Practice Recommendations For Use Research Articles

Society for Vascular Surgery best practice recommendations for use of social media

The use of social media (SoMe) in medicine has demonstrated the ability to advance networking among clinicians and other healthcare staff, disseminate research, increase access to up-to-date information, and inform and engage medical trainees and the public at-large. With increasing SoMe use by vascular surgeons and other vascular specialists, it is important to uphold core tenets of our commitment to our patients by protecting their privacy, encouraging appropriate consent and use of any patient-related imagery, and disclosing relevant conflicts of interest. Additionally, we recognize the potential for negative interactions online regarding differing opinions on optimal treatment options for patients. The Society for Vascular Surgery (SVS) is committed to supporting appropriate and effective use of SoMe content that is honest, well-informed, and accurate. The Young Surgeons Committee of the SVS convened a diverse writing group of SVS members to help guide novice as well as veteran SoMe users on best practices for advancing medical knowledge-sharing in an online environment. These recommendations are presented here with the goal of elevating patient privacy and physician transparency, while also offering support and resources for infrequent SoMe users to increase their engagement with each other in new, virtual formats.

Best Practice Use Of Wearable Accelerometers In Gait Biomechanics

Advances in wearable technology provide opportunities to collect biomechanical data in real time and non-lab settings. However, there are currently no standards for best practice use of wearable sensors for gait applications. PURPOSE: Provide best practice recommendations for use of wearable accelerometers (WA) in gait biomechanics. METHODS: Literature was reviewed to determine appropriate WA range for gait biomechanics and establish procedures for calibrating and processing WA data for gait applications. Drop tests of three, simultaneously initialized, commercially available WAs were performed to determine signal time synchronization and 1 g acceleration accuracy. WAs were secured to different lower limb locations (pelvis, knee, ankle) and walking and running trials performed. Peak acceleration magnitude and timing were compared within and among WAs by location and gait type. Vertical ground reaction force (GRFvert) was estimated using a regression model, developed based on pelvis acceleration data, to determine the sensitivity of the GRFvert estimates to WA placement. RESULTS: Peak lower limb accelerations can exceed 25 g during running. WAs initialized at the same time had significant temporal differences (up to 1.06 s). Accelerations during freefall were within 17 % of 1 g. After synchronizing WA signals based on the drop test results, there were no significant differences in WA magnitude and timing among three WAs located around the right iliac crest, but there were significant acceleration differences among WAs located at the right iliac crest, knee, and ankle. Walking and running peak GRFvert estimates based on accelerations of the iliac crest differed from estimates based on accelerations of the knee (-5 ± 28 N and -142 ± 80 N, respectively) and ankle (261 ± 28 N and -274 ± 66 N, respectively). CONCLUSIONS: WAs should be: (1) selected to measure a range greater than 25 g, (2) calibrated to ensure accuracy, (3) manually time synched if using multiple sensors, (4) placed carefully though exact placement is not critical to anatomical site acceleration estimates near the hip, and (5) located at the same anatomical site that was used to develop an acceleration-dependent model if the goal is to use that model to estimate a particular quantity (i.e. GRFvert).

EDITORIAL COMMENT

The authors have conducted informative and important health services research on the “trends in extended-duration pharmacological prophylaxis (EDPP) to prevent venous thromboembolism (VTE) following radical cystectomy (RC)” using the national administrative claims database for the period 2012-2017. 1 URL-D-19-01447R1. 2019. Google Scholar Allowing for limitations of methodology using such databases, it was notable that a low proportion (19%) of cases received EDPP overall in the study period. Encouragingly, there was an improving time-trend from 9% utilization in 2012 to 26% in 2017. However, given that VTE following radical abdominal and/or pelvic surgery for cancer is a major cause of morbidity, mortality and cost, the findings of the current study portray an unfavorable picture for the current state of clinical practice with respect to EDPP utilization. Indeed, provided there are no contraindications, most international and/or national guidelines recommend the use of EDPP in this setting for high-risk cases. 2 Tikkinen KAO Craigie S Agarwal A et al. Procedure-specific risks of thrombosis and bleeding in urological cancer surgery: systematic review and meta-analysis. Eur Urol. 2018; 73: 242-251 Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar ,3 Key NS Bohlke K Falanga A Venous thromboembolism Prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update summary. J Oncol Practice. 2019; (Jop1900368) Crossref PubMed Scopus (19) Google Scholar The AUA Best Practice Statement from 2008 highlights the importance of thromboprophylaxis following RC, amongst other urological procedures, but falls short of touching upon the subject of EDPP in that context. 4 Forrest JB Clemens JQ Finamore P et al. AUA best practice statement for the prevention of deep vein thrombosis in patients undergoing urologic surgery. J Urol. 2009; 181: 1170-1177 Crossref PubMed Scopus (90) Google Scholar However, the evidence is accumulating to issue clear guidelines in support of EDPP, particularly as over 50% of symptomatic VTEs occur after discharge from hospital. 5 Sagalovich D Say R Kaouk J Mehrazin R The role of extended venous thromboembolism prophylaxis following urologic pelvic surgery. Urol Oncol. 2018; 36: 83-87 Crossref PubMed Scopus (5) Google Scholar , 6 VanDlac AA Cowan NG Chen Y et al. Timing, incidence and risk factors for venous thromboembolism in patients undergoing radical cystectomy for malignancy: a case for extended duration pharmacological prophylaxis. J Urol. 2014; 191: 943-947 Crossref PubMed Scopus (76) Google Scholar , 7 Kukreja JE Levey HR Scosyrev E et al. Effectiveness and safety of extended-duration prophylaxis for venous thromboembolism in major urologic oncology surgery. Urol Oncol. 2015; 33 (387.e387-316) Crossref PubMed Scopus (35) Google Scholar Lower compliance to EDPP use may in part be due to underappreciation of the risks in the absence of clear guidelines. 8 Sterious S Simhan J Uzzo RG et al. Familiarity and self-reported compliance with american urological association best practice recommendations for use of thromboembolic prophylaxis among american urological association Members. J Urol. 2013; 190: 992-998 Crossref PubMed Scopus (40) Google Scholar By highlighting the current trends in EDPP utilization after RC, the current study provides opportunities to look more closely into this issue and update the guidelines in relation to EDPP use following major urological oncological surgery, including RC.

Best Practices for Use of Blended Learning

Objective. To determine instructional best practice recommendations for use of blended learning from the students' perspective. Methods. Three focus groups were created, one for each of the first three years at a school of pharmacy. The focus group discussions were audio recorded and transcribed for content analysis. Results. Ten instructional best practices were identified from the focus groups: setting the stage, consistency when team teaching, timeliness in posting materials, time on task, accountability for online activities, use of structured active learning, instructor use of feedback on student preparation, incorporation of student feedback into the course, short reviews of online material during class, and ensuring technologies are user friendly. Conclusion. Instructors using blended learning should consider incorporating these best practices into their course design and management. More evaluation is needed to see if implementation of these practices affects student performance.

Familiarity and Self-Reported Compliance with American Urological Association Best Practice Recommendations for Use of Thromboembolic Prophylaxis among American Urological Association Members

Thromboprophylaxis with subcutaneous heparin or low molecular weight heparin is now an integral part of national surgical quality and safety assessment efforts, and has been incorporated into the current AUA Best Practice Statement. We evaluated familiarity and compliance with the AUA Best Practice Statement, assessed practice patterns in terms of perioperative thromboprophylaxis and specifically examined self-reported compliance in high risk patients undergoing radical cystectomy. An electronic survey was sent to AUA members with valid e-mail addresses (10,966). Associations between AUA Best Practice Statement adherence and factors such as urological specialty, graduation year and guideline familiarity were assessed using chi-square analyses and generalized estimating equations. With 1,210 survey responses the largest group of respondents was urological oncologists and/or laparoscopic/robotic specialists (26.0%). This group was more likely to use thromboprophylaxis than nonurological oncologists and/or laparoscopic/robotic specialists in high risk patients (OR 1.3, CI 1.1-1.5). Respondents aware of the AUA Best Practice Statement guidelines (50.7%) were more likely to use thromboprophylaxis (OR 1.4, CI 1.2-1.6). Although 18.1% of urological oncologists and/or laparoscopic/robotic specialists and 34.2% of nonurological oncologists and/or laparoscopic/robotic specialists avoided routine thromboprophylaxis in patients undergoing radical cystectomy, the former were more likely to use thromboprophylaxis (p <0.0001) than other respondents. Urologists graduating after the year 2000 used thromboprophylaxis in high risk patients undergoing radical cystectomy more often than did earlier graduates (79.2% vs 63.4%, p <0.0001). Although younger age and self-reported urological oncologist and/or laparoscopic/robotic specialist status correlated strongly with thromboprophylaxis use, self-reported adherence to AUA Best Practice Statement was low, even in high risk cases with clear AUA Best Practice Statement recommendations such as radical cystectomy. These data identify opportunities for quality improvement in patients undergoing major urological surgery.

Legislating child restraint usage –Its effect on self-reported child restraint use rates in a central city

Objective To assess the effect of the newly enacted child passenger safety law, Wisconsin Act 106, on self-report of proper restraint usage of children in Milwaukee's central city population. Method A prospective, non-randomized study design was used. The settings used were (a) a pediatric urban health center, and (b) two Women, Infants and Children offices in Milwaukee, Wisconsin. Participants included 11,566 surveys collected over 18 months that spanned the pre-legislation and post-legislation time periods from February 2006 through August 2008. Results The study set out to assess appropriate child passenger restraint. The results showed that the changes in adjusted proper restraint usage rates for infants between the pre-law, grace period, and post-fine periods were 94%, 94%, and 94% respectively. For children 1–3 years old, the adjusted proper usage rates were 65%, 63%, and 59%, respectively. And for children 4–7 years old, the rates were 43%, 44% and 42%, respectively. There was a significant increase in premature booster seat use in children who should have been restrained in a rear- or forward-facing car seat (10% pre-law, 12% grace period, 20% post-fine; p < 0.0005). There was no statistically significant change over time in unrestrained children (2.1%, 1.7%, 1.7%, p = 0.7, respectively). Conclusions The passage of a strengthened child passenger safety law with fines did not significantly improve appropriate restraint use for 0–7 year olds, and appropriate use in 1–7 year olds remained suboptimal with a majority of urban children inappropriately restrained. Although the number of unrestrained children decreased, we identified an unintended consequence of the legislation – a significant increase in the rate of premature belt-positioning booster seat use among poor, urban children. Impact on Industry The design of child restraint systems maximizes protection of the child. Increasing reports of misuse is a call to those who manufacture these child passenger restraints to improve advertising and marketing to the correct age group, ease of installation, and mechanisms to prevent incorrect safety strap and harness placement. To ensure accurate and consistent use on every trip, car seat manufacturers must ensure that best practice recommendations for use as well as age, weight, and height be clearly specified on each child restraint. The authors support the United States Department of Transportation's new consumer program that will assist caregivers in identifying the child seat that will fit in their vehicle. In addition, due to the increase in premature graduation of children into belt-positioning booster seats noted as a result of legislation, promoting and marketing booster seat use for children less than 40 pounds should not be accepted. Child passenger safety technicians must continue to promote best practice recommendations for child passenger restraint use and encourage other community leaders to do the same.

AUA Best Practice Statement for the Prevention of Deep Vein Thrombosis in Patients Undergoing Urologic Surgery

Summary of VTE prophylaxis recommendations Level of risk Prophylactic treatmentLow Risk ● No prophylaxis other than early ambulationModerate Risk ● Heparin 5000 units every 12 hours subcutaneous starting after surgery ● OR *Enoxaparin 40 mg. (Cr Cl 30 ml/min. 30 mg.) subcutaneous daily ● OR Pneumatic compression device if risk of bleeding is highHigh Risk ● Heparin 5000 units every 8 hours subcutaneous starting after surgery ● OR *Enoxaparin 40 mg. (Cr Cl 30 ml/min. 30 mg.) subcutaneous daily ● OR Pneumatic compression device if risk of bleeding is highVery High Risk ● *Enoxaparin 40 mg. (Cr Cl 30 ml/min. 30 mg.) subcutaneous daily and adjuvant pneumatic compression device, or ● Heparin 5000 units every 8 hours subcutaneous starting after surgery and adjuvant pneumatic compression device* Guidelines and Cautions for Enoxaparin Use ● In patients with a body weight 150 Kg. consider increasing prophylaxis dose of Enoxaparin to 40 mg. subcutaneous every 12 hours. ● Withhold Enoxaparin generally for at least 2 to 3 days after major trauma, and then only consider use after review of current patient condition and risk benefit ratio.