Cancellation Rate Research Articles

Study of factors leading to cancellation of elective surgeries in a tertiary care hospital

Background: The postponement of elective surgeries is a major problem that increases the time for patients on surgical waiting lists and can negatively affect psychologically and physically to patients and their families. Cancellation rates reported within the literature are highly variable with considerable differences depending on type of hospital, national health care systems or policies, geographical region, patient population, providers, and also the perioperative management practices present at specific institution. Aims and Objectives: The current study was to thoroughly understand the causes to minimize such cancellations in our institute. Materials and Methods: A prospective observational study was conducted in the Department of General Surgery in a tertiary care teaching hospital in North India. All the patients admitted for elective surgeries in the Department of General Surgery over a period of December 1st, 2022–May 30th, 2023 were noted and out of them, details of patients in whom surgery was cancelled were taken and they were followed for 2 months. Results: Out of a total 1065 patients, 92 patients got cancelled during the study period. Out of them, 67 patients (67.8%) were cancelled on the scheduled date of surgery or after reaching operation theatre whereas, 25 patients (27.2%) were cancelled on day before scheduled date of surgery. Maximum number of cancelled patients were of cholelithiasis planned for laparoscopic cholecystectomy followed by inguinoscrotal swellings. Maximum number of patients were deferred due to administrative-related factors, followed by medical related factors. Conclusion: This study will act as a quality improvement initiative by reducing the surgery cancellation rate thus improving utilization of limited resources and valuable time to provide better health care services in our institute. Such cancellations can be minimized by better planning and active inter-departmental communication regarding proposed plan of surgery.

Could the use of agonist protocols benefit patients who do not respond well to human reproduction treatment?

The primary goal of this article is to analyze whether there is still room for ovarian stimulation in poor responders prescribed the long protocol. This retrospective cohort study analyzed the medical charts of patients seen at the Vida Centro de Fertilidade, a private fertility clinic in Rio de Janeiro, Brazil, from January 2018 to June 2023. It included poor responders described based on the Bologna criteria who were first prescribed conventional treatment with an antagonist protocol, without success, and then the long agonist protocol. Statistical analysis was performed on the Statistical Package for the Social Sciences (version 20). Comparisons of continuous variables between groups were performed with the Mann-Whitney U test or Student's t-test, as appropriate. The chi-square test was used to compare categorical variables. Statistical significance was achieved when p<0.05. We found a better response among patients on the agonist than on the antagonist protocol in terms of number of follicles larger than 14 mm on the day of trigger (3.17 versus 2.1; p<0.05), number of eggs on the day of retrieval (3.5 versus 1.37; p<0.05), number of mature eggs (2.67 versus 1.37; p<0.05), and number of embryos after fertilization on the first day of development (1.87 versus 0.8; p<0.05). This protocol's cancellation rate was slightly lower (0.03 versus 0.43; p<0.05). The long protocol still yields positive results in poor responders who were previously prescribed the antagonist protocol.

Factors associated with elective surgical case cancellation at a tertiary hospital in Malawi.

Same-day cancellation of surgery affects up to 44% of cases at a public tertiary hospital in Lilongwe, Malawi. To characterize these cancellations, this study examines surgical volume, cancellation causes, and surgery completion rate after initial cancellation, which are not otherwise monitored for analysis in this setting. We conducted a serial cross-sectional study at the Kamuzu Central Hospital (KCH) during a 6month period. Variables included patient demographics, procedure information, and hospital capacity factors. Bivariate and multivariable regression models were constructed to assess factors associated with cancellation. Of the 3121 total surgeries, 2626 (84.1%) were elective procedures, of which 747 (28.4%) were canceled. Orthopedic surgery observed the highest cancellation rate (36.5%). Process-related factors, such as starting cases late, were the primary reason for cancellation (64.3%). Only 40% of patients with a canceled surgery underwent their procedure after index admission, with a median wait time of 3days. Emergency cases (aOR: 0.50 and CI: 0.39 and 0.64) and first cases of the day (aOR: 0.02 and CI: 0.01 and 0.04) were associated with lower odds of cancellation. Facility factors associated with lower odds of cancellation included number of open operating rooms (OR: 0.86 and CI: 0.77 and 0.96) and anesthetists assigned on duty (OR: 0.94 and CI: 0.88 and 0.99). Cancellation of elective surgery was primarily driven by process-related factors. We identify facility-related factors associated with lower odds of cancellation and thus provide targets for future interventions at KCH. Studies examining patient outcomes following elective case cancellation are warranted as most patients never return for surgery following cancellation.

Intracytoplasmic sperm injection compared with in vitro fertilisation in patients with non-male factor infertility with low oocyte retrieval: a single-centre, retrospective cohort study

ObjectiveTo investigate the effects of in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) on the clinical outcomes of non-male factor patients aged >35 with three or fewer oocytes retrieved.DesignRetrospective...

HPB SO55 - Utilisation of Telephone Assessment Clinic for booking Laparoscopic Cholecystectomy: Analysis of outcomes and cancellations

Abstract Background Despite extensive efforts to increase productivity after the Covid pandemic, there still remain areas of limited capacity. Face-to-face outpatient clinic provision is yet to return to normal levels, despite significant increases in referrals. Telephone assessment clinics are attractive solutions as they can be performed outside 'standard' operating hours of the hospital and require fewer support staff, giving increased flexibility to consultant and trainee surgeons who perform them. However, it is unclear whether telephone assessment alone is sufficient to book patients onto operating lists. This study aimed to assess the effectiveness of telephone assessment alone when booking patients for laparoscopic cholecystectomy. Method A standardised telephone assessment process was developed which included mandatory information about symptoms, past medical and surgical history and body weight. All patients referred for consideration of cholecystectomy from January 2023 to January 2024 received either a telephone or face-to-face clinic appointment; those who received a telephone appointment were not routinely offered face-to-face assessment unless clinically indicated. Patients were listed for laparoscopic cholecystectomy from either clinic and all operations took place on pooled operating lists. Operative and clinical outcomes were recorded, including cancellations on the day and unexpected anatomy or procedures. Outcomes between telephone and face-to-face appointments were compared. Results Over the study period, 189 patients had a laparoscopic cholecystectomy from an elective clinic source. Other sources included those patients who had presented acutely and were discharged and those on semi-acute lists. 106 patients had a telephone assessment as their only prior engagement with surgical services prior to surgery. Of these patients, there was one cancellation on the day (due to absence of symptoms between clinic assessment and date of surgery). Nine patients required cholangiography which had not been initially booked. In contrast, three patients who had had face-to-face assessment were cancelled on the day. Conclusion Telephone assessment alone is sufficient to book patients onto an elective theatre list for laparoscopic cholecystectomy, with no adverse impact on cancellations and theatre utilisation. To ensure low cancellation rates and safe surgery, senior decision making is required for telephone assessment clinics (in this study, all appointments were carried out by consultant surgeons) and a standardised proforma to ensure all relevant information is recorded. The low rate of cancellations was maintained even though a 'pooled' operating list is utilised in our hospital. Telephone assessment clinics for first appointments are safe and effective and could help in reducing overall waiting times.

Unexpected Events That Occur in Patients on the Day of Surgery: A Single-center, Prospective Observational Study

PurposeThe purpose of this study is to investigate the reasons for case cancellations on the day of surgery and determine the rates of unexpected events and case cancellations. DesignThis is a prospective, cross-sectional study conducted at a single hospital. MethodsThe patients’ reasons for surgical cancellation were classified as preventable or nonpreventable. Patient data were obtained in the operating room after standard anesthesia monitoring by anesthesiologists. Unexpected problems that emerged in patients and cases canceled due to these problems were recorded. We evaluated blood pressure values according to the American College of Cardiology and American Heart Association guidelines. FindingsElective surgery was planned for a total of 4,287 patients. The incidence of an unexpected event detected on the day of surgery was 5.8% (n = 250), and the case cancellation rate was 2.16%. Examination or medical condition-related factors (n = 78, 83.9%) were the most common reason for case cancellation. Among the 250 unexpected events, patients with undiagnosed hypertension were in the majority (n = 130, 52%). Severe hypertension was observed in 30 patients (12%) who were previously diagnosed with hypertension, and the surgery was canceled in 25 (83.3%) of these (P < .001). ConclusionsPreventable causes (60.2%) were more common than nonpreventable ones among case cancellations. Our findings showed that many patients had high blood pressure and were unaware of this condition. Our study allowed referral of patients to a cardiologist to begin the follow-up process. Additionally, our study highlights the need for adequate preoperative anesthesia preparation and comprehensive nursing care.

Evolution of the "Internet Plus Health Care" Mode Enabled by Artificial Intelligence: Development and Application of an Outpatient Triage System.

Although new technologies have increased the efficiency and convenience of medical care, patients still struggle to identify specialized outpatient departments in Chinese tertiary hospitals due to a lack of medical knowledge. The objective of our study was to develop a precise and subdividable outpatient triage system to improve the experiences and convenience of patient care. We collected 395,790 electronic medical records (EMRs) and 500 medical dialogue groups. The EMRs were divided into 3 data sets to design and train the triage model (n=387,876, 98%) and test (n=3957, 1%) and validate (n=3957, 1%) it. The triage system was altered based on the current BERT (Bidirectional Encoder Representations from Transformers) framework and evaluated by recommendation accuracies in Xinhua Hospital using the cancellation rates in 2021 and 2022, from October 29 to December 5. Finally, a prospective observational study containing 306 samples was conducted to compare the system's performance with that of triage nurses, which was evaluated by calculating precision, accuracy, recall of the top 3 recommended departments (recall@3), and time consumption. With 3957 (1%) records each, the testing and validation data sets achieved an accuracy of 0.8945 and 0.8941, respectively. Implemented in Xinhua Hospital, our triage system could accurately recommend 79 subspecialty departments and reduce the number of registration cancellations from 16,037 (3.83%) of the total 418,714 to 15,338 (3.53%) of the total 434200 (P<.05). In comparison to the triage system, the performance of the triage nurses was more accurate (0.9803 vs 0.9153) and precise (0.9213 vs 0.9049) since the system could identify subspecialty departments, whereas triage nurses or even general physicians can only recommend main departments. In addition, our triage system significantly outperformed triage nurses in recall@3 (0.6230 vs 0.5266; P<.001) and time consumption (10.11 vs 14.33 seconds; P<.001). The triage system demonstrates high accuracy in outpatient triage of all departments and excels in subspecialty department recommendations, which could decrease the cancellation rate and time consumption. It also improves the efficiency and convenience of clinical care to fulfill better the usage of medical resources, expand hospital effectiveness, and improve patient satisfaction in Chinese tertiary hospitals.

Inequity in Fertility Treatment for Patients that Speak a Language Other than English: A Retrospective Cohort Study.

To assess fertility treatment outcomes according to primary language spoken in patients undergoing fertility treatment in an Australian setting. This retrospective cohort study examined female patients who received fertility treatment through a public hospital fertility service between September 2020 and May 2023. The primary outcome was clinical pregnancy rate following embryo transfer for patients who spoke English and patients who primarily spoke a language other than English. Poisson regression was used to estimate the association between language spoken and clinical pregnancy rate. Secondary outcomes included rate of other pregnancy outcomes following embryo transfer, number of fertility treatments performed, embryo quality, IVF cancellation rate, discontinuation rate, and time from first fertility appointment to treatment commencement. Of the 916 patients who accessed fertility treatment during the study period, 112 patients (12.23%) primarily spoke a language other than English. There were no significant differences in clinical pregnancy rate following embryo transfer (IRR 0.92, 95% CI 0.60-1.36), or rates of biochemical pregnancy, miscarriage, or negative pregnancy. However, patients who spoke a language other than English received significantly fewer IVF cycles (1.29 ± 0.61 vs 1.63 ± 1.16 cycles, p = 0.006), greater all-cause IVF cancellation rate (41.33% vs 28.33%, p = 0.048), and longer median time from first appointment to first treatment of any type (341 vs 234.5days, p < 0.001). Inequity in all-cause IVF cancellation rate, mean number of IVF cycles, and duration from first fertility appointment to treatment commencement were observed for patients who spoke a language other than English.

Predictors of Patient Experience for 89,205 Physical and Occupational Therapy Patients Seen for Musculoskeletal Disorders: A Retrospective Cohort Study

OBJECTIVE: To identify predictors of patient experience among a cohort of 89,205 individuals who sought physical and occupational therapy services for musculoskeletal disorders. DESIGN: Retrospective cohort. METHODS: Patient experience was measured using a previously validated tool, the Select Medical Patient Reported Experience Measure (SM-PREM©), for physical and occupational therapy outpatient clinics. Linear and logistic regression models measured the association between demographic, clinical, and payment-related variables and SM-PREM© scores at discharge. RESULTS: Multiple variables that were statistically significantly associated with SM-PREM scores across regression analyses (p&lt;0.05); 4 predictors consistently emerged from the regression analyses. The use of paper outcomes capture (OR=1.21, 95%CI 1.17, 1.26), higher cancellation rates (OR=1.00, 95%CI 1.00, 1.01), higher percent out-of-pocket costs (OR=1.00, 95%CI 1.00, 1.01), and failure to meet the outcomes MCID (OR=0.76, 95%CI 0.73, 0.78) were predictors of a less favorable patient experience. CONCLUSION: Outcome capture methods, managing cancellation rates, and addressing financial barriers were important for improving patient experiences. More research is needed to investigate the underlying mechanisms driving these associations, explore interventions to mitigate their negative impacts and consider additional variables that may further explain variations in SM-PREM scores.

Critical patient safeguards for ambulatory surgery centers.

The role of ambulatory surgery centers in surgical care is evolving, as lower facility fees and improved patient experience increase the popularity of these venues. As care expands in ambulatory surgery center, so does the complexity of cases and patients cared for in these centers, which may pose a risk for patient safety. Anesthesiologists should lead multidisciplinary teams to screen for appropriate patients and procedures. Patient considerations go beyond physical status and include psychosocial factors. Ensuring patients understand preoperative instructions is crucial to decrease case cancellation rates and facilitate efficiency. Pediatric patients require special considerations including extra attention to preprocedure and postoperative care and instructions, PALS-certified staff, pediatric equipment and medications, as well as heightened awareness of respiratory complications. Procedural concerns start with the capabilities of the facility such as equipment, pharmacy, and staffing for each phase of care. However, nuances such as patient throughput in a given day, emergency preparedness, and after-hours staffing will affect both patient safety and staff morale. This article outlines the issues leaders need to consider to ensure patient safety in ambulatory surgery centers.

Impact on ambulatory palliative appointment lead times by standardizing scheduling protocols based on cognitive computing models.

62 Background: Although palliative care is available across the United States, access continues to remain variable. In Texas, only 52% of hospital systems have palliative services. As a result, optimizing existing systems is critical to providing timely services to this vulnerable population. The Supportive Care Services Clinic at University Health in San Antonio, TX provides ambulatory palliative services to patients including physical and psychosocial symptom management and care coordination. For the period April 1, 2023 to June 30, 2023 average lead times for new palliative patient visits (NPPV) and hospital consult discharge visits (HCDV) was 53 days and 39 days respectively. The aim of this project was to decrease the lead times for NPPV and HCDV through standardization of scheduling criteria. We hypothesized that by applying a scheduling protocol utilizing cognitive computing models (CCM) calculating readmission risk scores to prioritize referrals, we could reduce appointment lead times. Methods: During the implementation phase, we developed referral triage criteria to prioritize patients on a scheduling wait list, including patients who were at higher risk of hospitalization or rapid decline based on CCM readmission risk scores calculated within the electronic medical record. Patients were assigned to next available in template. If a cancelation occurred, patients were pulled forward and vacancy was filled based on priority score. Results: For the initial post-implementation period between September 1, 2023 and November 30, 2023 NPPV average lead time was 47 days which was a reduction of 11% from baseline. The average lead time for HCDV was 33 days which was a reduction of 15% from baseline. In a second follow-up period from February 1, 2024 to April 30, 2024, the average lead time of NPPV was 22 days, a 58% decrease from baseline. The average lead time for HCSV was 24 days which was a significant reduction (p-value = 0.011) of 38% from the pre-implementation baseline. Conclusions: Utilization of CCM risk scores to triage NPPV and HCDV significantly reduced the lead times and resulted in more timely services for critical patients. We also noted increased template utilization. Future projects aim to study the effects of scheduling protocols on template utilization, cancellation rates, no-show rates, readmission rates and other health care utilization. Palliative appointment lead times. April-June 2023 Sept-Nov 2023 Feb-Apr 2024 Total Pt Seen 292 364 534 Avg Lead Time (d) 41 38 29 New Patient New Patient New Patient Completed 66 82 74 Avg Lead Time (d) 53 47 22 Hospital Discharge Hospital Discharge Hospital Discharge Completed 27 28 25 Avg Lead Time (d) 39 33 24

EP.07A.06 Usefullness and Appropriate Indication of Intraoperative CT-Guided Marking Using O-Arm Based on Cancellation Rate

EP.07A.06 Usefullness and Appropriate Indication of Intraoperative CT-Guided Marking Using O-Arm Based on Cancellation Rate

Predictors of No-Shows and Cancellations in an Outpatient Neuropsychology Clinic in a Large Healthcare System.

The purpose of this study was to evaluate potential predictors of no-shows and late cancellations in an outpatient clinic within a large healthcare system serving vulnerable communities. Demographic data and appointment status were recorded for 537 consecutive patients scheduled for neuropsychological evaluation in an outpatient psychiatry clinic. Patients include 220 males and 317 females with an average formal education of 11.01 years (SD = 3.87) and age of 55.64 years (SD = 16.20). The overall rate of no-shows or late cancellations was 20%. Of the 106 patients who no-showed/late cancelled, 41% rescheduled, and of those, 23% missed or late cancelled their second appointment. No-shows and late cancellations were associated with historical/prior no-show rate, while race/ethnicity and activation of MyChart had slight impacts. These data suggest that prior no-show rates and MyChart access may be targets for interventions to improve show rates. This is important for the patients' gaining access to care as well as minimizing financial strains for the system and increasing wait times/delays to care for other patients.

Process improvements related to new patient scheduling.

26 Background: With over 530 physicians across 280 locations, the new patient time to first appointment varied across the state, with results ranging from 1 to 33 average days to schedule. Beginning in January 2021, a new patient scheduling model was developed to improve access to care and the patient experience. A new patient scheduling model was developed. The program was structured to support both on site and remote scheduling. Methods: Provider scheduling cards detailing physician preferences for scheduling, required records and prioritization for the type of diseases seen was implemented. Physicians were required to designate new patient time slots in their clinics tied to new patient volume trends. New patient scheduling workflows and required record guidelines were standardized and revised. Reporting and tracking metrics were created – average days to schedule, average days to appointment, referral fulfillment rate, referral to appointment ratio, true cancellation rate. Physicians were eligible to participate in a yearly bonus if time to first appointment goals were met. Utilized Virtual and in-person APPs provided benign hematology consults to address capacity constraints. Results: New patient true cancellation rates decreased from 9.84% to 5.22% resulting in capture of over 800 patients a month. There was a 56% increase in patient retention with a 138% increase in referral volume. The Practice realized a 69% reduction in average days to schedule from 9 to 3 days. The average time to first appointments improved from 23 to 14 days; a 38% decrease. Conclusions: With increasing numbers of new cancer patients, increasing numbers of cancer survivors and shortages of medical oncologists, it is essential to maintain access to timely cancer care. New models helped improve patient experience and practice retention of new cancer patients, by focusing on administrative staff to implement these programs. APP benign hematology clinics freed up physician time for new cancer patient consults. Physician support was obtained with education, frequent outreach, and financial incentives. 2021 Q1 2021 Q2 2021 Q3 2021 Q4 2022 Q1 2022 Q2 2022 Q3 2022 Q4 2023 Q1 2023 Q2 2023 Q3 2023 Q4 2024 Q1 Referral Volume 44,305 54,379 57,282 57,475 67,890 75,111 79,281 75,843 85,419 91,811 94,286 88,396 100,115 Avg. Days to Scheduled 9.1 6.9 5.4 6.2 5.8 4.9 3.9 4.0 3.7 4.0 3.8 3.6 3.3 Avg. Days to Appointment 22.4 24.3 23.3 22.9 20.9 21.8 20.0 19.2 17.0 17.5 17.1 16.7 14.9

Testing an artificial intelligence algorithm to predict fetal heartbeat of vitrified-warmed blastocysts from a single image: predictive ability in different settings.

Could an artificial intelligence (AI) algorithm predict fetal heartbeat from images of vitrified-warmed embryos? Applying AI to vitrified-warmed blastocysts may help predict which ones will result in implantation failure early enough to thaw another. The application of AI in the field of embryology has already proven effective in assessing the quality of fresh embryos. Therefore, it could also be useful to predict the outcome of frozen embryo transfers, some of which do not recover their pre-vitrification volume, collapse, or degenerate after warming without prior evidence. This retrospective cohort study included 1109 embryos from 792 patients. Of these, 568 were vitrified blastocysts cultured in time-lapse systems in the period between warming and transfer, from February 2022 to July 2023. The other 541 were fresh-transferred blastocysts serving as controls. Four types of time-lapse images were collected: last frame of development of 541 fresh-transferred blastocysts (FTi), last frame of 467 blastocysts to be vitrified (PVi), first frame post-warming of 568 vitrified embryos (PW1i), and last frame post-warming of 568 vitrified embryos (PW2i). After providing the images to the AI algorithm, the returned scores were compared with the conventional morphology and fetal heartbeat outcomes of the transferred embryos (n = 1098). The contribution of the AI score to fetal heartbeat was analyzed by multivariate logistic regression in different patient populations, and the predictive ability of the models was measured by calculating the area under the receiver-operating characteristic curve (ROC-AUC). Fetal heartbeat rate was related to AI score from FTi (P < 0.001), PW1i (P < 0.05), and PW2i (P < 0.001) images. The contribution of AI score to fetal heartbeat was significant in the oocyte donation program for PW2i (odds ratio (OR)=1.13; 95% CI [1.04-1.23]; P < 0.01), and in cycles with autologous oocytes for PW1i (OR = 1.18; 95% CI [1.01-1.38]; P < 0.05) and PW2i (OR = 1.15; 95% CI [1.02-1.30]; P < 0.05), but was not significantly associated with fetal heartbeat in genetically analyzed embryos. AI scores from the four groups of images varied according to morphological category (P < 0.001). The PW2i score differed in collapsed, non-re-expanded, or non-viable embryos compared to normal/viable embryos (P < 0.001). The predictability of the AI score was optimal at a post-warming incubation time of 3.3-4 h (AUC = 0.673). The algorithm was designed to assess fresh embryos prior to vitrification, but not thawed ones, so this study should be considered an external trial. The application of predictive software in the management of frozen embryo transfers may be a useful tool for embryologists, reducing the cancellation rates of cycles in which the blastocyst does not recover from vitrification. Specifically, the algorithm tested in this research could be used to evaluate thawed embryos both in clinics with time-lapse systems and in those with conventional incubators only, as just a single photo is required. This study was supported by the Regional Ministry of Innovation, Universities, Science and Digital Society of the Valencian Community (CIACIF/2021/019) and by Instituto de Salud Carlos III (PI21/00283), and co-funded by European Union (ERDF, 'A way to make Europe'). M.M. received personal fees in the last 5 years as honoraria for lectures from Merck, Vitrolife, MSD, Ferring, AIVF, Theramex, Gedeon Richter, Genea Biomedx, and Life Whisperer. There are no other competing interests. N/A.

Ride-hailing technology mitigates effects of driver racial discrimination, but effects of residential segregation persist

We assess racial disparities in the service quality of app-based ride-hailing services, like Uber and Lyft, by simulating their operations in the city of Chicago using empirical data. To generate driver cancellation rate disparities consistent with controlled experiments (up to twice as large for Black riders as for White riders), we estimate that more than 3% of drivers discriminate by race. We find that the capabilities of ride-hailing technology to rapidly rematch after a cancellation and prioritize long-waiting customers heavily mitigates the effects of driver discrimination on rider wait times, reducing average discrimination-induced disparities to less than 1 min-an order of magnitude less than traditional taxis. However, our results suggest that even in the absence of direct driver discrimination, Black riders in Chicago wait about 50% longer, on average, than White riders because of historically informed geographic residential patterns. We estimate that if Black riders in the city had the same wait times as White riders, the collective travel time saved would be worth $4.2 million to $7.0 million per year.

A - 66 Factors Impacting Appointment No-Shows and Cancellations in Neuropsychology: Predictors for Improving Access to Care for a Diverse Patient Population

Abstract Objective Access to care can be impacted adversely by appointment adherence. We aimed to identify predictors of no-shows and cancellations for neuropsychological services offered by a healthcare system serving diverse communities. Method Demographics and appointment status were documented from a sample of 537 consecutive patients scheduled for neuropsychological evaluation at an outpatient psychiatry clinic. Patients included 220 males and 317 females with an average formal education of 11.01 years (SD = 3.87) and age of 55.64 years (SD = 16.2). Chi-square analyses were used to evaluate the association between appointment status and gender, race/ethnicity, payor, availability of a collateral, and MyChart access. Multivariate analysis of variance was used to assess the relationship between age, education, proxy income, and prior no-show rate with appointment status. Results The overall rate of no-shows or late cancellations was 20%, and some patients no-showed multiple times. No-shows and late cancellations were associated with historical no-show rates and older age (F = 14.60, p &amp;lt; 0.0001), while race/ethnicity and MyChart activation had slight impacts (χ2 = 5.572, p = 0.062 and χ2 = 3.69, p = 0.055, respectively). Being a monolingual Spanish speaker was associated negatively with MyChart activation, but positively with collateral availability (p &amp;lt; 0.05). Conclusions No-show rates, which impact access to care, are high and associated with prior history of no-shows. Other factors, such as MyChart activation and culturally-associated barriers may also impact access. Implementing interventions addressing prior no-show rates and enhancing MyChart access could significantly increase show rates; such improvements could increase patient access to care, reduce the system’s financial burden, and decrease wait times for other patients.

Outcomes of IVF treatments in women with antiphospholipid antibodies or antiphospholipid syndrome

BackgroundOvulation induction for in vitro fertilization (IVF) may increase intravascular thromboses among patients with antiphospholipid autoantibodies (aPLs) or antiphospholipid syndrome (APS) due to the high estrogen levels. While natural or modified natural IVF treatment cycles (MNC) are sometimes used instead of stimulated cycles with empiric anticoagulant treatment among these infertile patients, their efficacy is unclear. Materials and methodsA retrospective cohort study including all IVF cycles of patients diagnosed with aPLs or APS in a tertiary, university-affiliated hospital between 2012 and 2022. The outcomes of stimulated cycles with anticoagulants and MNC and natural IVF cycle attempts were compared. Results121 oocyte retrievals from 38 women were analyzed: 93 stimulated and 28 MNC or natural IVF cycles. The rates of cycle cancellation (0 % vs. 17.9 %, p < 0.001) and cycles in which no oocytes were retrieved (0 % vs. 43.5 %, p < 0.001) were significantly lower following stimulated cycles vs. natural and MNC. In parallel, positive β-hCG (31.9 % vs. 10.9 %, p = 0.03), clinical pregnancy rate (23.6 % and 3.6 %, p < 0.001) and live birth rates (18.1 % vs. 3.6 %, p = 0.01) were significantly higher following stimulated cycles. No thrombotic events or bleeding occurred in any cycle. ConclusionOvarian stimulation for IVF is more effective for successful pregnancy and delivery than natural cycles and MNC and can be safely undertaken in aPLs or APS women undergoing IVF. Rates of complication from hormonal treatment are not increased when treated with LMWH during ovarian stimulation.

The effects of growth hormone supplementation in poor ovarian responders undergoing In vitro fertilization or Intracytoplasmic sperm injection: A systematic review and meta-analysis of randomized controlled trials.

To evaluate the effect of growth hormone (GH) supplementation on outcomes of in vitro fertilization (IVF) or Intracytoplasmic sperm injection (ICSI) for women with poor ovarian response. Relevant randomized controlled trials (RCTs) were obtained through search in several databases including PubMed, Scopus, Clinicaltrials.gov, Google Scholar, and Cochrane Library. Outcome measures included live birth rate, clinical pregnancy rate, cycle cancelation rate, number of retrieved oocytes, number of transferred embryos, total dose of gonadotropin, duration of gonadotropin treatment, and peak estradiol level. Additionally, a meta-regression analysis was carried out to determine any potential linear relationships between these outcomes and IVF success. After analyzing 18 RCTs comprising of 1870 patients, the study found that GH supplementation improved the number of retrieved oocytes [standardized mean difference (SMD), 0.65; 95% confidence interval (CI), 0.29-1.00] and transferred embryos group (SMD, 0.80, 95% CI, 0.39, 1.21) as well as peak E2 level (SMD, 1.20; 95% CI, 0.59, 1.81). While reduced the total dose and duration of gonadotropin treatment (SMD, -0.82, 95% CI, -1.25, -0.39, and SMD, -0.63, 95% CI, -1.04, -0.22, respectively). The meta-regression analysis found no linear relationship between clinical pregnancy, live birth rate, or cycle cancelation rate and the outcomes measured (p>0.1). Based on the available evidence, GH supplementation appears to improve the outcomes of IVF or ICSI in women with poor response. However, there is a need for further RCTs with larger sample sizes to determine the cost-effectiveness of adding GH to conventional protocols of IVF/ICSI for treating infertility in women with poor ovarian response.

Efficacy of a full management model in daytime surgery for gastrointestinal polyps based on WeChat: A study protocol for randomized controlled trials.

The objective of this study is to improve the efficiency of daytime surgery for gastrointestinal polyp and ensure the safety of patients. We tried an information management method based on WeChat platform in patients undergoing daytime gastrointestinal polypectomy and to explore the feasibility and effectiveness of a full management model. Five hundred and ninety-three patients were randomly divided into two groups: the control group was treated with traditional management methods and the experimental group was treated with the whole-process management mode based on the WeChat platform. The WeChat platform-based full management model included establishing a day surgery management WeChat group, developing multidisciplinary, full-management protocols and processes for day surgery, establishing an information-based surgical scheduling system and adopting diverse forms of day surgery education and continuity of care. This feature included illustrated brochures, vivid verbal presentations, WeChat public numbers and Internet management platforms. The treatment time, hospitalization cost and patient satisfaction of the two groups were counted. In the experimental group, 408 patients were enrolled. The preoperative waiting time and patients' length of stay were 3 days and 1 day, respectively. The medical and nursing intake time was 7 min. The procedure cancellation rate and postoperative complications rate was 0.07% and 0.02%. In the control group, 185 patients were enrolled in the study, The preoperative waiting time and patients' length of stay was 7 days and 3 days. The medical and nursing intake time was 28 min. The procedure cancellation rate and postoperative complications rate were 0.13% and 0.05%, respectively. The hospitalization costs were reduced by an average of $140/person and the satisfaction scores were higher than the control group. In summary, the preoperative waiting time, medical reception time, surgical cancellation rate, length of hospital stay and hospitalization cost in the observation group were less than those in the control group (p < 0.05). Patient satisfaction scores were significantly higher than those in the control group (p < 0.05). Through the full management model based on WeChat, the preoperative waiting time, medical reception time, surgical cancellation rate, length of hospital stay and hospitalization cost in the experimental group were less than those in the control group. Patient satisfaction scores were significantly higher than those in the control group and the difference was statistically significant.