Discharge Rate ◽  
Treatment Options ◽  
Pulseless Electrical Activity ◽  
Ambulance Service ◽  
National Guidelines ◽  
Improve Patient Survival ◽  
The United Kingdom ◽  
Improve Patient

BackgroundIn the United Kingdom, out of hospital cardiac arrest patients with pulseless electrical activity (PEA) have a poor survival to discharge rate of 5.3%.1 PEA is managed according to national guidelines.2 These guidelines are imperfect due to limited research resulting in ambulance services locally amending guidelines to support resuscitation decisions.3 This review aimed to examine the local guidelines of UK ambulance services for the management of PEA.MethodsA three-step search strategy was applied from August 2020 to October 2020. 1) A search of UK ambulance service websites was conducted to identify published local guidelines. Where guidelines were not available a written request was made for the guideline, associated guideline or a narrative summary in the absence of a guideline. 2) Documents referenced within the local guidelines specific to pulseless electrical activity were identified and extracted as supporting literature. 3) Documents referenced in the supporting literature identified as having pulseless electrical activity in the title were extracted.ResultsTwenty-two documents of textual data met the inclusion criteria. Twenty-nine conclusions were extracted and analysed to generate ten categories, forming three synthesised themes relating to the variability in the clinical management of PEA between UK ambulance services, the early identification of reversible causes and appropriate treatment options to increase survivability and the consensus for further research.ConclusionComprehensive national guidelines are lacking due to limited research. The local clinical guidelines and practices of UK ambulance services which aim to address the gaps in research, introduce variability in the management of pulseless electrical activity. Early identification and treatment to reverse the cause of pulseless electrical activity was highlighted to improve patient survival, however, this was complex and challenging to achieve during pre-hospital resuscitation. There was a consensus in the paucity of evidence and the potential for future prognostic research to improve patient outcomes.

scholarly journals Embedding neuroscience in psychiatry training

2020 ◽  
Vol 26 (6) ◽  
pp. 379-380
Author(s):  
Christopher O'Loughlin
Keyword(s):  
Patient Care ◽  
Royal College ◽  
Treatment Options ◽  
Improve Patient Care ◽  
Medical Specialty ◽  
Psychiatry Training ◽  
Clinical Assessments ◽  
The Uk ◽  
Improve Patient ◽  
Scientific Fields

SUMMARYTraining in neuroscience is vital to the future of psychiatry as a medical specialty. Trainees and trainers alike demonstrate a desire to keep up to date with developments in the associated scientific fields. Neuroscience increasingly underpins clinical assessments, treatment options and patients’ expectations. Psychiatry training in the UK can embrace neuroscience at many levels, from discussing patient presentations with supervisors, to teaching programmes supported by the Royal College of Psychiatrists’ activities. Although challenges remain, neuroscience literacy enhances the specialty and will improve patient care.

scholarly journals Immunotherapy in gastroesophageal cancers: Current state and future directions

2020 ◽  
pp. 107815522096353
Author(s):  
Hira Shaikh ◽  
Amir Kamran ◽  
Dulabh K Monga
Keyword(s):  
Patient Outcomes ◽  
Molecular Targeted Therapy ◽  
Treatment Options ◽  
Cell Cycle Checkpoints ◽  
Future Directions ◽  
Alternative Strategies ◽  
Current State ◽  
Dismal Prognosis ◽  
The World ◽  
Improve Patient

While gastroesophageal (GE) cancers are one of the most common cancers worldwide, unfortunately, the mortality remains high. Commonly used treatment options include surgical resection, chemotherapy, radiotherapy, and molecular targeted therapy, which improve survival only minimally; thus, affirming the dire need for exploring alternative strategies to improve patient outcomes. Immunotherapy, which has revolutionized the world of oncology, has somewhat lagged behind in GE malignancies. Tumor-associated microenvironment and regulatory T cells, alongside cell cycle checkpoints, have been proposed by various studies as the mediators of carcinogenesis in GE cancers. Thus, inhibition of each of these could serve as a possible target of treatment. While the approval of pembrolizumab has provided some hope, it is not enough to override the dismal prognosis that this disease confers. Herein, we discuss the prospects of immunotherapy in this variety of cancer.

scholarly journals P087: Procedural sedation in Canadian emergency departments a national survey of pharmacological agent selection and practice variation

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S87-S87
Author(s):  
E. Leci ◽  
K. Van Aarsen ◽  
A. Shah ◽  
J. W. Yan
Keyword(s):  
Practice Variation ◽  
Procedural Sedation ◽  
Pharmacologic Agent ◽  
Electronic Survey ◽  
Canadian Association ◽  
Institutional Influences ◽  
Agent Selection ◽  
Practice Variability ◽  
American Society ◽  
Question Survey

Introduction: Emergency department (ED) physicians strive to provide analgesia, amnesia and sedation for patients when performing painful procedures through the use of procedural sedation (PS). Examination of the literature suggests that the application of PS appears to be variable with institutional influences and clinician disagreement on pharmacology, airway management, and monitoring. The primary goal of this research project was to describe the variability of practice with respect to pharmacologic choices and clinical applications of PS among Canadian ED physicians. Methods: An electronic survey was distributed through the Canadian Association of Emergency Physicians (CAEP). Practicing physician members of CAEP were invited to complete the survey. The 20 question survey encompassed various aspects of PS including physician choices regarding PS indications and pharmacology. The primary outcome was the quantification of practice variability among ED physicians with respect to the above listed aspects of PS. The data was presented with simple descriptive statistics. Results: To date, 278 ED physicians responded to our survey (response rate 20.3%). Respondents were primarily academic hospital (53.2%) or community hospital based (38.2%). With emergency medicine training as: CCFP-EM (55.2%), FRCPC (30.1%), and CCFP (9.0%). There was relative agreement on the following interventions requiring PS: 98.4% applied PS for electrical cardioversion and 98.1% for brief (<10 mins) orthopedic manipulations. However, only 36.3% utilized PS for burn debridement in the ED. PS was utilized less frequently (78.1%) for prolonged (>10mins) orthopedic manipulations than brief manipulations. For all procedures aggregated, in hemodynamically stable patients with an American Society of Anesthesiology (ASA) score of 1, ED physicians utilized propofol 76.3% of the time. Additional agents were utilized at the following rates: fentanyl-propofol (7.6%), ketamine (7.6%), and fentanyl (4%). This inclination towards propofol alone appears to be consistent across modality of ER training, type of ER setting (rural vs academic), and volume of PS performed. Conclusion: This study demonstrates that Canadian ED physicians have a clear preference for propofol as a first line pharmacologic agent when administering PS in hemodynamically stable, ASA1 patients. Conversely, there appears to be more variation amongst ED physicians with respect to second line pharmaceutical choices for PS.

scholarly journals Treatment preferences of opiate-dependent patients

2004 ◽  
Vol 28 (2) ◽  
pp. 47-50 ◽  
Author(s):  
Jason Luty
Keyword(s):  
Substance Misuse ◽  
Treatment Options ◽  
Treatment Preferences ◽  
Clinical Implications ◽  
Card Sorting ◽  
Heroin Use ◽  
Injectable Drugs ◽  
Oral Methadone ◽  
Sorting Technique ◽  
Drug Free

Aims and MethodTo assess the preferences of people attending a substance misuse facility towards the treatment options available for opiate dependency. Interviews were conducted using a card sorting technique.ResultsThe majority (60%) of the 101 participants believed that detoxification was superior to maintenance in preventing illicit heroin use. The preferred treatment options were oral methadone, buprenorphine, drug-free rehabilitation, in-patient detoxification and prescription of injectable drugs.Clinical ImplicationsBoth pharmacological and psychosocial options, including in-patient detoxification and rehabilitation, are among the treatments preferred by clients of substance misuse services. There is also a significant demand for both injectable drugs and dihydrocodeine.

Expectations for Tinnitus Treatment and Outcomes: A Survey Study of Audiologists and Patients

2018 ◽  
Vol 29 (04) ◽  
pp. 313-336 ◽  
Author(s):  
Fatima T. Husain ◽  
Phillip E. Gander ◽  
Jaclyn N. Jansen ◽  
Sa Shen
Keyword(s):  
Patient Satisfaction ◽  
Treatment Options ◽  
Treatment Success ◽  
Survey Study ◽  
Hierarchical Regression ◽  
Current State ◽  
Tinnitus Treatment ◽  
Definition Of ◽  
Improve Patient ◽  
Scale Format

AbstractRoughly 10–15% of the general population is affected by tinnitus and this percentage is estimated to rise in future. Because there is currently no cure for tinnitus, treatment is limited and is primarily achieved through management of symptoms and counseling.This study compared audiologists’ and patients’ responses to related survey questions about their expectations regarding tinnitus treatment. Two separate surveys were created, one for patients with tinnitus, and one for practicing audiologists who may treat such patients. The surveys included several related questions, such that comparison of the two could reveal where patients’ and audiologists’ expectations for tinnitus care were in agreement and areas in which they differed.The surveys for audiologists and adults with tinnitus were 31- and 38-item questionnaires, respectively. Both surveys comprised demographic questions followed by several tinnitus-related questions in either multiple-choice or Likert-scale format.We received 230 completed Patient Surveys and 68 completed Audiologist Surveys.All survey recruitment was completed online. Responses were collected via the Survey Monkey web tool (http://www.surveymonkey.com/). Responses were analyzed within and between surveys and grouped into topical categories (assessment, counseling, current available tinnitus information, satisfaction and expectations, improving tinnitus management). For data within each survey, descriptive statistics and correlation analyses were used. For selected comparisons between surveys, cross-tabulations were used. Hierarchical regression modeling was conducted to further explore (1) the perceived effectiveness of treatment received, and (2) how each group defined treatment success.Differences were noted between the two groups’ responses to the question on the definition of treatment success; audiologists reported decreased awareness (77%), stress/anxiety relief (63%), and increased knowledge of tinnitus (63%) most commonly, whereas patients reported reduction of tinnitus loudness (63%) and complete elimination of tinnitus (57%) most often. The topic of greatest agreement was the desire for more information on tinnitus; 62% of patients felt more information from their healthcare provider would be the most important factor for improved tinnitus management, and 67% of audiologists reported currently having “some access” or less to appropriate resources for tinnitus treatment. Modeling results for effective tinnitus management and definitions of treatment success highlighted the importance of resource access and information sharing for both audiologists and patients.Patients and audiologists differed in terms of their expectations for successful treatment, with the patients focusing on perceptual factors and the audiologists on the reaction to the sound. Patient satisfaction with tinnitus treatment may be improved through access to more information, specifically, more information about current tinnitus treatment options and how these focus on the patient’s reaction to the tinnitus rather than the percept itself. Providing credible tinnitus information resources to audiologists, and focusing resources on training a small number of tinnitus specialist audiologists could greatly improve patient satisfaction with the current state of tinnitus palliative care.

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