Hospital-based Practice Research Articles

Analysis of the ESCRS calculator's prediction accuracy.

To evaluate prediction accuracy of formulas included in the ESCRS online intraocular lens (IOL) calculator using standard keratometry (K) or total keratometry (TK). Hospital-based academic practice. Retrospective case-series. 523 patients with cataract (523 eyes) were included in this study. The outcome measures were trimmed means of the spherical equivalent prediction error (SEQ-PE, trueness), precision and absolute SEQ-PE (accuracy) of all 7 formulas available on the ESCRS online IOL calculator, as well as mean (Mean-All) and median (Median-All) of the predicted SEQ refraction of all formulas. Subgroup analyses evaluated the effect of axial length on formula accuracy. Trimmed-mean SEQ-PE range of all formulas varied from -0.075 to +0.071 diopters (D) for K-based and from -0.003 to +0.147 D for TK-based calculations, with TK-based being more hyperopic in all formulas ( P < .001). Precision ranged from 0.210 to 0.244 D for both K-based and TK-based calculations. Absolute SEQ-PE ranged from 0.211 to 0.239 D for K-based and from 0.218 to 0.255 D for TK-based calculations. All formulas, including Mean-All and Median-All, showed high accuracy, with 84% to 90% of eyes having SEQ-PEs within 0.50 D.Myopic trimmed-mean SEQ-PEs significantly different from zero were observed in long eyes for Pearl DGS (-0.110 D, P = .005), Hill RBF (-0.120 D, P < .001), and Hoffer QST (-0.143 D, P = .001) and in short eyes for EVO 2.0 (-0.252 D, P = .001), Kane (-0.264 D, P = .001), Hoffer QST (-0.302 D, P < .001), Mean-All (-0.122 D, P = .038), and Median-All (-0.125 D, P = .043). Prediction accuracy of all ESCRS IOL calculator formulas was high and globally comparable. TK-based calculations did not increase prediction accuracy and tended toward hyperopia. Observations indicating formula superiority in long and short eyes merit further evaluation.

Exploring Research Trends on Digital Health in Nursing Science in Korea: A Topic Modeling Approach.

Digital health technology is utilized in contemporary nursing practice and education. This review explored the scope of digital health applications and major trends in nursing research involving digital health in Korea using topic modeling. Our analysis of data using the Latent Dirichlet Allocation model identified four distinct research topics: nursing education using digital technologies (35.17%), hospital-based nursing practice using digital technologies (19.88%), digital technologies for health education (25.75%), and development of digital technologies to support self-management of chronic conditions (19.20%). Our findings reveal trends, current issues, and gaps in digital health nursing research.

Knowledge about metabolic dysfunction-associated steatotic liver disease among the medical professionals from countries in the MENA region

Introduction and ObjectivesGiven the substantial burden of metabolic dysfunction-associated steatotic liver disease (MASLD), there is an urgent need to assess knowledge and awareness levels among physicians. We assessed MASLD knowledge among healthcare providers from Saudi Arabia, Egypt, and Türkiye. Materials and MethodsTwo global surveys containing 54–59 items assessed awareness and knowledge of MASLD/NAFLD- one was for hepatologists and gastroenterologists, and the second was for non-specialists (e.g. endocrinologists, primary care providers [PCPs], and other healthcare professionals). Data were collected using an electronic data collection form. Knowledge scores and variables associated with higher knowledge scores were compared across all specialties. ResultsA total of 584 physicians completed the survey (126 hepatologists, 178 gastroenterologists (GEs), 38 endocrinologists, 242 PCPs/others). Practice guidelines were the primary source for knowledge across all specialties (43–51%), then conferences (24–31%) except PCPs/others who selected the internet as the second common source (25%). Adherence to societal guidelines varied by specialty (81–84% of specialists vs 38–51% of non-specialists). Hepatologists and GEs showed similar mean knowledge scores (51–72% correct answers across three knowledge domains, p > 0.05); endocrinologists outperformed PCPs/others in knowledge scores in all knowledge domains, including Epidemiology/Pathogenesis (72% vs. 60%), Diagnostics (73% vs. 67%), and Treatment (78% vs. 67%) (all p < 0.01). Hospital-based practice and seeing a greater number of patients with MASLD/NAFLD were identified as independent predictors of higher knowledge scores among specialists (both p < 0.05). ConclusionsA knowledge gap in the identification, diagnosis, and management of MASLD/NAFLD was found despite the growing burden of MASLD/NAFLD in Saudi Arabia, Egypt, and Türkiye. Education to increase awareness is needed.

Practice Patterns and Barriers to Vascular Genetic Testing Among Vascular Surgeons

Engaging patients living with or at risk of aortic dissection via the Aortic Dissection Collaborative, physician education in vascular genetics was identified as a research priority. We surveyed vascular surgeons to characterize practice patterns, motivations, and barriers regarding aortopathy genetic testing. An anonymous 27-question survey was distributed on social media platforms between November and December 2022. Domains included demographics, vascular genetic education, testing attitudes and utilization, and experience in treating patients with genetic vascular aortopathies. The analysis included summary statistics and unpaired t-test to compare responses by interest in incorporating testing and practice type. A total of 171 vascular surgeons from 15 countries responded to the survey (23% trainees). Over half received vascular genetics education during training (59%), and most (86%) were interested in incorporating genetic testing into their practice. Academic surgeons were more likely to have cared for a patient with a known genetic aortopathy over the past year than surgeons in hospital-based and private practices (83% vs. 56% vs. 27%; P<0.01), to have ever made a referral to a medical geneticist (78% vs. 51% vs. 9%; P<0.01), and have access to genetic counselors or geneticists (66% vs. 46% vs. 0%; P<0.01). Barriers to genetic testing were rated as more significant by surgeons in nonacademic practices, with top barriers being insurance coverage of testing, cost of genetic testing, and access to genetic counselors. Evidence-based professional society guidelines were the strongest rated motivating factor for testing incorporation among respondents. Vascular surgeon attitudes are not major barriers to incorporating genetic testing for patients with aortopathies; however, practical challenges regarding genetic testing and counseling are barriers to implementation especially for vascular surgeons in nonacademic practices. Future efforts should focus on evidence-based society guidelines, continuing medical education to increase adoption, and facilitating access to genetic counseling.

Transitioning from Hospital-based to Office-Based Practice

The decision to change your career path from a hospital-based practice, whether it's from being a hospital employee or a member of a private practice, can be an emotionally draining choice that is complex and overwhelming to say the least. There are many factors to consider before making this switch, but most importantly, one must realize it may be the hardest but most rewarding work in your career. While the physical, emotional and financial stresses placed on you while developing a practice can be rather demanding, on the flip side, if done correctly and the practice thrives, it can be a change that will bring you great pride and satisfaction, as well as personal reward and freedom.

Bringing social accountability education into hospital-based clinical practice.

How can social accountability education be made relevant for hospital‐based practice? Shah et al. address this question by exploring the dichotomy between primary/community and secondary care.

Use of Knowledge Translation Action Framework to Improve Physical Therapy Rehabilitation Outcomes in Concussion Management.

Translating new evidence into clinical practice is a dynamic and iterative process. Research is ever evolving specific to concussion rehabilitation and requires a systematic approach rooted in science for translation into clinical practice. The knowledge-to-action (KTA) cycle framework is an effective strategy to ensure optimal outcomes and sustainability. The objective of this study was to investigate changes in clinical outcomes and clinician self-efficacy specific to concussion management in a suburban health care system utilizing the KTA framework. Pretraining and posttraining intervention study. Rehabilitation professionals were electronically surveyed pre-post targeted concussion educational intervention. Questions were adapted from the General Self-Efficacy scale and tailored specifically to confidence in current concussion management. Retrospective chart reviews were also completed pre-post knowledge translation educational intervention to examine practice patterns. Data from the presurvey and retrospective chart review were utilized to identify the know-do gap and design intentional educational interventions. Statistical analysis was performed utilizing SPSS (version 28). Within-group differences revealed an increase in confidence with evaluation (P = .01), intervention (P = .01), and consultation (P = .01) in concussion management. When comparing physical therapists who participated in the intervention with those who did not, there was significantly higher self-confidence in all areas (P ≤ .001) for those who engaged in the educational intervention. Pre-post chart reviews revealed improvement in clinical practice patterns in the following constructs: use of patient-reported outcome measures (P ≤ .001), objective outcome measures (P = .002), exertional testing (P ≤ .001), completion of comprehensive evaluation (P ≤ .001), and use of evidence-based practice (P ≤ .001). Utilizing the KTA framework resulted in improved self-efficacy of clinicians as well as improved clinical practice patterns in concussion management in an outpatient hospital-based practice. The KTA framework is a potential tool for translating current evidence related to concussion management for improved clinical outcomes.

Trends in engagement with cognitive-behavioral therapy for chronic pain conditions after referral.

Cognitive-behavioral therapy for chronic pain (CBT-CP) is an important evidence-based non-pharmacologic treatment for chronic back and neck pain that is frequently recommended as a component of multidisciplinary treatment. However, the success of CBP-CP's implementation in clinical settings is affected by a variety of poorly understood obstacles to patient engagement with CBT-CP. Expanding upon the limited prior research conducted in heterogeneous practice settings, this study examines patterns of treatment initiation for CBT-CP at an interdisciplinary, hospital-based chronic pain practice and conducts exploratory comparisons between groups of patients who did and did not engage in CBT-CP after receiving a referral. Patients' descriptive data, including pain severity, work status, prior therapy, and behavioral health questionnaire scores at intake visit, were obtained through a retrospective chart review of electronic medical records. Data were then analyzed using inter-group comparisons and logistic regression modeling to determine factors that predicted treatment initiation for CBT-CP. On multivariate analysis, we found that patient's depression level as measured by their Patient Health Questionnaire 9 (PHQ-9) score was solely predictive of treatment initiation, as chronic pain patients with a higher level of depression were found to be more likely to attend their recommended appointments of CBT-CP. Anxiety score as measured by GAD-7, work status, pain scores, and prior therapy engagement were not independently predictive. No single "profile" of patient-level factors was found to delineate patients who did and did not initiate CBT-CP, demonstrating the limitations of clinical variables as predictors of uptake.

Role of primary care for individuals with childhood-onset neurologic conditions

BackgroundIndividuals with childhood-onset neurologic conditions often face challenges in the pediatric-to-adult health care transition (HCT). Furthermore, the importance of implementing primary care is unrecognized. We investigated the situation of adults with childhood-onset neurologic conditions from the perspective of health care professionals (HCPs) in community- and hospital-based primary care practice. Design and methodsOverall, 1334 HCPs in medical facilities across Tokyo (mainly in Kita, Nerima, and Itabashi Cities) were surveyed regarding their experience caring for adults with childhood-onset neurologic conditions. Snowball sampling was also deployed to enhance the input from various health professions. The questionnaire included quick response codes linked to web-based questionnaires identical to paper-based ones, enabling additional HCPs to answer the questionnaire. The survey included questions about the care provided by HCPs, the perceived challenges and worthwhileness of the care, and their views on HCT. ResultsWe collected 276 responses (response rate, 20.7%): 224 by mail and 52 online. In total, 94 HCPs of the respondents (75 doctors, 11 nurses, 5 therapists, 2 care workers, and 1 medical social worker) involved in caring for this population were analyzed. Doctors and nurses managed medical devices, educated patients, and provided consultation and care. Doctors cited the management of comorbidities outside of their expertise and difficulties securing hospitalization during emergencies as barriers to care. HCPs found the valuable opportunities to enrich their clinical experience and long-term relationships with patients worthwhile. HCPs expressed the need for systems that guarantee patient hospitalization and multidisciplinary conferences between HCPs and specialists. ConclusionWe described the roles of HCPs in community- and hospital-based primary care, which are vital components of HCT for adults with childhood-onset neurologic conditions. Their practice includes multidisciplinary involvement, patient education, and care coordination. For better HCT in this population, efforts are required to enhance HCPs’ capability to respond to patients with disabilities, patients’ multiple comorbidities, and families’ needs. Practice implicationsFurther efforts to deepen community-based care are desired to improve HCT for people with childhood-onset neurologic conditions.

Unlocking the learning potential of simulation-based education.

Simulation is ubiquitous in the training of hospital-based doctors worldwide, often focusing on an individual level in traditional 'skills and drills'-based training. However, there has been an expansion in the use of simulation in healthcare practice and training. Simulation is being adopted into many disciplines that traditionally have not used this form of experiential learning. Moreover, simulation is increasingly being harnessed to enhance team and organisational learning in hospital-based practice. This article shares some insights into simulation-based education and makes the 'familiar unfamiliar' about this important method of learning. The aim is to broaden readers' outlook about what simulation has to offer beyond the classic notion of skills and drills-based training.

Enhanced Support Services Including Nurse Navigation Mitigate Socioeconomic Disparities in the Treatment of Patients with Acute Lymphoblastic Leukemia

Background: Despite recent advances in therapy (especially in the pediatric population), the treatment of acute lymphoblastic leukemia (ALL) in adult patients remains extremely challenging with only an estimated 30-40% of patients achieving long-term remission. Therefore, it is imperative to identify barriers that may impact delivery of therapy and lead to disparities of outcomes. One area of concern that has been consistently identified is the impact of socioeconomic disparities on the delivery of care. The primary objective of this study is to determine whether increased neighborhood socioeconomic disadvantage as measured by the Area Deprivation Index (ADI) impacts overall survival (OS) in patients with ALL. Methods: All patients who presented to the Levine Cancer Institute, a tertiary hospital-based specialty practice, from January 1, 2016 to December 31, 2022 were eligible for inclusion. Patients were included for final analysis if they were aged ≥ 18 years, and had a verified new diagnosis of ALL. All patients received supportive care per institutional standards including nurse navigation, social work, and financial counseling with referral to Financial Toxicity Tumor Board if indicated. Patient demographic, treatment, and disease characteristics were summarized with frequencies (and percentages) or medians (and ranges). Correlation between national and state ADIs were assessed with Spearman's rank correlation coefficient. National and state ADI were analyzed as continuous ranks and as quartile (median for both national and state ADI; quartiles for national ADI). Kaplan-Meier methods were used to summarize OS and estimate landmark survival rates. Cox proportional-hazards models estimated hazard ratios and 95% confidence intervals associated with ADI. Multivariable models with adjustments for clinical covariates included age at diagnosis, risk group, and treatment received (including Oncology Nurse Navigation [ONN] services). Results: A total of 100 patients were found to meet criteria for inclusion. Specific characteristics of the analyzed population are listed in Table 1. The population had a median age of 54 years and were primarily treated per three treatment paradigms (standard adult intensive (57%), pediatric-based (14%), and reduced-intensity (28%)). Overall median follow-up (95% CI) was 52.2 months (44.1, 55.5) with a median OS of 51.4 months (25.3 to non-estimable) and median relapse free survival (RFS) of 22.8 months (17.0 to 35.7). When dichotomized by median ADI, there was no significant difference in patient characteristics in the two groups including age, gender, race/ethnicity, ALL type, insurance type, induction regimen, and receipt of ONN services. In univariate modeling, ADI as a continuous variable was not found to be associated with OS (HR 1.01; 95% CI 0.99-1.02, P=0.321) or RFS (HR 1.01; 95% CI 0.99-1.02, P=0.288). This lack of association remained true when dichotomized by median ADI into high and low ADI areas (OS HR 1.01; 95% CI 0.58-1.79, P=0.966; RFS HR 1.17; 95% CI 0.70-1.94, P=0.552), as well as by splitting ADI into quartiles (Figure 1). A multivariate model including age at diagnosis, ALL type, ONN services received, and treatment regimen similarly showed no association between ADI and OS (p=0.221) and RFS (p=0.453). Of particular interest is the high extent of navigation services received in this population (62.8% of patients in areas of less disadvantage, and 73.5% of patients from areas of higher disadvantage). Patients who received navigation services also appeared to be a higher risk population, as multi-variable modeling confirmed both decreased OS (HR 2.11; 95% CI 1.12-4.00, P=0.023) and RFS (HR 2.08; 95% CI 1.17-3.71, P=0.012) when compared to those who were not deemed by the nurse navigators to need this service. Conclusions: Contrary to larger database derived studies, patients with ALL treated at our center did not show differences in OS or RFS when compared by neighborhood disadvantage. This is likely a consequence of the strong support systems available at this institution in nurse navigation and financial toxicity related programs which help mitigate some of the risk factors for disparate outcomes. These findings should be validated in a larger cohort with prospective data with a particular focus on designing sustainable and realistic options to be utilized at community-based and underserved systems.

Completion of Recommended Tests and Referrals in Telehealth vs In-Person Visits

Use of telehealth has increased substantially in recent years. However, little is known about whether the likelihood of completing recommended tests and specialty referrals-termed diagnostic loop closure-is associated with visit modality. To examine the prevalence of diagnostic loop closure for tests and referrals ordered at telehealth visits vs in-person visits and identify associated factors. In a retrospective cohort study, all patient visits from March 1, 2020, to December 31, 2021, at 1 large urban hospital-based primary care practice and 1 affiliated community health center in Boston, Massachusetts, were evaluated. Prevalence of diagnostic loop closure for (1) colonoscopy referrals (screening and diagnostic), (2) dermatology referrals for suspicious skin lesions, and (3) cardiac stress tests. The study included test and referral orders for 4133 patients (mean [SD] age, 59.3 [11.7] years; 2163 [52.3%] women; 203 [4.9%] Asian, 1146 [27.7%] Black, 2362 [57.1%] White, and 422 [10.2%] unknown or other race). A total of 1151 of the 4133 orders (27.8%) were placed during a telehealth visit. Of the telehealth orders, 42.6% were completed within the designated time frame vs 58.4% of those ordered during in-person visits and 57.4% of those ordered without a visit. In an adjusted analysis, patients with telehealth visits were less likely to close the loop for all test types compared with those with in-person visits (odds ratio, 0.55; 95% CI, 0.47-0.64). The findings of this study suggest that rates of loop closure were low for all test types across all visit modalities but worse for telehealth. Failure to close diagnostic loops presents a patient safety challenge in primary care that may be of particular concern during telehealth encounters.

Abstract 18955: Post Webinar Survey Responses Regarding Maternity and Legal Rights for Cardiologists

Introduction/Background: Women are under-represented in cardiology and cardiology subspecialties. Work life challenges are often a stated reason why women do not choose cardiology. Pregnancy and motherhood represent a time of significant challenges to women in cardiology due to lack of support and discrimination. The American Heart Association (AHA)Women in Cardiology (WIC) Committee recently held a case-based webinar to increase awareness about the issues, discuss available resources for support, and understand laws protecting women against discrimination. Goals/Aims: The goal of the survey was to understand the current landscape of perceived institutional support during the maternity period and gauge awareness of the laws protecting women against discrimination. Methods/Approach: After the webinar, an email survey was sent to all those who registered on behalf of the AHAWIC Committee within 7days of the event. Results/Data: There were 189registrants for the webinar, of which 29(15%)responded to the survey. Of those who responded, 72%were female, 48%were &lt;40years of age, 33%of the attendees were mothers, and 20%reported fertility issues. Almost all respondents reported working in a hospital-based practice (90%),59%were attending physicians and 38%were trainees. Only 28%reported that their work environment was very supportive of mothers and only 31%were aware of maternal legal rights in the workplace. After the webinar, 76%planned to learn or implement new maternal rights related policies in their workplace (Figure 1). Conclusions: Pregnancy and motherhood represent a challenging time in the career of a female cardiologist or trainee. Perceived support in the workplace is low. Very few women know their legal rights, but a majority had a plan to learn more after the webinar. This survey highlights opportunities for the cardiology community and national societies to help support women cardiologists.

Understanding functional dyspepsia and its subtypes and the role of prokinetics in its management: a cross-sectional clinician-based survey

Background: This survey evaluated opinions of consulting physicians or gastroenterologists on functional dyspepsia (FD) in the Indian population and the management of FD with prokinetics, especially itopride. Methods: A total of 243 clinicians involved in the clinical practice of FD were invited to complete an internet-based, structured survey questionnaire. Questionnaire comprised 29 questions on the diagnosis and treatment options for FD. Results: Majority of the clinicians opined that females were more affected by FD than males in both hospital-based (53.4%) and community-based (56.6%) practices. As per 33.3% of clinicians each, the age group of 21-40 years and 41-60 years were the two most commonly affected groups. FD symptoms were present for &gt;6 months before patients seek consultation as reported by 62.6% of the clinicians. The participating clinicians preferred using detailed patient history (77.7%) and ROME IV criteria (71.1%) for diagnosing FD. Prokinetics were regarded as the therapy of choice primarily because of their efficacy in reducing FD symptoms. Among all prokinetics used, itopride was most preferred for postprandial distress syndrome (64.2% clinicians) and for epigastric pain syndrome in combination with PPIs (66.7% clinicians). Itopride was reported by 93.6% clinicians to be well tolerated, with the leading advantage being absence of extrapyramidal or cardiac side effects according to 40% of clinicians. Conclusions: The clinicians considered itopride to be most preferred to reduce FD symptoms and to be well-tolerated when taken alone or in combination with PPIs.

10044 Financial Implications of Offering Office Hysteroscopy in a Single Hospital-Based Gynecology Practice

10044 Financial Implications of Offering Office Hysteroscopy in a Single Hospital-Based Gynecology Practice

Cost Analysis of MR-Guided vs. CT-Guided Radiation Therapy for Locally Advanced Pancreatic Cancer

Stereotactic magnetic resonance guided on-table adaptive radiotherapy (SMART) is an increasingly utilized radiotherapy (RT) treatment for locally advanced pancreatic cancer (LAPC), providing improved local control and overall survival with reduced toxicity. Computed tomography (CT) guided RT options include stereotactic body radiotherapy (SBRT) and hypofractionated RT with volumetric modulated arc therapy (VMAT). Currently there are no financial comparisons for MR vs CT-guided RT for LAPC. We completed a cost analysis comparing the physician and hospital charges associated with RT options for LAPC. To compare RT costs, we identified Current Procedural Terminology (CPT) codes utilized for 5-fraction SMART with adaptation (50 Gy, biological effective dose (BED) 100 Gy), 5-fraction CT-guided SBRT (33 Gy, BED 55 Gy), and 15-fraction CT-guided hypofractionated VMAT (67.5 Gy, BED 98 Gy) in a hospital-based practice setting. Physician and hospital Medicare prices associated with these codes together summarize the overall cost. We determined physician fees using the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule Search to search the Healthcare Common Procedure Coding System (HCPCS) for "professional" costs included within "facility" costs. We determined hospital fees using the Outpatient Prospective Payment System addendum. To standardize costs, we searched for national payment amounts for the 2022 calendar year. Total cost of SMART with adaptation was 136% higher than the cost of CT-SBRT and 149% higher than the cost of hypofractionated RT. Physician fees for SMART were 173% higher and 157% higher than the fees for CT-SBRT and hypofractionated RT, respectively. Hospital fees for SMART were 129% higher and 147% higher than the fees for CT-SBRT and hypofractionated RT, respectively. The total cost of CT-SBRT was only 5% higher than cost of hypofractionated RT. The physician fees for hypofractionated RT were 6% higher than those for CT-SBRT, while the outpatient fees for CT SBRT were 7% higher than those for hypofractionated RT. With recent data demonstrating favorable efficacy and toxicity rates for SMART, practices may increasingly consider investing in this treatment modality. This is the first cost analysis comparing SMART to CT-guided SBRT and hypofractionated RT in LAPC. We demonstrate higher costs of SMART compared to CT-guided RT, attributable primarily to higher number of dosimetry calculations for this modality and for adapted fractions. We also demonstrate comparable costs of lower BED CT-guided SBRT and higher BED hypofractionated RT. Further investigation is needed to assess whether the survival benefit of SMART translates to favorable cost per quality adjusted life year.

Long term adherence to continuous positive Airway pressure in mild obstructive sleep apnea

BackgroundStudies have shown that a significant percentage of patients with obstructive sleep apnea (OSA) do not tolerate continuous positive airway pressure (CPAP) therapy and long-term use may be as low as 30%. Given the lower levels of symptoms and health-related risks, patients with mild sleep apnea may be at even higher risk for non-adherence to long term CPAP. The purpose of our study was to investigate the prevalence and associations of long-term CPAP adherence in first time users with mild sleep apnea diagnosed by home sleep apnea testing (HSAT).MethodsWe identified all the patients who were diagnosed with mild sleep apnea (5 = < AHI < 15) by home sleep apnea testing from 01/2013 to 06/2019 at a large, combined community and hospital-based sleep practice. Only first time CPAP users were included. Compliance was defined as CPAP usage ≥ 4 h per night on ≥ 70% of nights over 30 consecutive days. We defined long term adherence as compliance on the 12th month following CPAP set up. Patient demographics, comorbidities, and CPAP compliance at 1st, 3rd, 6th, 9th and 12th month after therapy initiation were collected. We compared and identified the factors that had significant difference (P < 0.1) between compliant and non-compliant groups at the 12th month.Results222 patients were included in the analysis. 57 (25.7%) patients were adherent with long term CPAP treatment. The following factors were associated with a greater likelihood for long-term CPAP adherence: older age, lower body mass index (BMI), presence of a bed partner, non-smoker, presence of Diabetes Mellitus (DM), presence of Heart Failure (CHF), lack of depression, and compliance at 1st, 3rd, 6th and 9th month.ConclusionsLong term CPAP compliance in mild sleep apnea patients is low. Long term adherence to CPAP can be predicted based on CPAP adherence during the first three months.

A Primer on Gene Editing.

Gene editing-based therapies are currently in development in the areas of oncology, inherited disease, and infectious disease. These potentially life-altering therapies are derived from decades of research in both academic and industry settings that developed technologies rooted in principles and products of nature. However, with such technologic developments come many important considerations, including adverse risks, high cost, and ethical questions. To educate pathologists about gene editing technologies, inform them of potential indications and risks, outline regulatory and practical issues that could affect hospital-based practice and laboratory testing, and advocate that pathologists need to be present at discussions among industry and regulators pertaining to gene editing-based therapies. A Gene Editing Workgroup, facilitated by the College of American Pathologists Personalized Health Care Committee and consisting of pathologists of various backgrounds, was convened to develop an educational paper to serve as a stimulus to increase pathologist involvement and inquiry in gene editing therapeutic and diagnostic implementation. Through multiple discussions and literature review, the workgroup identified potential gaps in pathologists' knowledge of gene editing. Additional topics that could impact pathology and laboratory medicine were also identified and summarized in order to facilitate pathologists as stakeholders in gene editing therapy administration and monitoring and potential use in diagnostics. Gene editing therapy is a complex but potentially transformative area of medicine. This article serves as an introduction to pathologists to assist them in future discussions with colleagues and potentially identify and alter pathology practices that relate to gene editing.

Identifying discrepancies between clinical practice and evidence-based guideline in recurrent pregnancy loss care, a tool for clinical guideline implementation

BackgroundPractice variation in recurrent pregnancy loss (RPL) care is common. International guidelines vary in their recommendations for the management of RPL couples, which could lead to an increase of cross border reproductive care. Currently, the Dutch RPL guideline is being adapted from the European Society for Human Reproduction and Embryology (ESHRE) guideline. We aim to identify discrepancies between RPL guidelines and RPL practice. These discrepancies could be considered in the development of a new guideline and implementation strategies to promote adherence to new recommendations.MethodsA nationwide survey on the management of RPL patients was conducted across all 107 hospital-based obstetrics and gynaecology practices in the Netherlands. The survey was sent via the Dutch Society for Obstetricians and Gynaecologists to all affiliated clinicians. The questionnaire consisted of 36 questions divided in four sections: clinician’s demographics, RPL definition, investigations and therapy. The data were compared to the recommendations given by the Dutch national guideline and the most recent guideline of the ESHRE.ResultsAll hospital-based practices (100%; n = 107) filled in the online questionnaire. The majority of respondents defined RPL similarly, as two or more pregnancy losses (87.4%), not obligatory consecutive (93.1%). More than half of respondents routinely perform thrombophilia screening ( 58%), although not advised by the ESHRE, while thyroid function (57%), thyroid auto-immunity (27%) and β2-glycoprotein antibodies (42%) in the context of antiphospholipid syndrome (APS) are recommended but investigated less often. Regarding parental karyotyping, 20% of respondents stated they always perform parental karyotyping, without prior risk assessment. because of RPL. Treatment for hereditary thrombophilia was frequently (43.8% (n = 137)) prescribed although not recommended. And finally, a considerable part (12–16%) of respondents prescribe medication in case of unexplained RPL.ConclusionWhile many clinicians perform investigations recommended by the ESHRE, there is a considerable variation of RPL practice in the Netherlands. We identified discrepancies between RPL guidelines and RPL practice, providing possibilities to focus on multifaceted implementation strategies, such as educational intervention, local consensus processes and auditing and feedback. This will improve the quality of care provided to RPL patients and may diminish the necessity felt by patients to turn to multiple opinions or cross border reproductive care.

Utilization pattern of prophylactic measures for prevention of post-ERCP pancreatitis: a National Survey Study.

Post-ERCP pancreatitis (PEP) is the most frequent adverse event of ERCP. Various prophylactic measures are endorsed by the American Society for Gastrointestinal Endoscopy and the European Society of Gastrointestinal Endoscopy to both lower the incidence of PEP and to decrease its severity. The extent to which these interventions are practiced throughout the United States is unclear. The aim of this study was to describe the utilization pattern of various PEP measures and determine factors that affect utilization of these measures. A 27-question electronic survey was distributed using a cloud-based program (Qualtrics). The questions assessed ERCP training, practice setting, experience, practice patterns, and perceptions for PEP prophylaxis interventions. Endoscopists with practices based in the United States listed in the American Society for Gastrointestinal Endoscopy member directory received a survey invitation via e-mail. The invitation outlined the study and contained a link with instructions to complete the voluntary survey if they had an active ERCP practice. Data were de-identified for the purposes of analysis. Of survey respondents (N= 319), 46% reported therapeutic endoscopy fellowship training and 37% practiced in teaching programs. Annualized ERCP volume of >100 cases per year were reported by 47%, with pancreatic ERCP comprising≤5% of procedure volume reported by the majority of respondents (61%). The majority of respondents used prophylactic pancreatic stent (PPS), and 54% reported frequent use during high-risk ERCP. The most common indications for PPS were difficult cannulation, to assist biliary access, and multiple pancreatic duct injections. Most respondents reported frequent use of indomethacin (89%). Of physicians who did not use PPS, use of indomethacin was the most common reason (80%). Variables associated with frequent use of PPS were ERCP fellowship training (P≤ .001), practice at a teaching program (P≤ .001),<10 years in practice (P= .005), higher procedure volume (P≤ .001), and higher proportion of pancreatic cases (P≤ .001). Physicians with higher annual ERCP volume, who teach at hospital-based ERCP practices, and who regularly perform pancreatic ERCP are more likely to use PPS. Therapeutic ERCP fellowship training and recent entry into practice were also associated with PPS utilization. Indomethacin use seems to be more frequent than PPS. Our findings suggest that indomethacin is supplanting PPS as the preferred method of PEP prophylaxis.