Cancellation Rate Research Articles

Embryo donation: national trends and outcomes, 2004–2019

In 2016, the Food and Drug Administration amended existing regulations to increase access to donated embryos for reproductive use. Current information regarding characteristics and outcomes of embryo donation cycles could benefit patients and providers during counseling and decision making. To examine trends in utilization of embryo donation, pregnancy rates and live birth rates per transfer between 2004-2019; to describe recipients of donated embryos and outcomes of frozen donated embryo transfer cycles during the most recent time period: 2016-2019 STUDY DESIGN: We conducted a retrospective population-based cohort study of frozen donated embryo transfer cycles in United States fertility clinics reporting to the National Assisted Reproductive Technology Surveillance System during 2004-2019. Trends in the annual number and proportion of frozen donated embryo transfers, pregnancy rates and live birth rates from 2004-2019 were described. During 2016-2019, rate of cycle cancellation, pregnancy, miscarriage, live birth, singleton birth, and good perinatal outcome (delivery ≥37 weeks, birthweight ≥2500 grams) of frozen donated embryo transfers were also calculated. Transfer and pregnancy outcomes stratified by oocyte source age at the time of oocyte retrieval were also described. From 2004-2019, there were 21,060 frozen donated embryo transfers in the United States resulting in 8,457 live births. During this period, the annual number and proportion of frozen donated embryo transfers of all transfers increased, as did the pregnancy rate and live birth rate. Among all initiated cycles during 2016-2019, the cancellation rate was 8.2%. Among 8,773 transfers with known outcomes, 4,685 (53.4%) resulted in pregnancy and 3,820 (43.5%) in live birth. Among all pregnancies, 814 (17.4%) resulted in miscarriage. Among all live births, 3,223 (84.4%) delivered a singleton of which 2,474 (76.8%) had a good perinatal outcome. The clinical pregnancy rate and live birth rate per frozen donated embryo transfer decreased with increasing age of oocyte source. The outcomes of embryo donation cycles reported in this national cohort may aid patients and providers when considering use of donated embryos.

Minimal Stimulation Using Gonadotropin-Releasing Hormone Antagonist is Associated with Higher Live Birth Rates: A National Study of 13,050 Cycles.

The optimal protocol for minimal stimulation in vitro fertilization (IVF) has yet to be established. This study aims to determine if the use of gonadotropin-releasing hormone (GnRH) antagonist during minimal stimulation improves outcomes. All cycles designated as minimal stimulation from 2014 to 2016 from the Society for Assisted Reproductive Technology Clinic Online Reporting System were identified. Cycles in which GnRH antagonist was administered (n = 5984) were compared to those that did not receive it (n = 7066). Wilcoxon's rank-sum test and chi-square test were used to analyze continuous and categorical variables. A total of 6750 patients undergoing 13,050 cycles were included. GnRH antagonist use was associated with a significantly higher total gonadotropin dosage (median 975.0 [interquartile range, IQR, 600.0, 1575.0] vs. median 660.0 [IQR 375.0, 975.0], p < 0.001), lower cycle cancelation rate (11.3% vs. 13.6%, p < 0.001; OR 1.24, 95% CI 1.12-1.38, p < 0.001), and higher live birth rate (4.3% vs. 2.1%, p < 0.001; OR 0.47, 95% CI 0.39-0.58, p < 0.001). GnRH antagonist use was associated with a significantly higher live birth rate in women ≥35 years of age (2.7% vs. 0.9%, p < 0.001; OR 0.34, 95% CI 0.25-0.47, p < 0.001) and antimullerian hormone <1 (4.9% vs. 2.6%, p = 0.004; OR 0.52, 95% CI 0.33-0.81, p = 0.004). The use of GnRH antagonist suppression during minimal stimulation IVF is associated with an improved live birth rate, especially in older women and in women with diminished ovarian reserve. Although GnRH antagonist use may increase costs, it significantly decreases cancelation rate, increases number of embryos cryopreserved, and should be encouraged for minimal stimulation IVF.

Strategies for Safely Maintaining Surgical Volume During the COVID-19 Pandemic: A Mixed-Methods Study.

Resuming elective surgeries that were canceled during the COVID-19 pandemic necessitated a change to preprocedure patient preparation at a pediatric tertiary care center in middle Tennessee. We conducted a prospective, observational, mixed-methods study to determine the effectiveness of a preprocedure COVID-19 testing team to prevent COVID-19-related cancellations among pediatric patients receiving planned anesthesia. The intervention involved family member and patient education and a change in health record reporting to include COVID-19 test results. A team tasked with follow-up reviewed test results, consulted with families, and coordinated the administration of rapid tests if necessary. We compared preimplementation and postimplementation cancellation rates in four procedural areas and found no significant difference in the cancellation or rescheduling rates (P = .89, 95% confidence interval = -4.29 to 3.09). The team-based intervention was associated with the preservation of low procedural cancellation rates by mitigating barriers to preprocedural testing.

Presence of Endometrioma Does Not Impair Embryo Quality and Assisted Reproductive Technology (ART) Cycle Outcome in Diminished Ovarian Reserve (DOR) Patients.

This study aims to assess the impact of endometrioma on embryo quality and cycle outcome in patients who undergo assisted reproductive technology (ART) treatment due to diminished ovarian reserve (DOR). Retrospective case-control study was conducted in women ≤ 40years of age who underwent ART treatment caused by DOR, defined according to POSEIDON criteria, at a university-based infertility clinic between January 2015 and December 2020. Three groups of patients were selected: group A included patients with an idiopathic DOR, group B included patients with endometrioma(s) who underwent ovarian cystectomy, and group C included patients with endometrioma(s) without surgical treatment. A total of 351 women with DOR were included in the final analysis. Demographic characteristics, including age and AMH, were similar between the groups. Significant differences were observed among groups on mean number of MII oocytes retrieved (1.88 ± 1.59 vs. 2.84 ± 2.89 vs. 2.78 ± 2.41, respectively; p < 0.001) and mean number of embryos (1.04 ± 1.18 vs. 1.87 ± 2.01 vs. 1.66 ± 1.81, respectively; p < 0.001). However, the mean number of top-quality embryos, cycle cancellation, and live birth rates were similar between the groups. Clinical pregnancy (35 (26.5%) vs. 8 (18.2%) vs. 18 (42.9%), respectively; p = 0.038) and miscarriage rates (12 (9.1%) vs. 0 vs. 8 (19.0%), respectively; p = 0.009) were higher in endometrioma group without surgery. Women with DOR appear to have similar ART cycle outcomes regardless of the etiology, in terms of live birth rates. Infertility of endometrioma patients might be related to altered endometrium rather than to decreased oocyte quality. Cystectomy for endometrioma before IVF did not seem to affect the LBR.

Association of Medical Appointment Cancellation Rates on Survival After Esophagectomy for Esophageal Cancer

BackgroundCancelled healthcare appointments, especially in patients with complex cancers, such as esophageal cancer, risk delayed treatment and adverse outcomes. We hypothesized that patients with greater rates of healthcare appointment cancellations would have decreased survival after esophagectomy for esophageal cancer. MethodsA retrospective analysis of patients from a single institution who underwent esophagectomy for esophageal cancer between 2004 and 2020 was performed. Appointment cancellations were queried 2 years pre-/post-esophagectomy and categorized as medical or ancillary. Continuous and categorical variables were compared by Mann–Whitney and chi-squared analyses, respectively. Survival associations post-esophagectomy were made by Kaplan–Meier analysis. ResultSeventy-six patients were identified. Total medical and ancillary appointments post-esophagectomy increased by 188% and 136%, respectively. Per patient, there was a median increase of 57.5 medical appointments in the post-esophagectomy period. Of medical appointments, 23.7% were cancelled pre-esophagectomy but 33.4% post-esophagectomy (p < 0.001). This trend held true for ancillary appointments. Patients with increased medical cancellation rates post-esophagectomy had shortened recurrence-free (p = 0.09) and overall survival (p < 0.01) versus patients with low cancellation rates. ConclusionA significant increase in healthcare appointments is seen after esophagectomy. Patients with increased healthcare appointment cancellations have decreased post-esophagectomy survival which presents an opportunity to intervene in patients who historically have a high cancellation rate.

Incidence and predictors of case cancellation within 24 h in patients scheduled for elective surgical procedures

ObjectiveAvoidable case cancellations within 24 h reduce operating room (OR) efficiency, add unnecessary costs, and may have physical and emotional consequences for patients and their families. We developed and validated a prediction tool that can be used to guide same day case cancellation reduction initiatives. DesignRetrospective hospital registry study. SettingUniversity-affiliated hospitals network (NY, USA). Patients246,612 (1/2016–6/2021) and 58,662 (7/2021–6/2022) scheduled elective procedures were included in the development and validation cohort. MeasurementsCase cancellation within 24 h was defined as cancelling a surgical procedure within 24 h of the scheduled date and time. Our candidate predictors were defined a priori and included patient-, procedural-, and appointment-related factors. We created a prediction tool using backward stepwise logistic regression to predict case cancellation within 24 h. The model was subsequently recalibrated and validated in a cohort of patients who were recently scheduled for surgery. Main results8.6% and 8.7% scheduled procedures were cancelled within 24 h of the intended procedure in the development and validation cohort, respectively. The final weighted score contains 29 predictors. A cutoff value of 15 score points predicted a 10.3% case cancellation rate with a negative predictive value of 0.96, and a positive predictive value of 0.21. The prediction model showed good discrimination in the development and validation cohort with an area under the receiver operating characteristic curve (AUC) of 0.79 (95% confidence interval 0.79–0. 80) and an AUC of 0.73 (95% confidence interval 0.72–0.73), respectively. ConclusionsWe present a validated preoperative prediction tool for case cancellation within 24 h of surgery. We utilize the instrument in our institution to identify patients with high risk of case cancellation. We describe a process for recalibration such that other institutions can also use the score to guide same day case cancellation reduction initiatives.

Intracytoplasmic sperm injection cycle success in patients under 35 years old with diminished ovarian reserve plus severe male factor.

We aimed to evaluate intracytoplasmic sperm injection (ICSI) outcomes in young patients with diminished ovarian reserve (DOR) plus severe male factor (SMF) compared with age-matched controls with DOR. A total of 189 infertile women under 35 years with DOR undergoing ICSI procedures were included retrospectively. Participants whose partners' sperm analysis was normal considered as the DOR group (n=154) and whose partners' had SMF considered as the DOR + SMF group (n=35). The two groups were compared regarding cycle characteristics and pregnancy outcomes. Demographic features except infertility duration were similar between two groups. The duration of infertility was significantly longer in the DOR + SMF group compared to the DOR group (p=0.02). Ovarian stimulation characteristics, oocyte retrieval parameters, fertilization rate, quality of embryos, embryo cancellation rate, and development up to blastocyst stage were found similar between two groups. Implantation, clinical pregnancy, abortion, and live birth rate, multiple pregnancy rate per cycle were distributed homogenously between the DOR and DOR + SMF groups. Regarding perinatal and neonatal outcomes of groups, fetal height and weight were significantly lower in DOR + SMF group than in DOR group (p=0.001 and 0.01, respectively). Gestational week at delivery was lower in the DOR + SMF group compared to the DOR group (p < 0.0001). Fetal anthropometric measures were lower regarding to preterm delivery in the DOR + SMF group than the DOR group. Large sample-sized studies should be performed to explain the decreased gestational week at the time of delivery in the DOR + SMF group.

Same-Day Cancellation is Higher in Outpatient Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy.

PurposeSafety and efficiency of ambulatory pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) patients is worthy of attention, since patients always have severe systemic diseases. The purpose of this study was to compare the incidence of same-day cancellation of PPV for PDR between outpatients and inpatients and to analyze the causes of cancellations.Patients and MethodsThis is a retrospective review of consecutive PPV procedures for PDR from January 2019 to April 2021 at either the ambulatory or the inpatient surgery center in an academic tertiary referral center. Data on patient surgery plan, same-day surgical cancellation and follow-up were recorded. Differences in cancellation rate and reasons for cancellation (e.g. medical factors, patient reasons and administrative problems) between outpatients and inpatients were compared.ResultsIn total, 1810 consecutive PPV procedures of 1367 patients were identified; 1509 (83.4%) were managed as inpatient surgeries and 301 (16.6%) as outpatient surgeries. The total same-day cancellation rate was 5.2% for all patients. Although outpatients were younger (51 years vs 52 years, P < 0.001), had less proportion of hypertension (60.5% vs 74.0%), coronary artery disease (10.0% vs 18.8%), renal insufficiency (9.3% vs 18.0%) and cerebrovascular diseases (1.0% vs 11.4%) (all P < 0.001), had less proportion of patients with ASA III status (14.9% vs 27.4%, P < 0.001), and had higher proportion of regional anesthesia with MAC (19.9% vs 5.0%, P < 0.001), the cancellation proportion was significantly higher for outpatients than inpatients (12.3% vs 3.8%, P < 0.001). Overall, the most common reason for surgical cancellation was medical factors, occurring more frequently in outpatients than inpatients (91.9% vs 68.4%, P = 0.012).ConclusionSame-day cancellation is higher in outpatient pars plana vitrectomy for proliferative diabetic retinopathy. To reduce ambulatory surgery cancellations, it is important to strengthen the monitoring of preoperative systemic comorbidities and adjust medication if necessary.

Improving the breast MRI process: A longitudinal QI project at the Houston VA.

371 Background: The number of female veterans is increasing by more than 18,000 per year, and 700 veterans enrolled in VA healthcare are diagnosed with breast cancer each year. The American Cancer Society recommends screening MRI in women with 20-25% or greater lifetime risk of breast cancer, and primary care physicians and oncologists order breast MRIs regularly. The Michael E. DeBakey Veteran’s Affairs Medical Center (MEDVAMC) performs mammograms and ultrasounds on site, but breast MRI is not currently available. Care in the Community arranges for veterans to obtain these studies at outside facilities. This is a complex process, requiring coordination among multiple departments at the MEDVAMC, outside MRI facilities, and patients. Methods: We created a comprehensive process map for the current breast MRI ordering process to determine areas for improvement. We reviewed all breast MRI orders from 1/2019 to 5/2021 at the MEDVAMC and determined the cancellation rate and the rate of benign (BIRADS 1-2) vs non benign (BIRADS 0, 3-5) screening outcomes. We created a Pareto analysis of cancellation reasons. Our process measures were percentage of placed breast MRI orders that were cancelled and delay from MRI order to MRI performed. Our outcome measures were percentage of order cancellations due to incorrect or incomplete orders and delay from MRI order placement to results uploaded. Results: Of the 434 orders that were placed for breast MRIs, 64% were cancelled. Only 117 of the 167 patients that had MRIs ordered ultimately received one. Of the 104 patients without known malignancy who competed an MRI, 45% had non-benign findings requiring follow-up. Our pareto analysis showed that the top cancellation reason was incorrect orders, usually contrast or side verbiage. In June 2021, the CITC order set for MRI was changed from a free text box to discrete, clickable options for side and contrast. In December 2021, we held educational interventions on how to avoid delay or cancellation. Our p-chart of percentage of cancellations due to incorrect ordering shows an extremely promising decrease, with the last seven consecutive subgroups of 15 patients below the mean. The order cancellation percentage is also decreasing. The average delay pre-intervention from MRI order placement to results uploaded was 67 days. In January 2022, we implemented a breast MRI nurse navigator to help acquire results and expedite scheduling. Post-intervention, the average delay has decreased to 38.5 days. Using XmR and S charts, we have also shown an increase in precision. Conclusions: Providing discrete, clickable options within the MRI order set reduced the number of cancellations due to incorrect verbiage. Early data suggests that the educational intervention improved the cancellation rate. Instituting a nurse navigator decreased both the delay and variability for the time from order placement to results received, which will reduce the delay to follow-up of non-benign findings.

HIGH ANTI-MULLERIAN HORMONE LEVEL PREDICTS OVULATION INDUCTION FAILURE IN PATIENTS WITH POLYCYSTIC OVARY SYNDROME

To study how anti-mullerian hormone (AMH) level in patients with polycystic ovary syndrome (PCOS) affects ovulation induction (OI) cycle cancellation rates. Pregnancy and live birth rates were secondarily analyzed.

Reduction of In-Hospital Preoperative Waiting Time of Elective Surgeries in the Amidst of COVID-19 Pandemic: Experience from Ethiopia.

BackgroundThe higher demand for surgical services during the advancement of the COVID-19 pandemic has resulted from the need for a pre-admission negative result, the need for extra resources, and a shortage of skilled expertise. This quality improvement project aimed to reduce the in-hospital preoperative waiting time of elective cases to less than 24 hours.MethodsThe study was conducted in a tertiary care center. Following the collection of baseline data, we formed a multidisciplinary team to analyze the root causes and intervention ideas of delay using fishbone and driver diagrams, respectively. We prioritize key drivers and implemented several low-cost interventions using Plan-Do-Study-Act (PDSA) model. We monitored the average in-hospital preoperative waiting time of patients.ResultsOverall, in-hospital preoperative waiting time for elective cases has been reduced from a baseline of 4.89 days to 1.32 days on average by the end of 10 months of initiating the project. Similarly, monthly elective case cancellation rate due to COVID-19-related reason has been reduced from baseline 62.5% of the total cancellation to 0%. Due to this, the average monthly inpatient bed utilization has increased from 2.21 patients per month during pre-COVID-19 period to 5.9 patients per month in each bed of the surgical ward by the end of the project.ConclusionThe implementation of a quality improvement project can optimize operation theatre efficiency, inpatient bed utilization, and reduce the surgical backlog. Meticulous and rigorous effort has to be laid down to do root cause analysis, generate feasible change ideas, and continuous follow-up, and testing of multiple PDSA cycles is required to impact an improvement and sustain it in the long run. The emergence of COVID-19 pandemic could be used as an opportunity to reduce the length of stay in the hospital.

Can FMR1 CGG repeat lengths predict the outcome in ICSI cycles?

The aim of this study was to assess relationship between CGG repeat lengths and ovarian reserve and response to controlled ovarian stimulation (COH). This prospective cohort study was carried out on patients (n = 49) who were admitted to the in vitro fertilization (IVF) clinic of the Zeynep Kamil Women's and Children's Diseases Training and Research Hospital, University of Health Sciences. Women under 40 years of age with premature ovarian insufficiency underwent genetic analysis to determine CGG repeat lengths. Ovarian reserve was assessed for each participant and participants underwent ovarian hyperstimulation and intracytoplasmic sperm injection (ICSI) cycle. Relationships between ovarian reserve, cycle outcome and CGG repeat lengths were assessed. Variables including fertility assessment including ovarian reserve tests (Follicle stimulating hormone (FSH), Luteinizing hormone (LH), Estradiol (E2), Prolactin (PRL), Thyroid stimulating hormone (TSH), Antimullerian hormone (AMH), antral follicle count (AFC) tests) and some IVF cycle characteristics were assessed in relation to number of CGG repeat numbers. None of the ovarian reserve tests and cycle characteristics was found to be correlated with CGG repeat lengths. Comparison of ovarian reserve tests and cycle characteristics revealed no difference between groups of women with CGG repeat length > 55 and CGG repeat length ≤ 55. Antimullerian hormone (AMH) was a significant predictor for cycle cancellation (AUC = 0.779, P = 0.008). AMH level > 0.035 was found to be the optimal cut off value to predict cycles reaching to embryo transfer with 71% sensitivity and 85% specificity. The rate of cycle cancellation was 71% in cases with AMH ≤ 0.035 whereas it was 20% in cases with AMH > 0.035 (p = 0.001). No difference was determined between groups with and without cycle cancellation in terms of CGG repeat lengths (55.3 vs. 53.9, p = 0.769). Among cycles reaching to embryo transfer stage, 3 (13.6%) pregnancies were achieved. Our data showed no relationship between CGG repeat lengths and ovarian reserve and response to controlled ovarian stimulation. This data also showed that no clinical difference between FMR gene mutation related POI and other etiologies.

Busting Three Myths About the Impact of Telemedicine Parity

Summary Three beliefs — that telemedicine will reduce access for the most vulnerable patients; that reimbursement parity will encourage overuse of telemedicine; and that telemedicine is an ineffective way to care for patients — have for years formed the backbone of opposition to the widespread adoption of telemedicine. However, during the Covid-19 pandemic, institutions quickly pivoted to telemedicine at scale. Given this rapid move, the University of Rochester Medical Center (URMC) had a natural opportunity to test the assumptions that have shaped prior discussions. Using data collected from this large academic medical center, UR Health Lab explored whether vulnerable patients were less likely to access care via telemedicine than other patients; whether providers increased virtual visit volumes at the expense of in-person visits; and whether the care provided via telemedicine was lower quality or had unintended negative costs or consequences for patients. The analysis showed that there is no support for these three common notions about telemedicine. At URMC, the most vulnerable patients had the highest uptake of telemedicine; not only did they complete a disproportionate share of telemedicine visits, but they also did so with lower no-show and cancellation rates. It is clear that at URMC, telemedicine makes medical care more accessible to patients who previously have experienced substantial barriers to care. Importantly, this access does not come at the expense of effectiveness. Providers do not order excessive amounts of additional testing to make up for the limitations of virtual visits. Patients do not end up in the ER or the hospital because their needs are not met during a telemedicine visit, and they also do not end up requiring additional in-person follow-up visits to supplement their telemedicine visit. As the pandemic continues to slow down, payers may start to resist long-term telemedicine coverage based on previous assumptions. However, the experience at URMC shows that telemedicine is a critical tool for closing care gaps for the most vulnerable patient populations without lowering the quality of care delivered or increasing short-term or long-term costs.

Moving the Needle on Patient Cancellations Through Mobile Integration

The Annie application (Annie app) prompts patients to track and guide their adherence to colonoscopy bowel prep protocol referred to as nothing by mouth (NPO) instructions. The app is a series of timed educational text messages geared toward colonoscopy preparation. This quality improvement project aimed to establish whether implementing a short message service (SMS) application (Annie app) would decrease the same-day cancellation rate among individuals receiving a nonemergent colonoscopy in a large Houston hospital clinic. Most same-day cancellations are related to failure to follow NPO instructions provided by the clinic nursing staff. All patients received the standard 14-day call, as well as the 3-day nurse reminder calls. The Annie app SMS was in addition to the standard nurse reminder calls. There were significant associations between using the Annie app and cancellations. Cancellation rates decreased by 21% when patients elected to receive the Annie app messages versus receiving voice-mail-only messages. African American individuals benefitted the most from the Annie app decreasing from 28.4% to 17.9%.

Impact of Heart Disease History on Safety of Telemedicine Cardiac Clearance Appointments.

The objective of this study was to compare complication, readmission, mortality, and cancellation rates between patients who had either an in-person or telemedicine preoperative cardiac clearance visit before spine surgery. A retrospective review was conducted on patients who underwent a spine procedure at a single tertiary academic center from February 1, 2020, to June 30, 2021. Cancellations, inpatient complications, 90-day readmissions, and inpatient and 90-day mortality rates were compared between in-person and telemedicine cardiac clearance visits. Secondary analysis included multiple logistic regression to determine independent predictors of case cancellations and complications. Alpha was set at P < 0.05. A total of 1,331 consecutive patients were included, with 775 patients (58.2%) having an in-person cardiac clearance visit and 556 (41.8%) having telemedicine clearance. Overall, the telemedicine cohort did not have more cancellations, complications, or readmissions. Regardless of the type of clearance, patients with a history of cardiac disease had more inpatient complications (15.8% versus 6.9%, P < 0.001) and higher 90-day mortality rates (2.3% versus 0.4%, P = 0.005). Subgroup analysis of patients with a history of cardiac disease showed that patients who had telemedicine visits had more cancellations (4.6% versus 10.9%, P = 0.036) and higher 90-day mortality rates (1.4% versus 4.4%, P = 0.045). On regression analysis, telemedicine visits were not independent predictors of preoperative cancellation rates (P = 0.173) but did predict greater preoperative cancellations among patients with cardiac history (odds ratio 2.73, P = 0.036). Patients with cardiac disease who undergo preoperative telemedicine visits have greater preoperative surgical cancellation rates and postoperative 90-day mortality rates. Although preoperative telemedicine visits may be appropriate for most patients, a history of cardiac disease should be a contraindication.

Effect of telehealth implementation on an adolescent metabolic and bariatric surgery program.

Pediatric severe obesity is a worldwide health concern. Treatment with metabolic and bariatric surgery can reduce morbidity and mortality. The COVID-19 pandemic not only has had a significant effect on rates of pediatric obesity but also has necessitated a rapid transition to virtual medicine. We aimed to identify and examine adolescent metabolic and bariatric surgery patient participation rates through our program's virtual telehealth programming as compared with prepandemic traditional in-person clinic appointments. This study took place at an academic pediatric quaternary care center. We evaluated 92 adolescent patients with a total of 2442 unique encounters between January 2018 and July2021. The rate of attendance was found to be greater for telehealth visits (83.1%) than for in-person appointments (70.5%) for all clinics regardless of appointment type (preoperative versus postoperative). Cancellation rates were lower for telehealth visits (9.9%) than for in-person appointments (22.5%). This study provides evidence that telehealth can be implemented successfully in an adolescent metabolic and bariatric surgery program and can improve attendance rates for all provider and appointment subtypes.

A novel role of follicle-stimulating hormone (FSH) in various regeneration-related functions of endometrial stem cells

Follicle-stimulating hormone (FSH) promotes the production and secretion of estrogen, which in turn stimulates the growth and maturation of ovarian follicles. Therefore, consecutive FSH treatment to induce ovarian hyperstimulation (superovulation) is still considered the most cost-effective option for the majority of assisted reproductive technologies (ARTs). However, a relatively high cancellation rate and subsequent low pregnancy outcomes (approximately 15%) are the most challenging aspects of this FSH-based ART. Currently, the main cause for this low implantation rate of FSH-based ART has not yet been revealed. Therefore, we hypothesized that these high cancellation rates with FSH-based superovulation protocols might be associated with the harmful effects of consecutive FSH treatment. Importantly, several recent studies have revealed that tissue-resident stem cell deficiency can significantly reduce cyclic endometrial regeneration and subsequently decrease the pregnancy outcome. In this context, we investigated whether FSH treatment could directly inhibit endometrial stem cell functions and consequently suppress endometrial regeneration. Consistent with our hypothesis, our results revealed for the first time that FSH could inhibit various regeneration-associated functions of endometrial stem cells, such as self-renewal, migration, and multilineage differentiation capacities, via the PI3K/Akt and ERK1/2 signaling pathways both in vitro and in vivo.

The Effectiveness of Intra-Uterine Platelet Rich Plasma Infusion for Improving Endometrial Thickness and Pregnancy Outcomes: A Pilot Study Analysis

Background: Platelet rich plasma (PRP) is well researched and utilized in many medical fields to increase angiogenesis, tissue healing and regeneration a . Recent studies have reported that intra-uterine PRP infusions when used during frozen embryo transfer (FET) cycles, can similarly affect endometrial proliferation, resulting in decreased cycle cancellation rates and improved endometrial thickness and pregnancy outcomes in women with thin linings b , c Aim: To establish if intra-uterine PRP infusions can increase endometrial thickness and improve pregnancy rates in women with a history of thin endometrial lining. Method: An analysis of all PRP infusions and their FET cycles undertaken at Ballarat IVF between November 2020 and May 2021 was performed. Patients with a history of thin endometrial lining were offered a PRP infusion from day 6 of their cycle, followed by a second infusion 2-3 days later. Endometrial thickness was measured by ultrasound prior to PRP infusion, post infusion #1/prior to PRP infusion #2, and post PRP infusions, and pregnancy outcomes collected. Results: Thirty patients were offered PRP infusions prior to their FET cycle and all 30 patients received one infusion of PRP. Twenty-six patients went on to receive a 2nd PRP infusion. Twenty-five patients had an FET, only one cycle was cancelled due to poor endometrial thickness. Average Endometrial thickness increased by 0.8mm after each PRP infusion; from 6.2mm prior to PRP infusion, to 7.0mm prior to PRP infusion #2, to 7.8mm post PRP infusions. Clinical pregnancy rates and ongoing pregnancy rates were 48%* and 24%* respectively (*two scans pending: anticipated rates 48% and 28% respectively). Conclusion: Intra-uterine Platelet Rich Plasma infusions prior to a FET appear to offer a safe method to increase endometrial lining in women with a history of thin endometrium, allowing these cycles to proceed to an embryo transfer. Clinical pregnancy rates are increased compared to women who have no history of thin endometrial lining. Despite increased implantation, ongoing pregnancy rates (defined by a fetal heart) are decreased compared to women with no history of a thin lining. A longer-term study on a larger number of patients is required to confirm the effectiveness of this technique on live birth rates.

Analysis of refilling late appointment cancellations in an outpatient practice at a community-based health system

Mayo Clinic Health System — Southwest Minnesota Region, one of four practice regions in the Midwest, provides primary and speciality care in ambulatory, procedural and hospital settings. Clinic appointment fill rates, no-show rates and late cancellation rates are closely monitored operational metrics, but at the time this study began, less was known about the refill rates of late appointment cancellations. This metric is of importance because these unfilled appointment times contribute to increased expenses for healthcare organisations, unnecessary delays in care and decreases in revenue. The main objectives of this study were to understand the current state and potential opportunities for refilling late cancellations. Qualitative and quantitative methods were used, including variance analysis, the Tukey post hoc test, Pareto analysis, the completion of interviews with important stakeholders and data extraction from the institution’s electronic health record. Findings showed that late cancellation rates remained steady in 2021 and that late cancellations were not being refilled consistently across departments and regions. Appointment refill rates were higher in departments with few or no requirements for preparatory evaluation, whereas in specialties that did require preparatory evaluations, refill rates were lower across the four regions of the Mayo Clinic Health System. Even in departments with high demand, the refill rates were lower, resulting in missed opportunities for patient visits. Mapping the workflow for late cancellations indicated inconsistent methods for refilling late cancellation openings and the lack of a defined process for refilling them that was understood by the entire care team. The logistics of optimising refill rates for late cancellations were affected by provider preference, selfscheduling functionality and appointment requirements. This study identified opportunities for optimising workflows to use the waiting list proactively to refill late cancellations.

제주투자진흥지구 운영 개선방안 연구

This study aims to analyze the current situation and problems of the Jeju Investment Promotion District, which is the main means of Jeju Island development, and to seek for improvement plans for them in point of practical management. Since its introduction in 2002, the Jeju Investment Promotion District has been evaluated to have succeeded in attracting 7.6 trillion won in investment over 20 years, thanks to support such as unprecedented taxation. And it also exposed many problems such as abuse of tax benefits and land arbitrages. Past studies have mainly focused on improving the framework of the system to prevent these problems. This study looked for improvement plans by analyzing the current status of each region, investment amount, and industry in the investment promotion district and the types of business sectors of which designation has been lifted. Literature research method using literature data as that of local government, previous research papers and media contents was used. As a result of the study, there is relatively more investment in the west than the east, so it is necessary to induce more investment in the east in the future. The cancellation rate of designation of mega business sectors such as comprehensive recreation business was high, so it was necessary to reduce it through much more intensive management. In addition, there were many cases of Investment District Cancellation and land arbitrages, which included many comprehensive recreation business sectors. So it was necessary to prevent it through elaborate management.