Practice Patterns Research Articles

Over half of all deaths after traumatic brain injury (TBI) follow the decision to withdraw life-sustaining therapy (WLST). Despite recent improvements in TBI mortality, rates of WLST have remained unchanged, potentially reflecting outdated prognostic misconceptions. Determinants of the decision to WLST are multifaceted and complex, spanning just beyond clinical prognosis, which is reflected in the significant variability in WLST rates between centers. We aimed to create a machine learning (ML) model that could accurately predict the decision to WLST and hypothesized that facility WLST rate would emerge as a highly impactful WLST determinant. This observational study analyzed data from the American College of Surgeons Trauma Quality Improvement Project National Trauma Databank (2017-2021). Patients with severe TBI, defined by a maximum Abbreviated Injury Scale-Head ≥1 and presenting Glasgow Coma Scale (GCS) <9, were included. Burns, unspecified injury mechanisms, emergency room discharges, deaths, transfers, and patients with missing WLST data were excluded. ML models were developed to predict WLST using variables available at different time points. The performance of each model in predicting WLST was optimized for area under the receiver operating curve (AUROC). The most impactful determinants of WLST were assessed using Shapley additive explanation scores. Of 5,481,046 patients, 155,639 met inclusion criteria, with 32,385 (20.8%) undergoing WLST. The mean age was 43 ± 22 years, 26.5% of patients were female, and the median time to WLST was 46.4 hours. The AUROC of 0.875 (95% CI 0.871-0.879) in the admission model improved to 0.896 (95% CI 0.892-0.900) in the total length-of-stay model. Age, highest emergency department GCS, and facility WLST rate were the most important factors in prediction of WLST. In this study of using ML to predict WLST after severe TBI, our models reliably predict the decision to WLST. We found that institutional withdrawal culture is a strong independent determinant of WLST, irrespective of clinical condition. As TBI care improves, our findings underscore the importance of refining prognosticating tools to prevent premature WLST decisions which may be influenced by biases associated with self-fulfilling prophecies and institutional practice patterns.

Purpose/Objective(s): Adjuvant radiation therapy (RT) is an effective treatment in the management of patients with breast cancer. Evidence supports both standard fractionation and, more recently, moderate hypofractionation and ultra hypofractionation leading to a potential diversity of clinical practice. Whether or not physicians at main academic centers adopt hypofractionated regimens more readily than those working at community centers is not known. Practice patterns were analyzed within our large healthcare network comprising one main and eight community sites before and after 2020. Materials/Methods: Patients treated with adjuvant breast RT between 2017 and 2022 in our radiation oncology department were identified. Treatment techniques were evaluated: standard fractionation (25–28 fractions to 50–50.4 Gy), moderate hypofractionation (15–16 fractions to 40.05–42.56 Gy), and ultra hypofractionation (5 fractions of 26–30 Gy) for intact breast, partial breast, and chest wall cases. Use of each technique was compared between the main academic center (Main) versus eight community sites (Community) in two time periods, 2017–2019 and 2020–2022. Differences were assessed using z-ratios for the difference between independent proportions. Results: There was a statistically significant decrease in the use of standard fractionation for intact breast and chest wall cases from the early to the late period at both the community sites and the main center; however, a higher proportion of patients were treated with standard fractionation at the community sites versus the main center in the late period (7.8% community versus 2.0% main, p &lt; 0.01 for intact breast and 80.7% community versus 37.4% main, p &lt; 0.01 for chest wall). There was a statistically significant increase in the use of hypofractionation for intact breast and chest wall cases from the early to the late period at both the community sites and the main center; however, a higher proportion of patients were treated with hypofractionation at the main center versus the community sites during the late period (92.2% community versus 98.0% main, p &lt; 0.01 for intact breast and 19.3% community versus 62.6% main, p &lt; 0.01). Conclusions: The present study shows that recent trial evidence supporting the use of shorter RT treatments changed practice among providers more rapidly at our main academic center versus our community sites. The reasons for this difference are not known; however, standardization of treatment by implementation of an adjuvant RT treatment algorithm may facilitate uniform care among patients with breast cancer and we are investigating the impact of this approach.

Abstract Objectives This exploratory study examined how meditators’ orientations (e.g., motives, expectations, beliefs) are associated with experiences, perceived benefits/risks, and practice patterns in Hong Kong, with the aim of informing safer meditation. Method We conducted a cross-sectional online survey with 164 adults. Participants ranked nine possible motives for meditation and reported their adverse experiences, perceived risks, expectations of immediate benefit, practice techniques, weekly practice time, metaphysical beliefs about thoughts and feelings, and sense of nature-relatedness (NR-6). Non-parametric methods were used to examine links between ranked motives and practice/attitudinal variables. Open-ended responses were thematically analyzed for qualitative descriptions of challenges and harms while meditating. Results Despite 21% of participants reporting experiences of negative effects from meditation, 63% perceived it as entirely risk-free, underscoring common but potentially misleading views. The qualitative survey provided a more nuanced picture. It points to persistent learning difficulties, technique-related confusion, and experiences of physical, psychological, and spiritual distress. Importantly, some participants also reframed these difficulties as opportunities for growth. The rankings revealed two broad motivational typologies. The first profile, which we termed Utilizers , prioritizes meditation as a means of stress and anxiety relief. The second, Cultivators , emphasizes self-awareness and spiritual growth. Utilizers reported fewer hours of practice, a stronger expectation of immediate benefit, and a greater tendency to view thoughts and feelings during meditation as entirely private. By contrast, Cultivators practiced for longer periods, were less likely to expect immediate improvement, and more often perceived nature as healing. Conclusions The distinction between Utilizers and Cultivators suggests that meditation is not a one-size-fits-all practice. Programs may be safer and more effective if tailored to better help Utilizers manage expectations and challenges while supporting Cultivators’ longer-term development.

ABSTRACT This study reports archaeobotanical and crop stable-isotope results from Building M and its environs at Xeropolis (Lefkandi, Euboea), a key Aegean site spanning the Late Bronze–Early Iron Age transition. The results demonstrated diachronic patterns in crop use, agricultural management, and culinary practice. The assemblage included numerous food and wild plants, indicating a variable, culture-specific cuisine. Carbon and nitrogen stable isotope analyses revealed crop-specific, phase-dependent differences in water availability and manuring. During the first occupation phase, distinct cultivation regimes—likely reflecting separate field systems—were evident for most crops. In the second phase, all crops were grown under reduced manuring, possibly reflecting shifts in subsistence and plant management, underpinning periods that led to increasing socio-political stress. The data combined with comparative regional evidence, indicate that Xeropolis maintained both southern and northern Aegean contacts, reflected in its hybrid culinary traditions, while its diet was based on local and regional traditions. Overall, the study illuminates adaptability, agricultural planning, and food culture during a pivotal period, highlighting the interplay of environment, economy, and identity.

The charm of tourist villages across Indonesia is increasingly attracting attention as an alternative driver of community-based economic growth. Tourist villages serve not only as venues for cultural and natural preservation but also as incubators for various creative economic activities led by local communities. However, behind this economic dynamism, many business practices still operate without clear legal certainty—covering issues such as business entity status, partnership contracts, financial management, and the protection of intellectual property rights. This study explores three key questions: the forms and patterns of business practices within tourist villages, the legal challenges faced by business actors, and the ideal model of business regulation to strengthen the role of rural communities in managing tourist villages. The research employs a juridical-empirical method, using a problem-solving strategy that includes literature review, interviews, and direct observation of two tourist-village sites. The findings show that most business activities in tourist villages are carried out on a micro, small, and medium scale with informally managed operations. Several areas require greater attention and improvement: strengthening synergy between local government and village communities, enhancing legal awareness among local micro-enterprise actors, and addressing tourism safety and insurance standards. The study recommends a business-law regulatory model that formally designates local government as a mandatory partner for mentoring and supervision, implemented under the principle of “Community-Led, Government-Supported,” while ensuring that all major decisions in village tourism management reflect the outcomes of community deliberation.

Context/Objective Venous thromboembolism (VTE) poses significant risks in persons with traumatic spinal cord injury (tSCI) during the acute and sub-acute post-injury phases. This study examines VTE prophylaxis, surveillance, and treatment practices in the inpatient rehabilitation setting. Design Cross-sectional. Setting Online. Participants SCI providers at Spinal Cord Injury Model Systems (SCIMS). Interventions Survey via REDCap based upon a case scenario. Outcome Measures The primary aim of the study was to examine current practices related to the screening and prevention of deep vein thrombosis (DVT), as well as the monitoring and treatment of both DVT and pulmonary embolism (PE). Results Among 47 providers surveyed about management of a patient with C6 ASIA Impairment Scale (AIS) A tetraplegia 10 days post-injury, 53.2% order routine admission duplex scans (40.0% of those providers obtain scans of both upper and lower limbs). Low molecular weight heparin (LMWH) is the preferred agent for VTE prophylaxis (91%), most commonly enoxaparin 40 mg daily, followed by 30 mg twice daily. Approximately one-third of respondents continue prophylaxis for 8 weeks, another third for 12 weeks, and the remainder varied based on individual circumstances. For proximal DVT treatment, 61.1% prescribe a LMWH followed by a direct oral anticoagulant (DOAC), and 30.6% use a DOAC alone, with the majority of providers treating for 3 months. Conclusion This survey highlights diverse practices amongst tSCI providers regarding diagnostic testing, VTE prophylaxis, and treatment approaches for persons with tSCI in SCIMS centers. The variability underscores the need for high-quality research and updated, SCI-specific clinical guidelines.

Introduction/Background: Pulmonary hypertension (PH) is a frequent complication of congenital heart disease (CHD) that is estimated to account for 30-50% of pediatric group 1 PH patients, as defined by the World Symposium on Pulmonary Hypertension. Despite advancements in the field, many of the targeted therapies are understudied in the pediatric CHD population. While prior studies examined practice patterns in dedicated PH programs, medication use across pediatric heart centers with varying access to PH specialists and resources remains unclear. Research Questions/Hypothesis: Institutional site membership to Pediatric Pulmonary Hypertension Network (PPHNet) influences practice patterns in PH medication use in acute care cardiology units at participating Pediatric Acute Care Cardiology Collaborative (PAC 3 ) centers. Methods/Approach: PAC 3 registry data (2019–present) were analyzed for patients admitted to a participating ACCU with a PH diagnosis or who received new or chronic PH therapy during a PAC 3 encounter. Centers were grouped by institutional site membership to PPHNet. Summary and comparative statistics were performed. Results/Data: There were 10,223 encounters from 4,468 unique patients (94% with CHD) across 34 PAC 3 centers; 9 centers (26%) were PPHNet members, accounting for 41% of encounters. Phosphodiesterase-5 inhibitors (PDE5-i) were the most used PH medication, followed by endothelin receptor antagonists (ERAs). PDE5-i monotherapy was the most common treatment regimen (81.7% of encounters), followed by dual therapy with PDE5-i + ERA (9.6%) and triple therapy with PDE5-i + ERA + prostacyclin (4.6%). Among patients with CHD, 2.4% involved triple therapy. Compared to non-PPHNet centers, PPHNet centers used fewer PDE5-i but more ERAs and prostacyclins (Table 1). PPHNet centers exhibited a higher frequency of dual and triple PH therapies compared to non-PPHNet centers, while monotherapy was more prevalent in non-PPHNet centers (Table 2). Conclusions: PH monotherapy was more common in non-PPHNet participating centers while multi-drug PH regimens were more frequently used at PPHNet participating centers. Practice variations exist in the use of PH medications in participating PAC 3 centers who are PPHNet institutional site members compared to non-PPHNet members, suggesting differing practice patterns in centers with a larger PH presence.

Background: The optimal timing of epinephrine dosing in out-of-hospital cardiac arrest (OHCA) remains uncertain, and practice patterns may vary across emergency medical services (EMS) agencies. Understanding how epinephrine dosing intervals align with published guidelines as well as patient and arrest characteristics may provide insight into system-level influences on cardiac arrest care. Methods: We conducted a retrospective analysis of non-traumatic adult OHCAs in the United States from 2019–2023 using the National EMS Information System (NEMSIS) database. Cases were included if they received at least two doses of epinephrine with associated timestamps. Agencies that treated fewer than five OHCAs during the study period were excluded. The most frequent (modal) epinephrine interval was calculated for each agency, and agencies were stratified into four groups: &lt;3 minutes, 3-5 minutes (guideline-reference), &gt;5&amp;&lt;10 minutes, and ≥10 minutes. Agency, patient, and cardiac arrest characteristics were compared across groups, including agency volume, urbanicity, age, sex, race/ethnicity, location, witnessed status, CPR prior to EMS arrival, and initial rhythm. Results: Of 2,170,129 OHCAs, 811,959 treated by 6,728 EMS agencies met inclusion criteria. Most OHCAs (85.9%) were treated by agencies in the guideline-reference group (3-5 minute), 9.5% ≤3 minute group, 3.5% &gt;5&amp;&lt;10 minutes, and 1.2% ≥10 minutes. Agencies with longer modal intervals were primarily urban (&gt;5&amp;&lt;10 - 94.9%, ≥10 minutes - 94.9%, 3-5 minutes - 83.7%), and had higher median cardiac arrest volumes (&gt;5&amp;&lt;10 – 2,576, ≥10 minutes - 2,125, 3-5 minutes - 432). Urbanicity and OHCA volume were similar between the 3-5 minutes and &lt;3 minutes groups. Patient and arrest characteristics were generally similar across groups, though agencies in the ≥10 minute group had a higher proportion of public location arrests (13.0% vs 10.9% for 3-5 minutes). CPR prior to EMS arrival was also less frequent in the ≥10 minute group (21.5 vs. 26.0% for 3-5 minutes). Conclusion: The majority of agencies demonstrated epinephrine dosing intervals consistent with guidelines. A small proportion exhibited longer intervals, particularly among higher-volume urban agencies, which suggests this is likely an intentional practice. These findings highlight variability in epinephrine dose-interval practices across US EMS agencies with the potential to explore resulting differences in OHCA outcomes.

Background: On Apr. 1, 2022, the AHA/ACC/HFSA released guidelines recommending intravenous (IV) iron for patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency (ID) based on evidence from randomized trials suggesting improved patient outcomes. However, adherence to this Class 2a recommendation remains understudied. Methods: Using TriNetX’s US Collaborative Network, an aggregation of ~125 million de-identified patient electronic health records, we identified HFrEF patients with ID across eight 6-month time blocks relative to Apr. 1, 2022: one before and seven after, ending on May 16, 2025—the date of data extraction. For each time block, we applied a standardized cohort selection workflow to identify adults with HFrEF (ICD-10-CM: I50.2) and ID, defined as ferritin &lt;100 μg/L or 100–300 μg/L with transferrin saturation &lt;20%. We then searched for orders for oral, injectable, or unspecified iron placed after the diagnosis of ID and extracted relevant data. Chi-square tests were used to assess trends. Results: The sample of HFrEF patients with ID in each time block ranged from 1,753 to 35,810. In the 6 months prior to guideline release, the treatment rate was 25.4%. Post-guidelines, we observed a consistent increase in the treatment rates (p&lt;0.001), peaking at 42.4% between Oct. 2024 and Mar. 2025 before decreasing between Apr. 2025 and May 16, 2025. Additionally, the percentage of treated patients prescribed oral and unspecified iron decreased (p&lt;0.001 for both), whileinjectable formulations remained relatively consistent at approximately 48% with a slight overall increase across time blocks (p&lt;0.001). Conclusions: Despite updated national guidelines endorsing IV iron therapy for HFrEF patients with ID, treatment remains suboptimal across U.S. clinical settings. A marked increase in treatment rates was observed following guideline publication, suggesting growing clinician awareness and evolving practice patterns. Notably, even when accounting for all forms of iron, treatment rates remained below 50%, highlighting a significant gap relative to guideline intent, which specifically recommends IV iron. The shift away from oral and unspecified formulations toward consistent use of injectable iron likely reflects increased alignment with evidence-based care and improved documentation. These findings highlight the need for targeted interventions to promote consistent adoption of guideline-directed therapies in this high-risk population.

Introduction: Industry-funded level one data supports dual pathway inhibition (DPI; aspirin and low-dose rivaroxaban) after percutaneous vascular interventions (PVI), but interventionalists debate its widespread adoption. Research Questions: What are the rates of and factors associated with pre and post-PVI DPI prescription in the Vascular Quality Initiative (VQI)? Methods: We queried the VQI for PVI (2022-2024), excluding acute limb ischemia, aneurysmal disease, COVID+ patients, and those on full dose anticoagulation. DPI was defined as any antiplatelet therapy plus 2.5mg twice daily of rivaroxaban. Mann-Kendal tests evaluated pre- and post-PVI antithrombotic prescription trends. Mixed-effects logistic regression modeled factors associated with pre- and post-PVI DPI prescription, clustered by physician and treating facility, to evaluate the influence of provider and practice-level variation beyond patient characteristics. Results: There were no significant changes in pre-PVI prescription patterns over the study period. DPI prescription increased non-significantly from 0/20,058 (0%) in early 2022 to 434/9,488 (4.6%) in late 2024 (Figure 1a). Female sex, Latinx ethnicity, CAD, statin, and prior revascularization were associated with increased pre-PVI DPI prescription. Increasing age and BMI, CHF, ESRD, current smoking, and tissue loss were negatively associated with pre-PVI DPI prescription (Table 1). Physician accounted for 17.4% of variation in pre-PVI DPI prescribing, while treating facility accounted for 14.4% for a total of 31.8%. Post-PVI DPI prescription increased significantly over the study period from 0/20,075 (0%) in early 2022 to 742/9,200 (8.1%) in late 2024. Aspirin monotherapy decreased significantly (Figure 1b). Female sex, CAD, increased Trans-Atlantic Inter-Society Consensus (TASC) score, prior revascularization, drug coated balloon, and stent placement were associated with increased post-PVI DPI prescription. Increasing age and BMI, CHF, ESRD, and atherectomy were negatively associated with DPI prescription (Table 2). Physician accounted for 22.0% of variation in post-PVI DPI prescribing, whereas treating facility accounted for 12.6% for a total of 34.6%. Conclusions: Pre and post-PVI DPI prescription was low in our cohort, although did increase significantly to 8.1% post-PVI during the study period. Physician and treating facility practice patterns accounted for one third of the variation in DPI prescribing.

Introduction: Medicare is the largest health care payer in the U.S., and private-payer reimbursement is often influenced by Medicare rates. Thus, trends in Medicare reimbursement have implications for specialty practice patterns. However, literature on Medicare trends for cardiac electrophysiology (EP) procedures is limited. Medicare sets rates by assigning relative value units (RVUs) to services, each linked to a Current Procedural Terminology (CPT) code. RVUs are multiplied by a conversion factor to calculate reimbursement. Research Question: What are the inflation-adjusted Medicare reimbursement trends for EP procedures for 2013-2022? Methods: The Medicare Physician and Other Practitioners by Geography and Service Dataset was queried for EP CPT codes. Medicare Part B reimbursements were compiled and averaged for 2013-2022, limited to facility settings. All rates and conversion factors were adjusted for inflation to 2022 dollars using the Consumer Price Index. Aggregate reimbursement rates were weighted by each CPT code’s share of annual Medicare expenditures. Codes were categorized by procedure type as EP studies/ablations or implantable electronic devices. Results: Inflation-adjusted average reimbursement for all EP procedures increased 16.9% from 2013 to 2022. EP studies/ablations saw a 0.7% decrease, while implantable devices increased 31.7%. Over the same period, the Medicare RVU conversion factor declined by 16.6% (Figure 1). EP studies/ablations grew as a share of Medicare EP expenditures from 37.4% in 2013 to 47.6% in 2022, while implantable devices declined from 62.6% to 52.4%. Volumes for EP studies/ablations rose by 48.1%, while implantable devices declined by 27.8%. Among devices, pacemaker expenditure fell 14.6% with a 25.7% volume drop, and implantable cardioverter-defibrillator expenditure fell 12.2% with a 40.5% volume drop. Among EP studies/ablations, ventricular tachycardia ablation expenditure rose 38.2% with a 59.7% volume increase, supraventricular tachycardia ablation expenditure fell 17.3% with a 4.5% volume drop, and atrial fibrillation (AF) ablation expenditure increased 169.5% and volume grew 210.0%. Conclusions: From 2013 to 2022, inflation-adjusted Medicare reimbursement for EP procedures grew despite a declining RVU conversion factor. This trend was driven by increased implantable devices reimbursement and rising EP studies/ablation volume, particularly AF ablation, which may reflect expanding evidence favoring ablation for AF.

Introduction: While recommendations exist to guide timing of coronary artery bypass grafting (CABG) following STEMI, the optimal timing of staged CABG following percutaneous coronary intervention (PCI) for STEMI is unclear. Our aim is to utilize national claims data to assess national practice patterns for the timing of staged CABG following PCI for STEMI, predictors of timing and patient presentation, and the association of timing with post-operative outcomes. Methods: Inpatient Medicare MedPAR files were reviewed to identify patients aged ≥65 years who underwent isolated CABG from 10/2016-12/2021, who underwent urgent PCI for STEMI within the 12-months prior to CABG. Patients with a diagnosis of in-stent restenosis were excluded, isolating patients undergoing CABG for residual native disease. Timing of CABG relative to PCI was identified as same admission, elective readmission, and urgent readmission. The primary endpoint was five-year survival, assessed using propensity-matched Kaplan-Meier analysis with log-rank test, and Cox proportional hazards models. Comparison groups included same admission versus elective readmission, and elective versus urgent readmission. Among patients readmitted for CABG, predictors of presenting urgently were assessed utilizing logistic regression analysis. Results: During the study period, 428,867 patients underwent isolated CABG; of those, 14,652 (3.4%) underwent urgent PCI for ACS in the 12-months prior to CABG. After excluding patients with in-stent stenosis and NSTEMI diagnosis, the final cohort consisted of 7,792 STEMI patients who underwent CABG within 12-months of PCI for residual native disease. Among this cohort, 3,532 (45.3%) had CABG during the same admission as PCI, 2,805 (36.0%) returned for elective CABG, and 1,466 (18.8%) returned urgently for CABG. Patients undergoing same admission CABG had inferior five-year survival than those readmitted electively; however, patients readmitted urgently also had significantly reduced five-year survival (Figure 1, Table 1). Patients with increased comorbidity burden were more likely to be re-admitted urgently for CABG, with the highest risk ≤14 days post-PCI (Table 2). Conclusion: Among patients who undergo PCI for STEMI with residual coronary disease requiring CABG, optimal outcomes are observed in the setting of discharge and elective readmission; however, risk of disease progression and urgent readmission for revascularization must be weighed carefully.

To characterize nationwide real-world practice patterns and complications of pediatric ocular surface inflammatory diseases (POSID) using a large US health insurance claims database. This retrospective cohort study analyzed patients younger than 18 years diagnosed with POSID in the Optum Labs Data Warehouse between 2018 and 2019. Blepharokeratoconjunctivitis (BKC), herpes simplex keratoconjunctivitis (HSK), and vernal keratoconjunctivitis (VKC) were identified by ICD codes. Clinical data from 6 months before to 3 years after the index visit were assessed. Multivariate logistic regression identified risk factors for amblyopia. Among 6116 children (67.1% aged 5-15 years; 56.6% male), HSK showed the highest baseline rates of corneal scarring (7.5%) and ulceration (5.5%), compared with BKC (2.3%, 2.7%) and VKC (1.1%, 0.9%) (P < 0.001). High-potency topical corticosteroids were more frequently prescribed for BKC (17.8%) than HSK (15.0%) or VKC (14.2%) (P = 0.02), while topical immunomodulators were used in only 1.7% of cases despite recommendations. Amblyopia prevalence rose from 2.5% to 4.5% over 3 years, with stromal scarring at diagnosis (odds ratio 2.43, 95% confidence interval 1.40-4.24) and high-potency corticosteroid use (odds ratio 1.60, 95% confidence interval 1.17-2.18) as independent risk factors. POSID subtypes exhibit distinct clinical features, significant differences in management, and progressive complications over time. Nationwide patterns show over-reliance on corticosteroids, underuse of immunomodulators, and gaps between guideline recommendations and practice, underscoring the need for earlier recognition, steroid-sparing therapy, and sustained inflammation control.

A survey to assess practice patterns among clinicians administering collagenase Clostridium histolyticum for Peyronie's disease.

Background/Purpose: Teeth prepared for fixed dental prostheses are subject to various types of insults in the oral cavity. Therefore, to protect the tooth, the pulp, and supporting structures, provisional restorations are mandatory. Our study aimed to evaluate the knowledge and clinical practices regarding provisional fixed dental prostheses (PFDPs) among dental professionals in Saudi Arabia. Materials and Methods: A cross-sectional study based on a self-administered online survey was conducted among 312 dentists (general practitioners and specialists) across Saudi Arabia. The questionnaire assessed participants’ knowledge (11 items) and clinical practices (9 items) related to PFDPs. Statistical analyses included descriptive statistics, chi-square tests, and multivariate logistic regression. Results: Only 46.5% of respondents demonstrated adequate knowledge of PFDPs. Knowledge was significantly higher among specialists than general practitioners (57.4% vs. 41.7%, p = 0.011), and specialists were more likely to recognize the influence of PFDPs on treatment outcomes. Clinical practice patterns indicated that even though 94.2% of respondents frequently placed PFDPs, only 66.0% always did so. Moreover, 21.2% of respondents rarely or never disinfect PFDPs. Public sector dentists and specialists were more likely to use custom-made PFDPs. Key gaps in knowledge were observed regarding the materials and equipment used in the fabrication of PFDPs, particularly concerning CAD/CAM technology. Conclusions: Although most dentists in Saudi Arabia provided PFDPs to their patients, significant gaps remain in their knowledge, particularly regarding fabrication materials and techniques. Targeted educational interventions, especially for general practitioners, are needed to enhance clinical outcomes.

Practice Patterns and Outcomes for Tricuspid Interventions Among Medicare Patients With Cardiac Implantable Electronic Devices.

We conducted an online survey of 574 physiatrists in the Department of Veterans Affairs (VA) system to assess demographics and practice patterns in July 2024 and obtained 392 responses (68.3%). The majority of the physiatry workforce reported being between the ages of 36-65 yrs old (82.1%). Most physiatrists (35%) have been employed by the VA between 1 and 5 yrs. The number of physiatrists per facility ranged from 1 to 27 and most (86%) reported being employed full-time. Only 62% of the physiatrists have a faculty appointment with their affiliated academic institution while 67% teach physical medicine and rehabilitation residents. The majority of the physiatrists (96%) are board-certified in physical medicine and rehabilitation and 40% hold subspecialty certification. Electrodiagnostics is practiced exclusively by physical medicine and rehabilitation in 30% and is shared between physical medicine and rehabilitation and neurology in 64%. The most commonly reported practice type for physiatrists in the VA system was outpatient musculoskeletal medicine. Joint and soft tissue injections top the list of procedures performed by physiatrists. About 11% perform spinal injections. Use of orthobiologics for was reported by 14%. The greatest need identified was cancer rehabilitation. This VA physiatry workforce sheds light into the evolving practice of physiatry and future needs, essential for program and succession planning.

Influence of Specialty on Endovascular Practice Patterns and Outcomes in the BEST-CLI Trial.

Vascular Surgery Residents and Fellows Graduate at Higher Levels of Proficiency in Endovascular as Compared to Open Aortic Operations.

13285 Twenty-Two Years of Minimally Invasive Gynecologic Surgery in the US and Canada: Geographic Trends and Practice Patterns after Fellowship