Practice Patterns In Management Research Articles

Practice patterns in pediatric myopia management: Insights from a 2023 survey among Indian ophthalmologists.

This study investigates the practice patterns related to paediatric myopia among Paediatric Ophthalmologists in India, based on a 2023 survey conducted via Google Forms. The survey aimed to gather insights into physicians' perceptions and experiences concerning the clinical and treatment aspects of myopia in children. The survey reveals several key insights into current practice patterns among Paediatric Ophthalmologists in India regarding paediatric myopia management. The recommended mean age for a child's first eye checkup is 3 years, underscoring the importance of early detection. Refractive error thresholds for prescribing spectacles are set at 3.0 D for infants, 2.0 D for preschool children, and 1.0 D for school-going children older than 3 years. There is a growing trend in using 0.01% Atropine eye drops for myopia management, with a mean prescription age of 4.83 years. Notably, 80.11% of respondents prioritize documenting myopia progression regardless of the child's age. Orthokeratology and Peripheral Defocus spectacle lenses are gaining recognition, and lifestyle modifications such as increasing outdoor activities and reducing near activities are widely acknowledged as effective. While most respondents do not use progressive lenses for myopia, there is significant emphasis on axial length measurements and considering the lag of accommodation. Additionally, under-correction of myopia is favored by a notable proportion of practitioners. These findings indicate a shift towards early intervention and evidence-based strategies in myopia control. The survey highlights a shift towards early intervention and evidence-based myopia control strategies among practitioners. There is, however, room for improvement in standardizing approaches and considering additional factors like axial length and lag of accommodation. Collaborative efforts among policymakers, health regulatory bodies, and industry stakeholders are essential to enhance the accessibility and affordability of myopia control treatments and address the growing health burden associated with paediatric myopia.

Common Practice Patterns in the Diagnosis and Management of Acute Retinal Necrosis: A Survey Study of Uveitis Specialists

ABSTRACT Purpose Due to lack of large randomized clinical trials to determine best practices in treating acute retinal necrosis (ARN), there is not a clear consensus amongst ophthalmologists on how to best manage this potentially blinding condition. The aim of this study is to survey common practice patterns and analyze the factors that affect ophthalmologists’ management of ARN. Methods An anonymous survey was distributed to uveitis and retina specialists who are members of the American Uveitis Society (AUS) via email to query practice patterns regarding ARN. The survey included 22 questions with an additional 10 questions based on response. Survey question topics included demographic information, diagnostic testing, antiviral therapy, corticosteroids, and surgical procedures. Results 67 surveys were included for analysis. Most respondents (87%) always or frequently obtain intraocular aqueous fluid for diagnostic PCR testing. The majority of respondents would administer intravitreal antiviral injections to a unilateral immunocompetent ARN patient (67%), but would be even more likely to do so for a bilateral immunosuppressed ARN patient (87%). Respondents tend to treat ARN with systemic rather than local corticosteroids, with the majority (63%) of respondents initiating corticosteroid treatment 48 hours after treatment. Most respondents (79%) never perform a vitrectomy to manage ARN unless the patient has a retinal detachment or tear. The majority (63%) rarely or never perform prophylactic laser barricade, but may consider laser treatment if there is extensive retinal involvement. Conclusion Current practice patterns for diagnosis and management of ARN among AUS members generally align with the suggested practices outlined by the American Academy of Ophthalmology.

High Involvement Management Practices and Their Impact on Contextual Performance: An Analytical Study in the General Secretariat of the Council of Ministers

The main objective of this research is to evaluate the integration management at the higher level within the General Secretariat of the Cabinet and identify its role in achieving integration in the work environment through improving relationships between different management levels, facilitating participation and expression of opinions, and enhancing organizational belonging. A statistical approach and SPSS V.25 method were used for data analysis and various measurements. Data was collected from senior managers in the General Secretariat of the Cabinet using 87 distributed questionnaires, with 81 of them collected, resulting in a response rate of 95%. Study results indicate a pattern of integration management practices at the higher level within the General Secretariat, particularly after involving employees in decision-making. These practices contribute to strengthening employees' connection to the organization, enhancing their knowledge and decision-making skills, leading to increased productivity and effectiveness. Furthermore, participation contributes to the implementation of high-level integration management by enabling employees to participate in problem-solving and decision-making, fostering collaboration, coordination, and achieving high employee performance.

1177-P: Practice Patterns of Medical Management of Pediatric Obesity and Type 1 Diabetes (T1D)

1177-P: Practice Patterns of Medical Management of Pediatric Obesity and Type 1 Diabetes (T1D)

Analysis of British Columbia practice patterns in the management of female stress urinary incontinence with emphasis on mesh use.

Female stress urinary incontinence (SUI) is common and has a profound impact on quality of life. Suburethral slings are the most common treatment for SUI in this population. These can be placed with synthetic mesh or autologous fascia. Mesh-related complications after midurethral sling procedures are documented in the literature but the risk of complications and reoperation is lower than the use of transvaginal mesh for pelvic organ prolapse repair. In this study, we sought to evaluate local practice patterns of management of female SUI with specific emphasis on mesh use. A survey created by an expert panel was disseminated to respective provincial societies. Sixty-eight percent of respondents offer midurethral slings in their practice but only 60.6% of these respondents would offer surgical removal of the sling if there were complications, such as mesh erosion or pain. A large portion (39.4%) of respondents are performing transobturator slings as compared to retropubic midurethral slings (36.3%) and only 8.5% have removed the leg component associated with the transobturator sling in their practice. Furthermore, compared to most respondents offering midurethral slings (64.8%), only a minority of surgeons offer alternatives: 23.9% of respondents offer periurethral bulking agent injections, 15.5% offer pubovaginal slings, and 12.7% offer retropubic urethropexies. Our study supports that surgeons should continue to review surgical risks and alternative treatment options as part of the surgical consent process. As such, surgeons should be able to offer a variety of surgical approaches to manage female SUI.

Study on Pattern of Self-Management Practices in Patients of Diabetes in Rural Population in Aligarh

Self care involves all decisions which individuals, families,take for their own health particularly their own physical andmental well being. Staying fit, exercising, avoiding hazardous behavior etc. will all compound to self care.The aim ofthis study is to find the pattern of self care management practices in patients of Diabetes. A cross sectional study wasdone in registered villages of Rural Health Training Centre and 316 population was covered. All patients of the selectednon communicable diseases above 18 years of age were selected who gave their consent. Self care practice assessmentwas done by including: Diabetes specific section including SDSCA measure - Summary of Diabetes Self- Care ActivitiesQuestionnaire. The findings showed that the prevalence of self-care practices in patients of diabetes was not very high.Slightly more than 50% diabetics were following good levels of self-care practices. Individual levels of self-care practiceslike medication, physical activity/ exercise, adequate diet, risky behaviours of tobacco intake and alcohol consumption,monitoring blood pressure/ blood sugar/ symptoms of COPD, weight management etc. showed varied prevalence.Mostly the patients with any non-communicable disease were found adherent to their medications. In patients ofdiabetes; age group, presently attending any health facility for disease management and receiving health care provider’sadvice for lifestyle modifications were associated significantly with self-care practices.

Study on Pattern of Self-Management Practices in Patients of Diabetes in Rural Population in Aligarh

Self care involves all decisions which individuals, families,take for their own health particularly their own physical andmental well being. Staying fit, exercising, avoiding hazardous behavior etc. will all compound to self care.The aim ofthis study is to find the pattern of self care management practices in patients of Diabetes. A cross sectional study wasdone in registered villages of Rural Health Training Centre and 316 population was covered. All patients of the selectednon communicable diseases above 18 years of age were selected who gave their consent. Self care practice assessmentwas done by including: Diabetes specific section including SDSCA measure - Summary of Diabetes Self- Care ActivitiesQuestionnaire. The findings showed that the prevalence of self-care practices in patients of diabetes was not very high.Slightly more than 50% diabetics were following good levels of self-care practices. Individual levels of self-care practiceslike medication, physical activity/ exercise, adequate diet, risky behaviours of tobacco intake and alcohol consumption,monitoring blood pressure/ blood sugar/ symptoms of COPD, weight management etc. showed varied prevalence.Mostly the patients with any non-communicable disease were found adherent to their medications. In patients ofdiabetes; age group, presently attending any health facility for disease management and receiving health care provider’sadvice for lifestyle modifications were associated significantly with self-care practices.

Trial in Progress: Patient-Reported Outcome Measures in the Prospective Observational Cohort Study of Patients at Risk for Chronic Graft-Versus-Host Disease in the United States (THRIVE)

Background and Significance: Allogeneic hematopoietic cell transplantation (alloHCT) is a curative immunotherapy for patients with hematologic disorders. However, graft-versus-host-disease (GVHD) is a major limitation to the success of alloHCT, with chronic GVHD (cGVHD) as the leading cause of morbidity and mortality. The pleomorphic nature of cGVHD makes the diagnosis and patient management challenging for clinicians; thus, patient-reported symptoms often guide in diagnosing and determining the severity of cGVHD. Our current understanding of cGVHD is largely based on data from registries, single-institution prospective studies, and the cGVHD Consortium with representation from tertiary care academic centers. Prospective studies including patient-reported outcomes and a focus on a more representative and generalizable sample of patients with cGVHD are needed to better understand cGVHD symptoms, disease burden, and practice patterns for management. This trial in progress focuses on broad patient-centered assessment of post-alloHCT medical and psychosocial complications and patient-reported caregiver involvement in a diverse and contemporary patient population. This study uses multiple organ- or system-directed patient-reported outcome measures (PROMs) to help identify cGVHD symptoms, severity, and impact on patient quality of life including financial impact. The primary objective of THRIVE is to assess the clinical course and burden of cGVHD, including diagnosis and severity recorded in electronic case report forms (eCRFs) and PROMs. Secondary objectives include measuring healthcare resource utilization and patient economic and employment impact associated with cGVHD management, as well as patient-reported organ-specific symptoms. Study Design and Methods: THRIVE is a prospective, longitudinal, observational study (NCT05919511) of alloHCT recipients in the United States that uses a hybrid model designed to work with HCT centers and a virtual platform. Eligible patients are ≥18 years old, received alloHCT 90-180 days before enrollment, and are able to complete patient-assessment questionnaires provided in their preferred language either alone or with minimal caregiver assistance. Up to 1500 alloHCT recipients will be recruited at HCT sites (with the expectation that ~500 will have cGVHD symptoms at enrollment; ~500 are estimated to develop cGVHD during the course of the study; ~500 are estimated not to develop cGVHD during the study; Figure). Patients have the option to participate on a virtual platform. Patients will be followed for 36 months from date of enrollment or until the earliest of study termination, withdrawal, or death. Data from 13 PROMs (Table) divided into 3 groups will be collected every 3 months using a decentralized virtual platform. To reduce survey burden, patients will be randomized into 1 of 6 sequence groups to capture 4-5 PROMs per month in year 1 and every 2 months in years 2 and 3. Clinical data, including medications and adverse events, will be collected and abstracted into eCRFs every 3 months. In general, reporting of results will be descriptive for variables of interest. Summary statistics for continuous variables and for categorical variables will be calculated for all patients as well as for subgroups of interest. Whenever applicable, 95% confidence intervals will be calculated for endpoint estimates. Univariate, multivariate, or repeated-measurement analyses will be performed to assess factors associated with evolution of clinical manifestations of and complications from cGVHD. Recruitment for this study is ongoing.

2270. Dealing with an old foe –Assessment of Knowledge, Attitude, and Practices: A survey on management of Staphylococcus aureus bacteraemia among Indian Physicians

Abstract Background Staphylococcus aureus bacteraemia (SAB) is associated with high morbidity, mortality, and healthcare costs. Effective management of SAB significantly improves outcome. There is significant gap in the guidelines and clinical practice. This survey was conducted with aim to assess opinions and practice patterns in management of SAB among Indian clinicians. Methods We conducted a cross-sectional respondent-driven survey, using a 45-item, anonymous, voluntary, multiple-choice google form questionnaire among clinicians in India, after obtaining ethical approval from the institute. We distributed survey via social media, WhatsApp, and E-mail. Survey responses were analysed using SPSS, Version 25.0. Results The total of 125 practicing clinicians responded to this survey. Questions where systematically divided into treatment of choice for MSSA, MRSA, additional investigations, persistent bacteraemia, and adjunctive anti-toxin therapy. Around 57% of the respondents have 1-10 episodes of SAB every month. For suspected SAB, most respondents (74%) preferred vancomycin as empiric therapy. If MSSA was identified, 66.7% initiated on Anti staphylococcal penicillin, while in MRSA vancomycin was selected by majority (80%) (Figure 1 & 2). Most clinicians (74%) perceived 1st generation cephalosporins non-inferior to ASPs. Infectious diseases referral for SAB was undertaken in only in about 56% of the cases, with 25% respondents citing non-availability of ID specialist in the institute. Repeat blood cultures and echocardiography was performed by most respondents. Lack of consensus was apparent in diagnosis and management of persistent bacteraemia and oral switch of therapy (Figure 1 & 2).Most respondents managed SAB with at least 14 days of parenteral antibiotics in several scenarios. But, in patients with complicated SAB there was significant practice variation (Figure 3). Figure - 1 Drug of choice in MSSA, MRSA and management of persistent bacteraemia according to the respondents Figure 2 Persistent bacteraemia definition according to the respondents along with the additional tests performed Conclusion There were some areas of consensus, but this survey highlights considerable practice variation among clinicians. Although the value of ID consultation in SAB management has been established by multiple studies, this survey demonstrates that there remains ample opportunity to further define best practices and optimize management of this complex disease. Disclosures All Authors: No reported disclosures

Iron Surveillance and Management in Gastro-Intestinal Oncology Patients: A National Physician Survey.

Iron deficiency (ID) is a complication of gastrointestinal (GI) cancers that may manifest as iron deficiency anemia (IDA). Serum ferritin monitoring and oral iron supplementation have the limitations of being falsely elevated and poorly absorbed, respectively. This study aims to assess the discordance in surveillance, treatment practices, and awareness of ID/IDA in GI cancer patients by Canadian physicians treating these patients. From February 2020 to September 2021, a 22-question electronic survey was sent to medical oncologists (MOs), surgical oncologists (SOs), and gastroenterologists (GEs). The survey collected information about four domains: physician demographics, surveillance practices, treatment practices, and awareness of ID/IDA in GI cancer patients and ASCO/ASH guidelines. A total of 108 (34 MOs, 19 SOs, and 55 GEs) of the 872 (12.4%) invited physicians completed the survey. Of these, 26.5% of MOs, 36.8% of SOs, and 70.9% of GEs measured baseline iron parameters, with few continuing surveillance throughout treatment. Ferritin was widely measured by MOs (88.9%), SOs (100%), and GEs (91.4%). Iron was supplemented if ID/IDA was identified pre-treatment by 66.7% of MOs, 85.7% of SOs, and 94.2% of GEs. Parenteral iron was prescribed by SOs (100%), while oral iron was prescribed by MOs (83.3%) and GEs (87.9%). Only 18.6% of physicians were aware of the ASCO/ASH guidelines regarding erythropoiesis-stimulating agents with parenteral iron for treating chemotherapy-induced anemia. Results illustrate variations in practice patterns for IDA management across the different physician specialties. Moreover, there appeared to be gaps in the knowledge and care surrounding evidence-based IDA management principles which may contribute to poor clinical outcomes.

Survey of Retina Specialists’ Attitudes and Practice Patterns of Screening and Management of Candida Endophthalmitis

ABSTRACT Purpose To understand retina specialists’ attitudes and practice patterns for screening for and managing Candida endophthalmitis and any impact of the COVID-19 pandemic on these practice patterns. Methods A survey was developed on Survey Monkey and distributed to ASRS regular members via email in April 2021. Results The survey had 231 respondents, of whom 169 (73%) performed inpatient consultations. Ninety percent responded that they do not recommend routinely screening asymptomatic patients with candidemia. For unresponsive patients with candidemia that lack visible signs of endophthalmitis, 65% did not recommend routine screening. However, 85% reported their affiliated hospitals did not have a policy to defer such screening consultations; this proportion did not significantly change when asked if a policy was implemented in response to the COVID-19 pandemic. For patients with a dilated examination without signs of endophthalmitis, 89% surveyed recommended continuing systemic antifungals and reconsult PRN, while the remainder recommended repeat examinations until off antifungals. For initial management of Candida endophthalmitis, 55% indicated systemic antifungals only; 43% indicated systemic antifungals with tap & inject, and 2% indicated systemic antifungals with vitrectomy and intravitreal antifungals. Conclusion A discordance exists between the prevailing opinion among retina specialists against routine Candida endophthalmitis screening and hospital consultation policies, which were not significantly impacted by the COVID-19 pandemic. In cases of diagnosed endogenous endophthalmitis, slightly more than half of surveyed retina specialists would not initiate additional treatment beyond systemic antifungals while just under half surveyed recommended initial tap and inject in addition to systemic antifungals.

A Survey Study of Surgeons and Anesthesiologists Regarding Perioperative Multimodal Analgesia for Opioid-Tolerant Patients

PurposePerioperative pain management of opioid-tolerant patients can be challenging. Although regional anesthesia and multimodal analgesics may be beneficial, these modalities are often underused. It is unclear whether practice patterns for perioperative pain management are determined by the knowledge, attitudes, and beliefs of surgeons and anesthesiologists. DesignDescriptive survey. MethodsUsing a Qualtrics survey, we polled a randomly selected group of 25 surgeons and 25 anesthesiologists regarding their knowledge, attitudes, beliefs, and practices for pain management in an opioid-tolerant patient. FindingsOf 25, 23 anesthesiologists and 18/25 surgeons responded to the survey. Demographics were similar between the 2 groups. Most of the participant surgeons and anesthesiologists believed that pain management may be challenging in an opioid-tolerant patient. However, only 56% of surgeons would recommend a preoperative pain consultation. Most surgeons and anesthesiologists believed in the efficacy of regional anesthetics. However, 43% of surgeons would not advocate for a regional block, perhaps due to their perception of the added perioperative time. Multimodal analgesics were widely accepted by both surgeons and anesthesiologists. ConclusionsThere is an urgent need to reinforce the importance of patient-centered care, with a specific focus on addressing knowledge gaps and improving perceptions for all the members of the team, including surgeons, anesthesiologists, and perioperative nursing teams, if optimal outcomes are to be achieved for our patients.

Practice patterns in management of differentiated thyroid cancer since the 2014 British Thyroid Association (BTA) guidelines

BackgroundThe updated 2014 BTA guidelines emphasised a more conservative, risk adapted model for the management of low-risk differentiated thyroid cancer (DTC). In comparison to historical approach of total thyroidectomy combined with radioactive iodine, treatment de-escalation is increasingly supported. AimsTo evaluate the impact of the updated BTA guidelines on the management of DTC cases at regional UK centre. MethodsAll DTC patients were retrospectively identified from regional thyroid MDT database between Jan2009–Dec2020. Oncological treatment and clinico-pathological characteristics were analysed. Results623 DTC cases were identified; 312 (247 female: 65 male) between 2009 and 2014 and 311 (225 female: 86 male) between 2015 and 2020. Median age is 48 years (range 16–85). By comparing pre- and post-2015 cohorts, there was a significant drop in total thyroidectomy (87.1% vs 76.8%, p = 0.001) and the use of radioactive iodine (RAI) (73.1% vs 62.1%, p = 0.003) in our post-2015 cohort. When histological adverse features were analysed, extra-thyroidal extension (4.2% vs 17.0%, p=< 0.001), lymphovascular invasion (31.4% vs 50.5%, p=<0.001) and multi-centricity (26.9% vs 43.4%, p = 0.001) were significantly increased in the post 2015 cohort. Nonetheless, total thyroidectomy (TT) remains the treatment choice for low risk T1/2 N0 M0 disease in 65.3% (124/190) in post-2015 cohort for several reasons. Reasons include adverse histological features (50.8%), benign indications (32.5%), contralateral nodules (11.7%), patient preference (2.5%), and diagnostic uncertainty (2.5%). ConclusionOur study confirms a move towards a more conservative approach to patients with low-risk DTC in the UK, which is in keeping with the BTA 2014 guideline and international trends, but total thyroidectomy remains prevalent for low risk T1/2 N0 M0 disease for other reasons.

Systematic Review and Meta-Analysis of Nonoperative Management for SVS Grade II Blunt Traumatic Aortic Injury

SVS Grade II blunt traumatic aortic injury is defined as intramural hematoma with or without external contour abnormality. It is uncertain whether this aortic injury pattern should be treated with endovascular stent-grafting or nonoperative measures. Since the adoption of the SVS Guidelines on endovascular repair of blunt traumatic aortic injury, the practice pattern for management of grade II injuries has been heterogenous. The objective of the study was to report natural history outcomes of grade II blunt traumatic aortic injury. A systematic review of published traumatic aortic injury studies was performed. Online database searches were current to November 2022. Eligible studies included data on aortic injuries that were both managed nonoperatively and classified according to the SVS 2011 Guidelines. Data points on all-cause mortality, aorta-related mortality and early aortic intervention were extracted and underwent meta-analysis. The methodology was conducted in accordance with PRISMA guidance. Thirteen studies were included in the final analysis with a total of 204 cases of SVS grade II blunt traumatic aortic injury treated nonoperatively. The outcomes rates were estimated at 10.4% (95% CI 6.7% - 14.9%) for all-cause mortality, 2.9% (95% CI 1.1% - 5.7%) for aorta-related mortality and 3.3% (95% CI 1.4% - 6.2%) for early aortic intervention. The studies included in the analysis were of fair quality with a mean Downs and Black score 15 (±1.8). Grade II blunt traumatic aortic injury follows a relatively benign course with few instances of aortic-related mortality. Death in the setting of this injury pattern is more often attributable to sequelae of multisystem trauma and not directly related to aortic injury. The current data supports nonoperative management and imaging surveillance for grade II blunt traumatic aortic injury instead of endovascular repair. Longer-term effects on the aorta at the site of injury are unknown.

A Survey Study of Practice Patterns in Management of Very Early Small Cell Lung Cancer in Canada

Concurrent chemoradiotherapy (CRT) is the gold standard in management of limited-stage small cell lung cancer (LS-SCLC). Local therapy with surgery or stereotactic radiotherapy (SBRT), followed by adjuvant chemotherapy may be appropriate in patients with very early (T1-T2, N0) disease. This study aimed to determine practice patterns for very early LS-SCLC among lung cancer specialists in Canada. A survey was developed and distributed to Canadian medical and radiation oncologists specializing in lung cancer. The survey consisted of three sections: 1) physician demographics, 2) general practice approach, and 3) preferred approach for three clinical scenarios (1: a peripheral T1 lesion; 2: a central T1 lesion; 3: a peripheral T2 lesion). Responses were analyzed to detect differences in management across cases and among various physician groups. A total of 77 physicians participated. In case 1, when the patient was eligible for surgery, most respondents (73%) chose surgery with adjuvant chemotherapy as their preferred management, with only 19% choosing CRT. CRT was selected by a higher proportion in case 2 (48%) and case 3 (61%) (p<0.05). If medically operable, most chose CRT over SBRT and adjuvant chemotherapy in all cases. CRT was significantly more popular in case 2 (84%) and case 3 (86%) than in case 1 (55%) (p<0.05). Subgroup analysis showed physicians from Western Canadian were more likely to choose CRT, those from Ontario were more likely to offer SBRT, and those who have spent longer in practice were more likely to choose CRT over local therapy. There is no clear consensus regarding optimal management of patients with very early LS-SCLC among specialists in Canada, with significant variations in practice patterns. CRT remains the most popular strategy in most cases, with surgery and adjuvant chemotherapy preferred for small peripheral lesions. Increasing size of tumor as well as more central location are factors that drive physicians towards choosing CRT. Variation in practice is correlated to region of the country and to physician experience.

Optometric Practice Patterns for Acute Central and Branch Retinal Artery Occlusion.

Optometrists are often the first providers to evaluate patients with acute vision loss and are often the first to diagnose a central retinal artery occlusion (CRAO). How quickly these patients present to the optometrist, are diagnosed, and referred for evaluation are major factors influencing the possibility of acute therapeutic intervention. Our aim was to survey the U.S. optometric community to determine current optometric practice patterns for management of CRAO. An anonymous seven-question survey was emailed in 2020 to the 5,101 members of the American Academy of Optometry and the 26,502 members of the American Optometric Association. Of 31,603 optometrists who were sent the survey, 1,926 responded (6.1%). Most respondents (1,392/1,919, 72.5%) worked in an optometry-predominant outpatient clinic and were less than 30 minutes from a certified stroke center (1,481/1,923, 77.0%). Ninety-eight percent (1,884/1,922) of respondents had diagnosed less than 5 CRAOs in the previous year, and 1,000/1,922 (52.0%) had not diagnosed a CRAO in the prior year. Of the optometrists who diagnosed at least one CRAO in the previous year, 661/922 (71.7%) evaluated these patients more than 4 hours after the onset of vision loss. Optometrists who diagnosed a CRAO or branch retinal artery occlusion referred patients to an emergency department (ED) affiliated with a certified stroke center (844/1,917, 44.0%), an outpatient ophthalmology clinic (764/1,917, 39.9%), an ED without a stroke center (250/1,917, 13.0%), an outpatient neurology clinic (20/1,917, 1.0%), or other (39/1,917, 2.0%); most (22/39, 56.4%) who responded "other" would refer to a primary care physician. Optometrists are likely the first providers to evaluate patients with acute vision loss, including from a retinal artery occlusion. However, only 6.1% of optometrists responded to our survey despite 2 reminder emails, likely reflecting the lack of exposure to acute retinal artery occlusions, and a potential lack of interest of optometrists in participating in research. Of the optometrists who reported evaluating a CRAO in the previous year, less than 29% saw the patient within 4 hours of vision loss. In addition, a large portion of optometrists are referring acute CRAO patients to outpatient ophthalmology clinics, delaying appropriate acute management. Therefore, it is imperative that optometrists and ophthalmologists are educated to view acute retinal arterial ischemia as an acute stroke and urgently refer these patients to an ED affiliated with a stroke center. The delay in patient presentation and these referral patterns make future clinical trials for acute CRAO challenging.

Conservative Kidney Management Practice Patterns and Resources in the United States: A Cross-Sectional Analysis of CKDopps (Chronic Kidney Disease Outcomes and Practice Patterns Study) Data

Conservative kidney management (CKM) is a viable treatment option for many patients with chronic kidney disease. However, CKM practices and resources in the United States are not well described. We undertook this study to gain a better understanding of factors influencing uptake of CKM by describing: (1) characteristics of patients who choose CKM, (2) provider practice patterns relevant to CKM, and (3) CKM resources available to providers. Cross-sectional study. This study is a cross-sectional analysis of data from US nephrology clinics enrolled in the chronic kidney disease Outcomes and Practice Patterns Study (CKDopps) collected between 2014 and 2020. Data for this study includes chart-abstracted characteristics of patients with an estimated glomerular filtration rate≤30mL/min/1.73m2 (n=1018) and available information on whether a decision had been made to pursue CKM at the time of kidney failure, patient(n=407) reports of discussions about forgoing dialysis, and provider (n=26) responses about CKM delivery and available resources in their health systems. Descriptive statistics were used to report patient demographics, clinical information, provider demographics, and clinic characteristics. Among data from 1018 patients, 68 (7%) were recorded as planning for CKM. These patients were older, had more comorbidities, and were more likely to require assistance with transfers. Of the 407 patient surveys, 18% reported a conversation about forgoing dialysis with their nephrologist. A majority of providers felt comfortable discussing CKM; however, no clinics had a dedicated clinic or protocol for CKM. Inconsistent survey terminology and unlinked patient and provider responses. Few patients reported discussion of forgoing dialysis with their providers and even fewer anticipated a choice of CKM on reaching kidney failure. Most providers were comfortable discussing CKM, but practiced in clinics that lacked dedicated resources. Further research is needed to improve the implementation of a CKM pathway. For older comorbid adults with kidney failure, conservative kidney management (CKM) can be an appropriate treatment choice. CKM is a holistic approach with treatment goals of maximizing quality of life and preventing progression of chronic kidney disease (CKD) without initiation of dialysis. We investigated US CKM practices and found that among 1018 people with CKD, only 7% were planning for CKM. Of 407 surveyed patients, 18% reported a conversation with their provider about forgoing dialysis. In contrast, most providers felt comfortable discussing CKM; however, none reported working in an environment with a dedicated CKM clinic or protocol. Our data show the need for further CKM education in the United States as well as dedicated resources for its delivery.

Autonomic dysreflexia: Current pharmacologic management.

Autonomic dysreflexia (AD) is a frequent complication of spinal cord injury (SCI), though current clinical practice patterns for medication management of this condition are unknown. Correspondingly, it is unclear if national differences in practice patterns exist. To determine trends in current pharmacologic management of AD throughout the Americas. International survey of current physician practice patterns. Academic medical center. Sixty physicians managing patients with SCI and prescribing medications to manage AD. Not applicable. Presence of a formal pharmacologic AD management protocol, first- and second-line medications, patient characteristics influencing pharmacologic management. The majority of physicians (69%) had a formal AD management protocol for inpatient care, with nitroglycerin ointment (82%) being the most common first-line medication. Strong national differences existed regarding the use of nitroglycerin ointment, with 98% of U.S.-based physicians using this as first-line medication and 0% of physicians in Canada or Latin America using this due to recent lack of medication availability. Only 67% of physicians had a preferred second-line medication, with preferences split between hydralazine (48%) and nifedipine (28%). A systolic blood pressure threshold for pharmacologic management was used by 56% of physicians, wheres 26% considered neurological level of injury in decisions to use medications for AD. Heart rate was used by only 5% of physicians in their decision to manage AD with medications. As of 2023, U.S.-based physicians caring for individuals with SCI largely have formal inpatient protocols in place for medication management of AD, with nearly all relying on nitroglycerin ointment as their first-line medication. In areas outside of the United States where nitroglycerin ointment is unavailable, pharmacologic practice patterns significantly differ.

Market competition influences practice patterns in management of patients with intermittent claudication in the vascular quality initiative: Presented at the Forty-seventh Annual Meeting of the Southern Association for Vascular Surgery, Rio Grande, Puerto Rico, January 18-21, 2023.

Market competition influences practice patterns in management of patients with intermittent claudication in the vascular quality initiative: Presented at the Forty-seventh Annual Meeting of the Southern Association for Vascular Surgery, Rio Grande, Puerto Rico, January 18-21, 2023.

Current practice pattern among anaesthesiologists for difficult airway management: A nationwide cross-sectional survey.

The practice patterns for airway management vary among anaesthesiologists, depending on various setups and geographical divides. This survey assessed practice patterns in unanticipated difficult intubation and cannot intubate or cannot ventilate (CICV) situations/complete ventilation failure among Indian anaesthesiologists'. A validated questionnaire of 22 items related to practice preferences for airway management among anaesthesiologists was sent to Indian Society of Anaesthesiologists members online through Google Forms and distributed manually to delegates in continuing medical education programme. A total of 535 responses were obtained and analysed. In unanticipated difficult laryngoscopy and intubation, the order of preference for alternative airway devices was video laryngoscope (VL, 60.1%), intubating laryngeal mask airway/laryngeal mask airway (23.5%), fibreoptic bronchoscope (13.5%) and optical stylets (1.2%). Advanced difficult airway devices were unavailable in most nursing homes and government non-teaching hospitals. Seventy per cent of respondents experienced CICV situations at least once, most during head and neck surgeries. In CICV situations, the order of choice for the front-of-neck airway access was cricothyroidotomy (CT) by narrow bore cannula (48.9%), tracheostomy by the surgeon (30%), Seldinger CT (12.5%), open surgical CT (5.4%) and scalpel bougie CT (3.2%). The VL was the most preferred airway rescue device in unanticipated difficult intubation, and intravenous catheter cricothyroidotomy was the most selected technique in CICV situations.