Identify Practice Patterns Research Articles

Maximizing metastatic breast cancer therapy selection: Physician practice patterns and competence assessment.

127 Background: Due to the volume and pace of scientific advances within oncology, peer discussion and professional reflection regarding appropriate therapeutic decision making is necessary to provide the highest quality patient care. Increasing awareness in the breast cancer community of similarities and differences amongst practice management strategies helps to identify and benchmark individual practice patterns against one’s professional peers, ultimately leading to increased competence in therapy selection. Methods: During 2011 and 2012, educational outcomes assessments were gathered during 85 independent continuing medical education (CME) activities held within community practices and institutions across the USA. Participants were asked a series of case-based questions via an audience response system to assess baseline knowledge, competence, and identify practice patterns. Assessments were repeated post a 1-hour CME certified activity, with an additional 6-week electronic follow-up. Results: To date, over 330 physicians have participated in the program. Number of years in practice ranged from < 10 to > 30. The number of breast cancer patients seen per month ranged from ≤ 10 to > 40. Provider competency and preferences in applying guideline based therapy was assessed. Results of participant preferences including single-agent, combination, first-line, and second-line therapy preferences as well as toxicity management for select patient case scenarios in advanced breast cancer will be presented. Self-rated competence for the physician audience improved by approximately 50% as a result of participation. Conclusions: The results highlight the diversity of clinical opinion in selecting therapy for advanced breast cancer and need for continued dialogue and scientific advancement. Education and peer discussion of how to optimize translation of new scientific information into patient care contributes to maximizing physician competence in therapy selection for metastatic breast cancer.

Security practices and regulatory compliance in the healthcare industry

Securing protected health information is a critical responsibility of every healthcare organization. We explore information security practices and identify practice patterns that are associated with improved regulatory compliance. We employed Ward's cluster analysis using minimum variance based on the adoption of security practices. Variance between organizations was measured using dichotomous data indicating the presence or absence of each security practice. Using t tests, we identified the relationships between the clusters of security practices and their regulatory compliance. We utilized the results from the Kroll/Healthcare Information and Management Systems Society telephone-based survey of 250 US healthcare organizations including adoption status of security practices, breach incidents, and perceived compliance levels on Health Information Technology for Economic and Clinical Health, Health Insurance Portability and Accountability Act, Red Flags rules, Centers for Medicare and Medicaid Services, and state laws governing patient information security. Our analysis identified three clusters (which we call leaders, followers, and laggers) based on the variance of security practice patterns. The clusters have significant differences among non-technical practices rather than technical practices, and the highest level of compliance was associated with hospitals that employed a balanced approach between technical and non-technical practices (or between one-off and cultural practices). Hospitals in the highest level of compliance were significantly managing third parties' breaches and training. Audit practices were important to those who scored in the middle of the pack on compliance. Our results provide security practice benchmarks for healthcare administrators and can help policy makers in developing strategic and practical guidelines for practice adoption.

National Trends in Rotator Cuff Repair

Recent publications suggest that arthroscopic and open rotator cuff repairs have had comparable clinical results, although each technique has distinct advantages and disadvantages. National hospital and ambulatory surgery databases were reviewed to identify practice patterns for rotator cuff repair. The rates of medical visits for rotator cuff pathology, and the rates of open and arthroscopic rotator cuff repair, were examined for the years 1996 and 2006 in the United States. The national incidence of rotator cuff repairs and related data were obtained from inpatient (National Hospital Discharge Survey, NHDS) and ambulatory surgery (National Survey of Ambulatory Surgery, NSAS) databases. These databases were queried with use of International Classification of Diseases, Ninth Revision (ICD-9) procedure codes for arthroscopic (ICD-9 codes 83.63 and 80.21) and open (code 83.63 without code 80.21) rotator cuff repair. We also examined where the surgery was performed (inpatient versus ambulatory surgery center) and characteristics of the patients, including age, sex, and comorbidities. The unadjusted volume of all rotator cuff repairs increased 141% in the decade from 1996 to 2006. The unadjusted number of arthroscopic procedures increased by 600% while open repairs increased by only 34% during this time interval. There was a significant shift from inpatient to outpatient surgery (p < 0.001). The increase in national rates of rotator cuff repair over the last decade has been dramatic, particularly for arthroscopic assisted repair.

Inferior Turbinoplasty during Cosmetic Rhinoplasty

BACKGROUND The sheer number of accepted inferior turbinoplasty techniques emphasizes the fact that there is no general agreement on which approach yields optimal results, nor are there data available that describes prevalent techniques in turbinate surgery among plastic surgeons. OBJECTIVE The aim of this study was to identify practice patterns among plastic surgeons who perform inferior turbinoplasty during rhinoplasty. METHODS Members of the American Society of Plastic Surgeons were invited to participate in an anonymous, Internet-based survey containing questions related to personal preferences and outcomes in inferior turbinate surgery. RESULTS A total of 534 members of the American Society of Plastic Surgeons participated in the survey. Most (71.7%) trained in an independent plastic surgery program with prerequisite training in general surgery. More than half (50.6%) had more than 20 years of operative experience; only 15.2% reported performing greater than 40 rhinoplasties per year. The 5 most preferred inferior turbinate reduction techniques were outfracture of the turbinates (49.1%), partial turbinectomy (33.3%), submucous reduction via electrocautery (25.3%), submucous resection (23.6%), and electrocautery (22.5%). Fewer than 10% of the respondents reported the use of newer techniques such as radiofrequency thermal ablation (5.6%), use of the microdebrider (2.2%), laser cautery (1.1%), or cryosurgery (0.6%). Mucosal crusting and desiccation were the most frequently reported complications. CONCLUSIONS The results of this survey provide insights into the current preferences in inferior turbinate reduction surgery. Plastic surgeons are performing more conventional methods of turbinate reduction rather than taking advantage of the many of the more novel technology-driven methods.

Influence of breast cancer CME on provider knowledge and competence.

214 Background: Due to the volume and pace of scientific advances within oncology, the timely dissemination of clinical trial results and discussion regarding the appropriate incorporation into therapeutic decision making is necessary to provide the highest quality patient care. Increasing awareness in the breast cancer community on similarities and differences amongst practice management strategies helps to identify practice patterns and benchmark individual knowledge and competence against one’s professional peers. Methods: During 2010 and 2011, educational outcomes assessments were gathered during 83 independent continuing medical education (CME) activities held within community and academic institutions across the USA. Participants were asked a series of case-based questions via an audience response system to assess baseline knowledge, competence, and identify practice patterns. Assessments were repeated post a 1-hour CME certified activity, with an additional 6-week electronic follow-up. Barriers to implementing the information learned were also captured. Educational gaps were identified through documentation and comparison of current best practices versus actual participant responses. Results: To date, a total of 1,515 healthcare providers have participated in the initiative. Number of years in practice ranged from <10 to >30. The number of breast cancer patients seen per month ranged from ≤10 to >40. Provider competency in applying recent literature to the patient care setting was both assessed and measured. Results of neoadjuvant data knowledge, adjuvant therapy selection, relapsed HER2+ disease treatment strategies, and competence in discussing efficacy and safety data from recent clinical trials will be presented. Participants reported a number of barriers to applying data learned at the activities into clinical practice. Responses included lack of reimbursement, treatment side effects, newness of treatment data, and perceived efficacy. Conclusions: The results suggest the education of providers on the most currently available clinical trial results and expert discussion of how to optimize translation of this information into patient care increases breast cancer provider knowledge and competence.

Practice patterns of Canadian glaucoma specialists: planning for the next generation.

To identify practice patterns of Canadian glaucoma specialists in order to begin identifying the needs of the work force to care for the next generation of glaucoma patients. Survey of 130 Canadian glaucoma specialists whose names were obtained from the Canadian Ophthalmological Society specialist list. The response rate was 62% (81/130); 77% (62/81) considered themselves glaucoma specialists, but only 77% (48/62) of these had at least 1 year of formal glaucoma training. Specialists had a mean of 6.4 half days per month in the operating room, devoting the majority of their surgical time to glaucoma but performing more cataract surgery than glaucoma surgery. Forty percent of glaucoma specialists do not perform glaucoma drainage implant surgery. All the respondents stated that wait time for emergency care was within hours, but only 21% could perform their nonurgent cases within the benchmark set in this study of 4 weeks, wait times averaging 9.2 (range: 3-24) weeks. Forty-eight percent of the glaucoma specialists were not satisfied with their mix of clinical, laser, surgery, and nonophthalmology activities. Forty-four percent plan to decrease their clinical load over the next 5 years: 23% plan to increase their teaching, 19% their research, and 35% plan to devote less time to ophthalmology over the next 5 years. Forty-eight percent of glaucoma specialists had concerns regarding timely intervention for semiurgent care, in that only 21% of these cases are performed within 1 month of a confirmed need for surgery. With a benchmark that surgery be performed within 1 month in patients whose glaucoma is progressing despite medical, laser, or prior incisional surgical care, we do not have adequate resources to care for current glaucoma needs. With the aging population and ongoing attrition of ophthalmologists, we need to plan for improved access to glaucoma surgery.

Chronic Kidney Disease, Pediatric Nephrologists, and Tobacco Counseling: Perceptions and Practice Patterns. A Study from the Midwest Pediatric Nephrology Consortium

We sought to identify practice patterns of pediatric nephrologists for tobacco counseling, because of a high incidence of secondhand smoke exposure and tobacco use in adolescents with chronic kidney disease. Counseling was minimal for several reasons, thus increasing the risk for heart disease inherent in children with chronic kidney disease.

Lymphadenectomy during endometrial cancer staging: Practice patterns among gynecologic oncologists

Objectives Several controversies surround lymphadenectomy for endometrial cancer; surgical approach, who to stage, and the anatomic borders of the lymphadenectomy. The purpose of this study was to identify practice patterns among gynecologic oncologists when performing a lymph node evaluation during staging for endometrial cancer. Methods A self-administered survey was sent via email to all SGO members on 3 occasions between 2/09 and 4/09. The survey addressed surgical approach, algorithms used to determine staging, and anatomic landmarks defining lymphadenectomy. Results Four hundred and six members (40%) responded. Eighty-two percent completed fellowship and 14% were fellows. Thirty-four percent finished fellowship in 2000 or later. Eighty-five percent educate fellows/residents in either academic (65%) or private practice settings (20%). For a majority of cases 40% prefer laparotomy, 31% perform robotic surgery, and 29% use laparoscopy. Minimally invasive surgery was associated with university-based practice ( p = 0.048). Most (53%) never/rarely use frozen section to determine whether or not to perform lymphadenectomy. A majority perform staging on all grade 2 and grade 3 cancers (66% and 90%, respectively). When performing paraaortic lymphadenectomy, 50% of respondents use the IMA as the upper border and 11% take the dissection to the renal vessels. Participants who completed fellowship in 2000 or later were less likely to go to the renal vessels ( p = 0.002). Conclusion Current controversies in surgical staging for endometrial cancer are reflected in the practice patterns among gynecologic oncologists. At this point it is unclear if standardizing surgical practice patterns will improve outcomes for patients with endometrial cancer.

Management of Female Sexual Problems: Perceived Barriers, Practice Patterns, and Confidence among Primary Care Physicians and Gynecologists

Although approximately 40% of women report female sexual problems--and particularly sexual desire disorders, there are numerous practical, professional, and personal barriers to their diagnosis and management by treating clinicians. To identify practice patterns, perceptions, and barriers to the diagnosis and management of female sexual problems among U.S. practicing primary care physicians (PCPs) and obstetrician/gynecologists (OB/GYNs). A random sample of practicing U.S. PCPs and OB/GYNs were sent a case-vignette survey by e-mail and fax. Response to the survey was considered consent. A regression model was analyzed to assess predictors of confidence. Frequency and variability in diagnostic tests ordered and treatment recommendations provided for a patient with diminished sexual desire. Percent of physicians who reported they were confident in treating hypoactive sexual desire disorder (HSDD) and percent who reported significant barriers to initiating a dialogue about sexual health with female patients. A total of 505 responses were analyzed (8.8% response rate). Of respondents, 21% of OB/GYNs and 38% of PCPs stated they were not at all confident in treating HSDD. The majority of physicians would order a thyroid panel (PCP = 63%, OB/GYN = 53%) to assess a patient's diminished desire and recommended counseling and stress management to treat a patient with sexual complaints (PCP = 48%, OB/GYN = 54%). Regression results identified time constraints, the perceived lack of effective therapies, perceptions regarding patient-physician gender discordance, years in practice, number of patients seen per week, and perceptions regarding continuing medical education and practice experience as significant and independent predictors of confidence in treating HSDD patients.

A Multicenter Assessment of the Use of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging With Appropriateness Criteria

The aim of this study was to assess the feasibility of evaluation for appropriate use of radionuclide myocardial perfusion imaging (MPI) in multiple clinical sites and to determine use patterns as well as identify areas of apparent inappropriate use. Although cardiac imaging is highly valued for decision-making, the growth and expense related to these procedures has raised questions regarding overuse. The publication of appropriate use criteria (AUC), including those for MPI, were designed to provide guidance in the rational use of testing. However, limited data regarding the implementation and evaluation of AUC are available. Six diverse clinical sites enrolled consecutive patients undergoing MPI, collecting point-of-service data entered into an online form. An automated algorithm assigned a specific indication from the AUC that was classified as appropriate, uncertain, or inappropriate. Site-specific feedback was later provided to each practice on ordering patterns. Of the 6,351 patients enrolled, 93% were successfully assigned an appropriateness level. Inappropriate use of MPI was found in 14.4% of patients, with a range of 4% to 22% among practices. Women and younger patients were more likely to undergo inappropriate MPI. Asymptomatic, low-risk patients accounted for 44.5% of inappropriate testing. Elimination of the 5 most common inappropriate use indications would reduce overall imaging volume by 13.2%. Inappropriate use by physicians from within the practice performing imaging was not greater than physicians outside of the practice. Educational feedback might have resulted in reduced inappropriate test ordering in 1 site. The tracking of appropriate use is feasible in clinical practice, with an automated system that can readily identify practice patterns and targets for educational and quality improvement initiatives. This approach might provide an alternative to utilization management.

Poster 138: Identifying Practice Patterns Among Physiatrists Treating a Commercially Insured Pain Population

Poster 138: Identifying Practice Patterns Among Physiatrists Treating a Commercially Insured Pain Population

Prescription of antihypertensive agents to haemodialysis patients: time trends and associations with patient characteristics, country and survival in the DOPPS

Haemodialysis patients were studied in 12 countries to identify practice patterns of prescription of antihypertensive agents (AHA) associated with survival. The sample included 28 513 patients enrolled in DOPPS I and II. The classes of AHA studied were beta blocker (BB), angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), peripheral blocker, central antagonist, vasodilator, long-acting dihydropyridine calcium channel blocker (CCB), short-acting dihydropyridine CCB and non-dihydropyridine CCB. To reduce bias due to unmeasured confounders, the associations with mortality were assessed by separate Cox models based on patient-level prescription and facility prescription practice. An increase in prescription of ARBs (9.5%) and BBs (9.1%) was observed from DOPPS I to II. Prescription of AHA classes varied significantly by country, ranging for BBs from 9.7% in Japan to 52.7% in Sweden and for ARBs from 5.5% in Italy to 21.3% in Japan in DOPPS II. Facilities that treated 10% more patients with ARBs had, on average, 7% lower all-cause mortality, independent of patient characteristics and the prescription patterns of other antihypertensive medications (P = 0.05). Significant and independent associations with reduction in cardiovascular mortality were observed for ARBs (RR = 0.79; P = 0.005) and BBs (RR = 0.87, P = 0.004) in analyses of patient-level prescriptions. These associations in the facility-level model followed the same direction. DOPPS data show large variations across countries in AHA prescription for haemodialysis patients. The data suggest an association between ARB use and reduction in all-cause mortality, as well as with the use of BBs and reduction in cardiovascular mortality among haemodialysis patients.

Knowledge and attitudes of primary care physicians in the management of patients at risk for cardiovascular events

BackgroundAdherence to clinical practice guidelines for management of cardiovascular disease (CVD) is suboptimal. The purposes of this study were to identify practice patterns and barriers among U.S. general internists and family physicians in regard to cardiovascular risk management, and examine the association between physician characteristics and cardiovascular risk management.MethodsA case vignette survey focused on cardiovascular disease risk management was distributed to a random sample of 12,000 U.S. family physicians and general internists between November and December 2006.ResultsResponses from a total of 888 practicing primary care physicians who see 60 patients per week were used for analysis. In an asymptomatic patient at low risk for cardiovascular event, 28% of family physicians and 37% of general internists made guideline-based preventive choices for no antiplatelet therapy (p < .01). In a patient at high risk for cardiovascular event, 59% of family physicians and 56% of general internists identified the guideline-based goal for serum fasting LDL level (< 100 mg/dl). Guideline adherence was inversely related to years in practice and volume of patients seen. Cost of medications (87.7%), adherence to medications (74.1%), adequate time for counseling (55.7%), patient education tools (47.1%), knowledge and skills to recommend dietary changes (47.8%) and facilitate patient adherence (52.0%) were cited as significant barriers to CVD risk management.ConclusionDespite the benefits demonstrated for managing cardiovascular risks, gaps remain in primary care practitioners' management of risks according to guideline recommendations. Innovative educational approaches that address barriers may facilitate the implementation of guideline-based recommendations in CVD risk management.

Infant Tracheotomy

To identify practice patterns regarding tracheotomy technique among pediatric otolaryngologists. Survey of physicians. Academic medical center. Members of the American Society of Pediatric Otolaryngology (ASPO) residing in the United States. Physician responses to survey questions, including both multiple choice and free-text responses. We used chi(2) tests to determine if demographic factors (pediatric otolaryngology fellowship training, the number of tracheotomies performed yearly) correlated with differences in the technique used to perform infant tracheotomies. A total of 168 of 225 surveys mailed to ASPO members (75%) were completed and returned. Most respondents (87%) report that they make a simple vertical incision in the trachea. An even greater number (94%) use stay sutures routinely. On other technical points, such as management of the thyroid gland, the subcutaneous fat, and the method of securing the tracheostomy tube, there was much greater variability: 22% of respondents reported having had a serious tracheotomy-related complication in the immediate postoperative period, and 58% of these physicians changed their technique as a result. In several areas, chi(2) analysis revealed statistically significant differences in technique that were dependent on both fellowship training and the number of tracheotomies performed (P < or = .05). Among ASPO members practicing in the United States, there is near-unanimity on certain technical points, with considerable divergence on others. A substantial percentage of our colleagues have experienced a tracheotomy-related complication in the early postoperative period. In many cases, these incidents led to changes in surgical technique.

Practice patterns of Canadian glaucoma specialists: planning for the next generation

Background: To identify practice patterns of Canadian glaucoma specialists in order to begin identifying the needs of the work force to care for the next generation of glaucoma patients.Methods: Survey of 130 Canadian glaucoma specialists whose names were obtained from the Canadian Ophthalmological Society specialist list.Results: The response rate was 62% (81/130); 77% (62/81) considered themselves glaucoma specialists, but only 77% (48/62) of these had at least 1 year of formal glaucoma training. Specialists had a mean of 6.4 half days per month in the operating room, devoting the majority of their surgical time to glaucoma but performing more cataract surgery than glaucoma surgery. Forty percent of glaucoma specialists do not perform glaucoma drainage implant surgery.All the respondents stated that wait time for emergency care was within hours, but only 21% could perform their nonurgent cases within the benchmark set in this study of 4 weeks, wait times averaging 9.2 (range: 3–24) weeks. Forty-eight percent of the glaucoma specialists were not satisfied with their mix of clinical, laser, surgery, and nonophthalmology activities. Forty-four percent plan to decrease their clinical load over the next 5 years: 23% plan to increase their teaching, 19% their research, and 35% plan to devote less time to ophthalmology over the next 5 years.Interpretation: Forty-eight percent of glaucoma specialists had concerns regarding timely intervention for semiurgent care, in that only 21% of these cases are performed within 1 month of a confirmed need for surgery.With a benchmark that surgery be performed within 1 month in patients whose glaucoma is progressing despite medical, laser, or prior incisional surgical care, we do not have adequate resources to care for current glaucoma needs.With the aging population and ongoing attrition of ophthalmologists, we need to plan for improved access to glaucoma surgery.

The Significant Negative Impact of In-Hospital Venous Thromboembolism after Cardiovascular Procedures

Our objective was to assess the impact of venous thromboembolism (VTE) on common postoperative cardiovascular surgical patients. An administrative database, the Nationwide Inpatient Sample (NIS, a sampling of 20% of all inpatients across the United States), from 1998 to 2001, was queried for all patients who were hospitalized for primary procedural diagnosis of abdominal aortic aneurysm repair (AAA), amputation (AMP), coronary artery bypass grafting (CABG), carotid endarterectomy (CEA), lower extremity revascularization (LE), and aortic or mitral valve repair (VALV) and for secondary diagnosis of VTE, using standard ICD-9-CM codes. To validate these findings for specificity, the same patient procedure groups with a secondary code of VTE and the same hospitalization procedural code for inferior vena cava (IVC) filter were also analyzed. Factors relating to VTE and the outcomes of death, length of stay (LOS), and unfavorable discharge were analyzed by logistical regression, with odds ratios (ORs) reported as well as analysis of covariance for cost and LOS determinations. A total of 191,666 patients were identified from the NIS, with a mean age of 68 years, 65% men, 85% white race, and a mean VTE incidence of 0.68%. VTE incidence varied with primary procedure: AAA = 1.2%, AMP = 1.1%, CABG = 0.54%, CEA = 0.26%, LE = 0.78%, VALV = 0.63%. VTE was more likely with AAA (OR = 3.9), AMP (3.1), LE (2.8), VALV (2.0), and CABG (1.9) (all compared with CEA, P < 0.0001) and female gender (1.14, P =0.03) but not race or age. Mortality was associated with increased age (1.05), female gender (1.2), and VTE (3.4) (all P < 0.0001). Inpatient costs were 14% higher (P < 0.001), and LOS was increased by 68% compared with those patients not having a VTE (P < 0.0001). Unfavorable discharge status was associated with increased age (1.05), female gender (1.4), and VTE (2.2), among others. A similar magnitude of effect was observed with the subgroup analysis (n = 150) of those undergoing the index procedures who received an IVC filter during the same hospitalization as VTE diagnosis, including increased risk of death, cost, LOS, and unfavorable discharge (all P < 0.001). The occurrence of VTE is not common and varies with the cardiovascular procedure but significantly increases the risk of in-hospital death, cost, LOS, and unfavorable discharge. Process variables should be examined to identify practice patterns that might better prevent this complication.

Obstetrician???Gynecologists and Primary Care: Training during Obstetrics???Gynecology Residency and Current Practice Patterns

To assess obstetrician-gynecologists' perceptions of their residency training in primary care, document health issues assessed at annual visits, and identify practice patterns of both generalist and specialist obstetrician-gynecologists. Questionnaires were mailed to a random sample of 1,711 American College of Obstetricians and Gynecologists Young Fellows in September 2005. Information was gathered on perceptions about adequacy of residency training, how well training prepared obstetrician-gynecologists for current practice, and typical practice patterns for various medical diagnoses. Data were analyzed using univariate analysis of variance, t tests, and chi-square tests. Of 935 respondents (55% response rate), physicians estimated that 37% of private, nonpregnant patients rely on them for routine primary care. Approximately 22% report that they needed additional primary care training, specifically for metabolism/nutrition and dermatologic, cardiovascular, and psychosexual disorders. A wide range of topics, except for immunizations, were typically discussed at annual visits. Patients with pulmonary diseases, vascular diseases, and nongenital cancers were most often referred to specialists, whereas patients with urinary tract infections, sexually transmitted infections, or who are menopausal are most often managed totally. Self-identification as a generalist or specialist was associated with some practice patterns. Respondents were neutral about the role of primary care in obstetrics-gynecology residency training. For several primary care issues, obstetrician-gynecologists assumed sole management for obstetric patients but deferred to a primary care physician for gynecological patients. There is a continuing need for primary care training in obstetrics-gynecology residency, although it is unclear whether current training is adequate to meet their needs.

Practice patterns of physiotherapists in the treatment of work‐related back pain

Although physiotherapists (PTs) are one of the health professionals most involved in the treatment of back pain, their practice patterns have not been well studied. The study objectives were to identify the practice patterns of PTs treating workers suffering from acute/subacute back pain, with and without radiating pain below the knee, and to assess the relationship between these patterns and characteristics of PTs. PTs working in private clinics in the province of Quebec, Canada were invited to participate. Each PT used a self-administered questionnaire to record, for each treatment session, treatment objectives, interventions used and education given to two workers with back pain, one without radiating pain (n = 189 PTs) and one with radiating pain (n = 136 PTs). Multiple correspondence analysis with hierarchical classification was used to identify practice patterns of PTs. Multinomial logistic regressions were used to assess the relationship between practice patterns and PTs characteristics. For workers without radiating pain, 51.9% of PTs focused their treatment on soft tissue mobilizations/massage and heat, 24.3% focused on the McKenzie approach and related interventions, and 23.8% focused on exercises and function. Similar results were found for workers with radiating pain. Most of the PT characteristics were not related to practice patterns. The practices of PTs appeared to be separated into three distinct patterns. These practice variations suggest that there may be disagreement or uncertainty among PTs in the management of work-related back pain. The lack of evidence for the majority of interventions used by PTs and the difficulties of integrating evidence into clinical practice may be possible explanations.

Factors in decision making following genetic counseling for pre‐natal diagnosis of de novo chromosomal rearrangements

A retrospective survey of genetic counselors was conducted in order to identify practice patterns and factors that influence a patient's decision making when a de novo translocation is diagnosed pre-natally. Different variables that influence patients' decisions about pregnancy management were assessed and compared. Specifically, the type of rearrangement and/or knowledge of the breakpoints, risks provided for abnormal outcome, anxiety, fetal ultrasound findings and personal reasons for parental decisions were evaluated. Our findings suggest that patient anxiety level significantly predicts pregnancy management decisions. This information may be of benefit in identifying potential areas of education for genetic counselors as well as other health care providers.

Distal radius fractures: Therapy practice patterns

Identifying practice patterns for therapy interventions following distal radius fractures (DRFs) is necessary to define the most frequently used examination and intervention techniques. The purpose of this study was to identify preferred practice patterns and physical and functional outcome measures used during DRF management. Two hundred forty-two therapists (PTs, OTs, and CHTs) were surveyed by questionnaire at an annual hand therapy meeting. A descriptive analysis of data was performed. Preferred practice patterns during the immobilization and the post-immobilization periods were identified. More than 75% of the surveyed therapists used upper extremity range-of-motion exercises and compressive wrap with retrograde massage during the immobilization phase. More than 90% of therapists included range-of-motion exercises and heat/cold modalities in the post-immobilization treatment plans. Physical impairment measures of outcome were used much more frequently than functional outcome questionnaires in assessing progress during treatment. This study advances the evidence-based practice of therapy by establishing a foundation for future research.