Duration Of Appointment Research Articles

Trends in Leadership Among Neurosurgical Oncology Fellowships

To examine current neurosurgical oncology leadership trends and provide a guide for those interested in obtaining fellowship directorship, we investigated fellowship director (FD) demographic, educational, and leadership characteristics. The American Association of Neurological Surgeons Academic Fellowship Directory and Committee on Advanced Subspecialty Training websites were reviewed for current U.S. program FDs for which data were collected using online resources and surveys. In total, 23 FDs (20 male and 3 female) were represented whose mean age was 52.4 years (standard deviation= 8.7). Our analysis found 65% of current neurosurgical oncology FDs to be singularly trained in neurosurgical oncology, with 8.7% possessing multiple fellowships and 34.8% possessing additional degrees. Fellowship programs producing the most FDs were University of Texas MD Anderson (4), Memorial Sloan Kettering (3), and University of Miami (2). FDs possessed an average of 148 publications, 6423 citations, and an h-index of 33.9. H-index had a high-positive correlation with age and time from residency graduation but not duration of FD appointment. Among survey respondents, 91.7% reported membership and 75% reported leadership positions among national academic societies, whereas 66.7% reported holding journal-editorial positions. The mean age of FD appointment was 46.8 years, with a mean time from fellowship completion to FD appointment of 10.0 years. Through the characterization of current leaders in the field, we provide valuable information with regards to training location trends, research productivity goals, career timelines, and target journal/national academic society involvement worth consideration among young trainees when making career decisions and plans.

P118 Drive-through phlebotomy - is this the future?

Background/AimsCentralised phlebotomy services have been an integral part of providing blood monitoring facility for people with chronic diseases prescribed vital therapies. However, the patient experience is not always optimal due to the issues of congestion, parking, long waiting times; this has been accentuated during COVID-19 pandemic with the need for minimising physical contact. In response to the growing pressure on phlebotomy service at our institution enhanced by the COVID-19 pandemic, our rheumatology service implemented a drive-through phlebotomy clinic to provide the option for patients and families to stay in their vehicles whilst having venepuncture.MethodsAt our large university teaching hospital, we set up a drive-through phlebotomy service provided by a senior HCA supervised by the lead nurse. Patients were identified from the departmental database and were offered the facility via telephone. Eligibility was assessed using a standardised proforma focusing on logistics such as ability to drive and access to a mobile phone. Appointments were scheduled in advance with patients choosing this care option. All the data was prospectively collated with patients’ consent and anonymised for analysis. In addition to demographics, diagnosis and drug record, duration of visit and patient feedback was collected.Results112 patients were offered the service during a 12-week pilot. Mean age of the participants was 49.5 yrs (19-91) with 73 (65%) women. 74 (65%) were of Caucasian and 28 (25%) of Asian origin. 94 (84%) had inflammatory arthritides and all were prescribed DMARDs and/or bone active agents. 69 (61%) had blood samples taken using this service. Most common reason to decline was an already arranged appointment with standard phlebotomy (n = 14, 12.5%). Six (5%) could not be bled due to difficult venepuncture. Mean duration of appointment was 12.5 mins (5-60). 68 (60%) provided feedback with 61 (90%) rating 5/5 and 60 (89%) rating it better than standard phlebotomy. All would like to have the option for future and 67 (98%) were highly likely or likely to recommend the service to family and relatives.ConclusionTo our knowledge, this is the first study to demonstrate the utility of drive-through phlebotomy for people with rheumatic diseases prescribed DMARDs. Excellent feedback of the participants confirms the need and desire for such innovation in health care. In post COVID-19 services reconfiguration, the availability of drive-through appointments and the close physical proximity to the clinic made it an appealing option for a vulnerable group of patients evidenced by their outstanding experience and feedback. Overall, an HCA-delivered, nurse-supervised drive-through pathway is highly effective, safe and provides an innovative solution to strained phlebotomy services.Disclosure J. Begum: None. M.K. Nisar: None.

Patient preferences for use of virtual consultations in an orthopaedic rehabilitation setting: Results from a discrete choice experiment.

ObjectiveVirtual Consultations may reduce the need for face-to-face outpatient appointments, thereby potentially reducing the cost and time involved in delivering health care. This study reports a discrete choice experiment (DCE) that identifies factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting.MethodsPrevious research from the CONNECT (Care in Orthopaedics, burdeN of treatmeNt and the Effect of Communication Technology) Project and best practice guidance informed the development of our DCE. An efficient fractional factorial design with 16 choice scenarios was created that identified all main effects and partial two-way interactions. The design was divided into two blocks of eight scenarios each, to reduce the impact of cognitive fatigue. Data analysis were conducted using binary logit regression models.ResultsSixty-one paired response sets (122 subjects) were available for analysis. DCE factors (whether the therapist is known to the patient, duration of appointment, time of day) and demographic factors (patient qualifications, access to equipment, difficulty with activities, multiple health issues, travel costs) were significant predictors of preference. We estimate that a patient is less than 1% likely to prefer a virtual consultation if the patient has a degree, is without access to the equipment and software to undertake a virtual consultation, does not have difficulties with day-to-day activities, is undergoing rehabilitation for one problem area, has to pay less than £5 to travel, is having a consultation with a therapist not known to them, in 1 weeks’ time, lasting 60 minutes, at 2 pm. We have developed a simple conceptual model to explain how these factors interact to inform preference, including patients’ access to resources, context for the consultation and the requirements of the consultation.ConclusionsThis conceptual model provides the framework to focus attention towards factors that might influence patient preference for virtual consultations. Our model can inform the development of future technologies, trials, and qualitative work to further explore the mechanisms that influence preference.

Digital approach to informed consent in bariatric surgery: a randomized controlled trial.

Informed consent is of paramount importance in surgery. Digital media can be used to enhance patient's comprehension of the proposed operation. The objective of this study was to examine the effects of adding a digital educational platform (DEP) to a standard verbal consent (SVC) for a laparoscopic Roux-en-Y gastric bypass (LRYGB) on patient's knowledge of the procedure, satisfaction with the clinical encounter and duration of the consent appointment. This prospective non-blinded randomized controlled trial allocated 51 patients, who were candidates for a LRYGB, into DEP+SVC (intervention, n = 26) or SVC (control, n = 25) groups. Data were collected at one Bariatric Centre of Excellence (Ontario, Canada) between December 2018 and December 2019. DEP consisted of a 29-slide video-supplemented module detailing the risks, benefits, expectations and outcomes for the LRYGB. Primary outcome was knowledge about the LRYGB operation following the consent discussion. Secondary outcomes were knowledge retention, patient satisfaction, and duration of time required to obtain an informed consent. Baseline demographic data were equivalent between groups except for a greater proportion of male patients in the DEP+SVC group (7/19 vs 0/25; p < 0.01). Baseline procedure-specific knowledge was equivalent between the groups (72.3 ± 11.3% vs 74.7 ± 9.6%; p = 0.41). Post-consent knowledge was significantly higher in the DEP + SVC vs SVC group (85.0 ± 8.8% vs 78.7 ± 8.7%; p = 0.01; ES = 0.72). The duration of time to obtain informed consent was significantly shorter for the DEP + SVC vs SVC group (358 ± 198sec vs 751 ± 212sec; p < 0.01; ES = 1.92). There was no difference in knowledge retention at 4-6weeks (84.4 ± 10.2% vs 82.9 ± 6.8%; p = 0.55) and in patient satisfaction (31.5 ± 1.1 vs 31 ± 2.7; p = 0.10). The addition of a DEP online module to a standard verbal consent for LRYGB resulted in improved patient's understanding of the procedure-specific risks and benefits, high patient satisfaction, and over 50% time savings for the bariatric surgeon conducting the consent discussion.

A randomised controlled clinical trial comparing the effectiveness of bandaging compared to the JuxtaCures™ device in the management of people with venous ulceration: Feasibility study.

The mainstay of treatment for venous ulceration remains compression therapy. Velcro Wrap devices are being increasingly used in these patients despite limited evidence. This feasibility study aimed to compare standard bandaging to the JuxtaCures™ Velcro wrap device. A single centre, unblinded RCT compared participants with venous ulceration randomised to either the JuxtaCures™ device or short stretch bandaging. Participants were followed up for 26 weeks. 160 participants were screened with 40 randomised. 3 participants in bandaging and 1 in JuxtaCures™ didn't complete the study. 60% in JuxtaCures™ healed v 55% in bandaging despite larger ulcers in the JuxtaCures™ arm (9.33 cm2 v 6.97 cm2). There was no significant difference in time to healing (12.17 v 13.64 weeks). JuxtaCures™ showed improved ulcer reduction for those that didn't heal (14.91-5.00 cm2 v 14.20-8.62 cm2; P = 0.06). JuxtaCures™ had more consistent sub-bandage pressure dropping from 39-36 mmHg versus 41-25 mmHg in bandaging between application and removal (P < 0.001). Quality of life (EQ5D) was improved in JuxtaCures at 3 months (mean difference 0.14, p = 0.04), but not at 1 and 6 months, or in disease specific quality of life. Cost was lower in JuxtaCures™ £842.47 v £1064.68. Duration of appointment was significantly shorter in JuxtaCures™ (41 minutes v 53 minutes; P = 0.003). This study has shown the feasibility and necessity of running a multicentre trial to evaluate the use of Velcro wrap devices for venous ulceration. It highlights the potential benefits of more consistent pressure, increased self-care, and potential with regards to ulcer healing, cost, nursing resource and quality of life.

Early Osia® 2 bone conduction hearing implant experience: Nationwide controlled-market release data and single-center outcomes

PurposeBone conduction hearing devices are a well-established treatment option for conductive or mixed hearing losses as well as single-sided deafness. The Osia® 2 System is an active osseointegrated device where a surgically implanted titanium fixture supports a newly developed piezoelectric actuator that is placed under the skin. MethodsNationwide data collected during a controlled-market release (CMR) of the Cochlear™ Osia® 2 System as well as outcomes at single, tertiary-level private practice Otology/Neurotology center were retrospectively reviewed. Key learnings from surgeons and audiologists are discussed. ResultsDuring the CMR period, 23 surgeons performed 44 operations on 43 recipients. The mean age of recipients was 44 years and mean surgery duration was 52 min. The most commonly used incision was postauricular but anterior to the device (78%). Five complications were observed during the CMR, none of which were device related. Twenty-one audiologists performed 33 Osia® 2 activations during the CMR. The mean age of this group was 47 years, and the mean duration of each activation appointment was 55 min. Single-center data at the authors' institution demonstrated an average additional PTA4 gain with the Osia® 2 patients of 9.6 dB compared to Baha Attract and 10.2 dB compared to Baha Connect. ConclusionThe Cochlear™ Osia® 2 System represents a significant advance in auditory osseointegrated implant technology. Digital piezoelectric stimulation delivers high power outputs, improves high frequency gain for optimal speech perception, and maintains safety while providing excellent patient satisfaction.

PREGNANCY AFTER IVF IN A PATIENT WITH SHERESHEVSKY-TURNER SYNDROME (clinical case)

Shereshevsky-Turner Syndrome (SJT) is caused by full or partial X-monosomy, presented in all or part of the cells of the body. For Shereshevsky-Turner syndrome, pronounced hormonal disorders are characteristic - these are primary ovarian, somatotropic, thyrotropic insufficiency, as well as defects of the cardiovascular and urinary systems. With the advent of ART, pregnancy has become more accessible for this category of patients, most often with a donor egg. In the available literature, it was not possible to find the exact information on the selection of progestogen support, duration of appointment, and term of withdrawal; therefore, the clinical case is presented below. In this case, we left high maintenance doses of progesterone, not only due to the use of ART, but also due to concomitant extragenital pathology, which leads to a decrease in all functions of the placenta, including endocrine.

Patients and doctors: what kind of changes in outpatient clinic services can be made in concert?

Abstract Background Search for possible improvements in outpatient clinic services is a key task for health care professionals worldwide. It is important to consider the satisfaction of the main participants in primary care: patients and doctors. If patients unsatisfied with primary care will not seek help again, this will reduce their life quality and life expectancy. Unsatisfied doctors will work not efficiently nor for a long time. The work is devoted to the search for possible factors, which change may affect the improvement of the situation in clinics in terms of both doctors and patients. Methods The opinions of 1672 patients of Krasnoyarsk outpatient clinics were investigated with the usage of semi-structured interviews. The opinions of 283 physicians of the city were collected using an anonymous questionnaire. Data were analyzed using SPSS 22 by the following methods (p &amp;lt; 0.05): descriptive statistics, U test, χ2-test. Results Coherence of doctors' and patients' opinions investigated in different ways such as primary care satisfaction, desirable main changes, optimal time, duration and structure of appointment, physician's mission, the possibilities of additional medical remote consultations and difficulties in doctors' access. At some points, the answers were consistent; at some, a compromise or new ways of the solutions were required. Conclusions Almost 61% of the doctors prefer morning work time (8-12 am) and 15.5% prefer work in the evenings (18-20 pm) while only 38.1% of patients can visit a doctor in the morning time and 39.5% in the evening. The main changes to be made according to the general opinion of doctors and patients is a reduction of a waiting time of doctors' appointment (38.1% and 38.5% respectively) and the creation of an electronic queue (26.5% and 30.5% respectively). Remote consultation service have to be organized for patients: phone service is more appropriate as for the doctors (30.5%) so as for the patients (34.7%). Key messages The reduction of a waiting time of doctors’ appointment, creations of an electronic queue and a remote consultation service have to be organized to improve primary care system. There is inconsistency in time preferences that have to be solved: doctors prefer to work in morning time and many patients can visit clinics only in the evenings.

A modified genetic algorithm for non-emergency outpatient appointment scheduling with highly demanded medical services considering patient priorities

This paper presents an optimization problem concerning the booking of non-emergency outpatient appointments, where a single machine (device) and limited medical staff are supposed to fulfill the medical requirements of a large number of waiting patients. A new mixed integer linear programming model is formulated, characterized by two main features: (1) the method applied to calculate the duration of every single appointment is based on patients’ particular therapy requirements and doctors’ operating speeds, where the duration of the appointments may be different; and (2) taking the priorities of patients into consideration as a key factor of scheduling in the form of the times they prefer to be booked. The proposed model is solved and evaluated using an exact solver on several small-scale numerical examples, and the optimal solutions show that the model is well-designed and accurate. For instances of larger scale, a genetic algorithm (GA) is used to solve them. The performance of the GA is analyzed by comparing it to the exact method using a set of defined examples. Results indicate that the GA performs satisfactorily within reasonable computational time.

Информационные системы в практике медицинской организации

Modern approaches in the provision of medical services, the need to comply with the procedures and standards of medical care imply the use of effective methods of managing the resources of the medical organization. It is these requirements that make it imperative to use automation systems in the work of medical organizations. In this study we proposed the experience of integrated use of information technologies in the activities of a medical organization and the assessment of obtained medical and socio-economic effects. Materials and methods.We used economic methods of evaluating the use of medical information systems in the medical organization. Results. The evaluation of the use of medical information systems in the medical organization showed medical and socio-economic effects in the form of an opportunity for employees to make optimal use of working hours, using unified directories developed by templates, automatically filling in model medical protocols; obtain statistical information on the number of provided services; a comprehensive approach to the write-off of consumable medical supplies; create standard documents with minimal time; prepare statements, conclusions, form a record in the outpatient card and, if necessary, an electronic prescription in the pharmacy. The duration of the doctor's appointment decreased by 50 % (from 30 minutes to 15-20 minutes), which made it possible to increase the number of served patients. Conclusion. The use of medical information systems ensures the medical organization and application of patients with the necessary social (in the form of ensuring the accessibility of medical services to more patients), medical (achieving high efficiency of medical services) and economic (cost reduction) effects.

High levels of socioeconomic deprivation do not inhibit patients’ communication of concerns in head and neck cancer review clinics

To examine associations between socioeconomic status and the extent to which patients with cancer of the head and neck expressed concerns to surgeons during routine follow-up clinics, we analysed audio recordings of 110 consultations with one consultant. We used the Verona Coding Definitions of Emotional Sequences (VRCoDES) to measure communication between the doctor and the patient, and grouped the English indices of multiple deprivation (IMD) 2015 scores into deciles to compare the VRCoDES with socioeconomic status. There were no significant correlations between IMD decile and the number and type of cues and concerns, or the type of response by the consultant, but there was a positive correlation between IMD decile and duration of appointment (r=0.288, p<0.01). When the duration of appointment was controlled for, there was a negative correlation between IMD decile and number of cues and concerns (r=−0.221, p<0.05). These findings question the assumption that socioeconomic status is associated with a patient’s willingness to express concerns. Shorter consultations suggest that less time is spent responding to their concerns or building a rapport. Clinicians might find it advantageous to adopt strategies that will improve their understanding of these patients and help them to communicate more effectively.

Lost in Interpretation: Effect of Video Remote Medical Interpretation on Duration of Appointment and Accuracy of Physician-Patient Communication

Lost in Interpretation: Effect of Video Remote Medical Interpretation on Duration of Appointment and Accuracy of Physician-Patient Communication

Lost in Interpretation: Effect of Video Remote Medical Interpretation on Duration of Appointment and Accuracy of Physician-Patient Communication

Purpose: Accurate medical interpretation services are essential for providing health care to the approximately 12 million U.S. children whose families primarily speak a non-English language at home. However, the additional time medical interpretation adds to appointments, as well as the variation in interpretation accuracy has yet to be thoroughly explored. This study has two primary aims: (1) to evaluate the time interpretation adds to patient care, and (2) to quantify translation errors made during medical interpretation within a controlled environment. Methods: Researchers scripted and simulated an appointment between a pediatrician and a parent of an infant with hyperbilirubinemia. A native Spanish-speaking member of the research team …

An Unfinished Puzzle.

An Unfinished Puzzle Christina Romo I have battled a number of health issues throughout my life—all of which I am asked to share whenever I see a new physician or specialist—but there is one section on every form that always gives me pause. In theory, it is the easiest section for me to complete, but emotionally, it serves as a reminder of the losses I have experienced. When I am asked to complete the same forms for my sons, that section becomes a source of guilt for me. Guilt over not knowing what I have passed on genetically to my sons. Guilt over not being able to protect or shield them from the losses I have experienced in life. When I meet with a physician or specialist for the first time, and upon reviewing my health history and lack of family medical history, the response is often the same. “I see you wrote ‘unknown’ in the Family Medical History section. Can you tell me about that?” “I don’t have knowledge of my family medical history because I was adopted.” “Oh.” Upon learning of my adoptee status, the exam room is often filled with a heavy and rather awkward silence. Some medical personnel seem less sure of themselves in that moment—not knowing what to say and seemingly frustrated over the fact that they caught this case that has now been complicated by the overwhelming unknowns. Some doctors insist on pressing me for more information, as though it is completely unfathomable to them that I would have no knowledge of my family medical history. Some doctors cannot seem to move on from that question fast enough and proceed to stare at my chart throughout the duration of my appointment, rather than make eye contact with me. The more adoption-competent doctors take my answer in stride and continue to treat me like a human being who deserves the same compassion, consideration, and medical care they offer to all of their patients. Though my lack of family medical [End Page 128] history is something I had no control over, it can sometimes feel as though I have done something wrong by existing as a complicated and unfinished puzzle in that space. In January of 2010, at the age of 28, I came down with strep throat, which is something I had never had before. It took a couple of visits with the doctor to treat, as I did not respond well to the medications prescribed. After successfully completing a round of antibiotics, I noticed that I still was not feeling well. I felt weak and achy, had low-grade fevers, and found it impossible to stay awake throughout the day. It eventually progressed to my barely being able to walk without the use of a cane. I also had a wheelchair for the days when I was too weak and in too much pain to walk at all. Throughout this period of deterioration that occurred over the course of a number of months, I was seeing my general practitioner and other specialists on an almost weekly basis while undergoing a seemingly endless series of tests. It felt like a seemingly endless battle for 3rd opinions and 4th opinions and any possible explanation as to why this was happening to me. I had stacks of medical records and was sure to bring symptom lists with me to every appointment. On many occasions, I would hear a specialist tell me that “this would be so much easier if [I] had [my] family medical history.” In the meantime, I was in a constant state of fatigue and excruciating pain, and I wasn’t receiving any course of treatment to combat the effects of the symptoms. Some physicians were sympathetic, while others treated me like I was an addict in search of pain meds and refused to believe there was anything wrong with me. The game changer happened when I developed a strange rash all over my body. The rash consisted of what appeared to be angry, red lesions and seemingly appeared out of the blue. A skin biopsy revealed traces of lupus. Armed with this information, my general practitioner was...

Know your medicine: A novel student-led community service learning program

IntroductionThe objective of this article is to describe the efforts of the student pharmacist organization called Know Your Medicine (KYM) as they conduct medication therapy management (MTM) for older adults and underserved communities. MethodsPatients brought medications, immunization records, and health concerns to KYM events during academic years 2012–2013 and 2013–2014. Student pharmacists performed health screenings, created personalized medication records (PMR), made recommendations, created personal action plans (PAP), and conducted follow-up phone calls. ResultsStudent pharmacists provided MTM services for a total of 107 patients. The mean duration of a KYM appointment was 62±21min, and student pharmacists provided a mean of 3.5±2.1 recommendations per patient. Patients had a mean age of 78±11 years, 4.5±3.2 disease states, 6.9±4.6 prescriptions, 1.9±1.9 OTC medications, and 2.8±2.6 vitamins or herbals. At the time of the follow-up phone call, a mean of 2.6±1.9 recommendations per patient had been followed. Discussion and conclusionsStudent pharmacists successfully implemented a new MTM program for older adults and underserved communities. This program can serve as an example of how other pharmacy colleges and schools might implement MTM training and real-world MTM experience for their student pharmacists.

PO-0044 A Review Of The Clinical Practice Of Paediatricians With Expertise In Cardiology (pecs) In The Uk: Abstract PO-0044 Table 1

Background Recently there have been significant developments in PEC training and service aims including the recognition of Paediatrician with Expertise in Cardiology Special Interest Group (PECSIG) by the RCPCH and British Congenital Cardiac Association (BCCA), the creation of an agreed SPIN-module training curriculum for PECs and the development of PEC-specific service standards by the BCCA. Aim To find out which clinical services are provided by PECs and to determine the extent of variability in their clinical practice. Methods An internet-based questionnaire was sent out via PECSIG and NICHe (Neonatologists with Interest in Cardiology and Haemodynamics) contact databases and an NHS directory. Non-responders were followed up via telephone. Results The response rate was 72% (129 of 179 hospitals). PECs carried out echocardiography in all hospitals in which they were employed (69%). Support for this service was provided by echo-technicians in 36% of hospitals and by neonatologists in 27%. PEC-led outpatient clinics were held at least fortnightly in 66% of hospitals. The mode duration of appointment for a new patient was 30 min (range 45 min) while for the follow-up appointment the mode was 20 min (range 45 min). Telemedicine facilities were established in only 45% centres, where sharing echocardiogram images via PACS was used most commonly. Conclusion There remains significant variation in PEC services especially regarding the frequency of clinics, the duration of appointments and telemedicine utilisation. It was reassuring to see a relatively high number of hospitals offering PEC-led echocardiography and other PEC service provision.

Breast screening assessment: the introduction of double consultant clinics

Background to the audit: Plans to extend the NHS Breast Screening Programme to a wider population will result in more patients being recalled to assessment clinic. To cope with increasing demand attempts must be made to maximise clinic efficiency without compromising care in this vulnerable patient group. Double consultant clinics have economic and clinical benefits over single clinics, this audit aims to show there is no negative impact on patients in terms of duration of clinic appointment or time spent awaiting preliminary results.

Perceptions of faculty development needs based on faculty characteristics

ObjectivesMany changes in pharmacy education have occurred in the past decade resulting in a need for faculty education. The increasing number of pharmacy schools, larger number of junior faculty, expanding use of technology in teaching, and the changing generation of pharmacy students has allowed educators to reassess their teaching practices. The purpose of this survey was to access faculty's preferences toward faculty development and determine needs based on faculty characteristics, including degree, rank, duration of appointment, and division. MethodsA survey was distributed to 58 faculty members at the School of Pharmacy. ResultsMore than half of the faculty responded to the survey (n = 34, 58%). Faculty members responded that their preferred needs for faculty development centered on teaching. Doctorate of Pharmacy faculty desired development in ability-based learning and establishing authority with students. New faculty members expressed a need for more instruction in manuscript writing and developing a research focus, while more experienced faculty members desired instruction in planning workshops and labs. Tenure track and nontenure track faculty had the most variability in their preferences toward faculty development. Tenure track faculty preferred more growth in the areas of research and development and nontenure track faculty desired more development relating to student issues. Both expressed a desire for more instruction in the areas of teaching. ConclusionsCharacteristics of faculty members should be analyzed when developing faculty development programs.

Cruise Medicine: The Dental Perspective on Health Care for Passengers During a World Cruise

Although more than 100 million passengers have taken a cruise since 1980, it is not known what dental treatment needs occur at sea. The routine dental documentation of a 2-month period at sea on a cruise ship carrying 1,619 passengers was analyzed. The subjects for the study were 57 passengers (3.5% of 1,619), with a mean age of 71 years (+/-9.8 y). Age, gender, number of natural teeth and implants, prosthetic status, diagnosis, treatment performed, percentage of emergency and routine procedures, number of appointments, duration of appointment, time since last visit to the dentist, and cabin category as indicator of socioeconomic status were extracted. Oral health-related quality of life (OHRQoL) was measured using the 14-item Oral Health Impact Profile. Passengers had a mean number of 20 natural teeth plus substantial fixed and removable prosthodontics. Emergency dental treatment accounted for 97% of the chairside time. The three most frequent emergency diagnoses were defective restorations (36%), pulpal disease (20%), and defective prosthesis and caries (both 11.5%). Common emergency therapies provided were complex surgical-prosthodontic rehabilitation, various endodontic treatments, and extractions. Per 1,000 persons/month, passengers required 21.6 emergency plus 2.5 routine appointments; 49% of passengers had seen a dentist within 3 months before going to sea. Passengers do attend their dentist for routine care/checkups before the voyage, yet experience complex dental emergencies. This is due to the presence of a high number of restorations that fail unexpectedly. Some failures are so severe that they would have forced the passenger to abort the cruise had there been no dental service available. The ease of access to quality dental care may explain the relatively low level of perceived problems as characterized by OHRQoL scores.

Using discrete choice experiments to go beyond clinical outcomes when evaluating clinical practice

This study builds on the results of a randomized controlled trial concerned with examining the effect of reducing waiting times on the health status of patients referred for non-urgent rheumatology opinion. No difference in clinical outcomes was found between a 'fast-track' and 'ordinary' appointment system. This suggests that rationing by waiting times is not detrimental to health. However, such an approach ignores the value patients attach to reducing waiting time. To estimate the monetary value of reducing waiting time, as well as changes in duration of appointment and the introduction of a pain management service, in the provision of rheumatology services. Discrete choice experiment (DCE). The main outpatient clinic of the rheumatology service for the Lothian and Borders region. 262 patients who had received a specialist rheumatology opinion--73 had received fast-track treatment, 65 standard care and 124 were non-trial patients. A response rate of 71% was achieved. Patients valued a 9-week reduction in waiting time at 131 pounds sterling. However, the introduction of a pain management service was valued at 209 pounds sterling. Thus, the latter is of more value to respondents. Evidence was also found of the internal consistency and theoretical validity of the DCE approach. The reduction of waiting times is a central plank of NHS policy. Whilst a reduction in waiting time is of value, a pain management service is of more benefit than a 9-week reduction in waiting time. DCE were shown to be a potentially useful technique for valuing different aspects of health care interventions.