Private Patients Research Articles

Experiences of health service access: A qualitative interview study of people living with Parkinson's disease in Ireland.

People with Parkinson's disease (PD) do not always access specialist outpatient services in a timely manner in Ireland. The perspectives of people living with PD, relating to service access, are largely absent in the existing literature. To explore experiences of PD service access for people living with PD, using a qualitative approach. Purposive maximum variation sampling was used. Semi-structured telephone interviews were conducted with 25 service users, including people with PD (n = 22) and supporting carers (n = 3). Informed consent was obtained from all participants. Interviews ranged in duration from 30 to 90 min. Data were managed in NVivo 12 and interpreted inductively using thematic analysis. The researchers were reflexive throughout the research process. The Consolidated Criteria for Reporting Qualitative Research checklist was employed to maximise transparency. The findings highlight several key barriers to and facilitators of equitable and timely service access. Three key themes were identified comprising experiences of PD service access including 'geographical inequity', 'discriminatory practices', and 'public and private system deficits'. Together, these themes illustrate how a two-tiered and under-resourced health system lacks capacity, in terms of infrastructure and workforce, to meet PD needs for both public and private patients in Ireland. These findings point to problems for PD care, relating to (i) how the health system is structured, (ii) the under-provision and under-resourcing of specialist outpatient PD services, including medical, nursing, and multidisciplinary posts, and (iii) insufficient PD awareness education and training across health settings. The findings also show that telemedicine can provide opportunities for making access to certain aspects of PD care more flexible and equitable, but the feasibility and acceptability of technology-enabled care must be assessed on an individual basis. Implications for policy, practice and research are discussed. The design and conduct of this study were supported by an expert advisory group (EAG) of 10 co-researchers living with PD. The EAG reviewed the interview schedule and the protocol for this study and provided detailed feedback from their perspective, to improve the methods, including the interview approach. The group also reviewed the findings of the study and contributed their insights on the meaning of the findings, which fed into this paper.

Developed A Hybrid Optimal Feature Vector Selection with Blockchain Technology for Smart Healthcare 4.0

The health economy has been an innovative technology since time-honored. Preserving and maintaining patient data are essential in a routine life. Patient’s medical information is very important for every individual not only for patients but also for doctors who are examining them. Advances in sensing technology, processing of data, and communication protocols have transformed the healthcare industry. Patients, physicians, hospitals, and other stakeholder may keep vital data and medical records with the use of electronic healthcare records (EHR). The goal of research should be to develop a Hybrid Optimal Feature Vector Selection with Blockchain Technology (HOFVS-BT) for smart healthcare 4.0 to improve the secure transmission of data which is supported intelligent IoT and medical detection platform possible. For Feature vector selection, proposed an Orthogonal Wolf Optimization (OWO) algorithm. Furthermore, safeguarding private patient details is taken into account by establishing an upgraded Blockchain-based IoT data security solution that not only secures the data, but also fosters trust between patients/users and healthcare service providers.

In-hospital outcomes by insurance type among patients undergoing percutaneous coronary interventions for acute myocardial infarction in New South Wales public hospitals

BackgroundInternational evidence suggests patients receiving cardiac interventions experience differential outcomes by their insurance status. We investigated outcomes of in-hospital care according to insurance status among patients admitted in public hospitals with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).MethodsWe conducted a cohort study within the Australian universal health care system with supplemental private insurance. Using linked hospital and mortality data, we included patients aged 18 + years admitted to New South Wales public hospitals with AMI and undergoing their first PCI from 2017–2020. We measured hospital-acquired complications (HACs), length of stay (LOS) and in-hospital mortality among propensity score-matched private and publicly funded patients. Matching was based on socio-demographic, clinical, admission and hospital-related factors.ResultsOf 18,237 inpatients, 30.0% were privately funded. In the propensity-matched cohort (n = 10,630), private patients had lower rates of in-hospital mortality than public patients (odds ratio: 0.59, 95% CI: 0.45–0.77; approximately 11 deaths avoided per 1,000 people undergoing PCI procedures). Mortality differences were mostly driven by STEMI patients and those from major cities. There were no significant differences in rates of HACs or average LOS in private, compared to public, patients.ConclusionOur findings suggest patients undergoing PCI in Australian public hospitals with private health insurance experience lower in-hospital mortality compared with their publicly insured counterparts, but in-hospital complications are not related to patient health insurance status. Our findings are likely due to unmeasured confounding of broader patient selection, socioeconomic differences and pathways of care (e.g. access to emergency and ambulatory care; delays in treatment) that should be investigated to improve equity in health outcomes.

Trends of Private Drugs' Sales and Costs Incurred by Patients on Anti-tuberculosis Drugs in Selected Districts of Jharkhand (2022): Results From Sub-national TB-Free Certification.

The government of India is committed to eliminating tuberculosis (TB) by 2025 under the National Tuberculosis Elimination Programme which provides free investigations and treatment as well as incentives for nutritional support during their treatment course. Many TB patients prefer to seek treatment from the private sector which sometimes leads to financial constraints for the patients. Our study aims to find the burden of TB patients in the private sector and the expenses borne by them for their treatment. Sales data of rifampicin-containing formulationdrug consumption in the private sector of six districts of Jharkhand was collected from Clearing and Forwarding agencies. Based on the drug sales data, the total incurring costs of the drugs, total number of patients, and cost per patient seeking treatment from the private sector were calculated for the year 2015-2021. ANOVA and the post hoc test (Tukey honestly significant difference (HSD)) were applied for analysis. There was a marked difference amongst all the districts in relation to all the variables namely total costs, cost per patient, and total private patients seeking treatment from the private sector which was statistically significant (p < 0.001). East Singhbhum had the highest out-of-pocket expense and private patients as compared to all six districts. Lohardaga showed the sharpest decline in total private patients from 2015 to 2021. The average cost borne by private patients in 2015 was INR 1821 (95% CI 1086 - 2556) which decreased to INR 1033 (95% CI 507 - 1559) in 2021. From the study, it was concluded that the purchase of medicines for TB treatment from the private sectoris one of the essential elements in out-of-pocket expenditure (OOPE) borne by TB patients. Hence, newer initiatives should be explored to foresee the future OOPE borne by the patients and decrease OOPE-induced poverty.

Coping with the economic burden of non-communicable diseases among hypertensive and diabetic patients in private and public health facilities in Ado-Ekiti, Nigeria.

To assess and compare how private and public health facilities patients cope with the economic burden of non-communicable diseases. Comparative cross-sectional study. Thirty-nine private and eleven public health facilities in Ado-Ekiti, Nigeria. Three hundred and forty-eight (Private:173; Public:175) patients with hypertension or diabetes, or both were recruited. Specific coping methods and numbers of coping strategies used by participants, as well as the perceived ability of participants to cope with the economic burden of non-communicable diseases. Majority of participants paid through out-of-pocket (OOP) than through health insurance(HI) (Private:OOP:90.2% HI:9.8%; Public:OOP:94.3% HI:5.7%; p=0.152). More participants in private used instalment payments(p<0.001). However, other coping strategies showed no significant difference in both groups(p>0.05). Delayed treatment (Private:102; Public:95) was the most used strategy in both arms, and the number of strategies used by the participants showed no significant difference(p=0.061). Lower levels of education, out-of-pocket payment, increasing number of clinic visits, and hospital admission were associated with the use of higher numbers of coping strategies in both groups while being female and retired/unemployed were associated with the private arm. Although most patients in both groups pay out-of-pocket and use detrimental coping strategies, more patients in private arm use instalment payment, a non-detrimental method. Healthcare providers, especially public providers, should adopt policies encouraging patients to use non-detrimental coping strategies to meet their healthcare expenditures. None declared.

Hospital response to Activity-Based Funding and price incentives: Evidence from Ireland

Activity-Based Funding (ABF) is a funding policy incentivising hospitals to deliver more efficient care. ABF can be complemented by additional price incentives to further drive hospital efficiency. In 2016, ABF was introduced for public patients admitted to Irish public hospitals. Additionally, a price incentive to perform laparoscopic cholecystectomy as day-case surgery was introduced in 2018. Private patient activity in public hospitals was subject to neither ABF nor price incentive. Using national Hospital In-Patient-Enquiry activity data 2013–2019, we evaluated the impact of ABF and the price incentive for laparoscopic cholecystectomy surgery in Ireland. We exploit variation in hospital payment for public and private patients treated in public acute Irish hospitals and employ a Propensity Score Matching Difference-in-Differences approach. We estimate the funding change impacts across outcomes measuring the proportion of day-case admissions and length of stay. We found no significant impact for either outcomes linked to ABF introduction. Similarly, no impacts linked to the price incentive were observed. It appears providers of laparoscopic cholecystectomy in Irish public hospitals did not react to the new funding mechanisms. The implementation of the funding policies did not improve hospital efficiency. Further strengthening of these new funding mechanisms are required to deliver more efficient care.

THROUGH THE LENS OF PRINCIPLED DATA PRACTICE A GROUNDBREAKING EXPLORATION INTO ETHICAL HEALTHCARE PLATFORMS

Fundamental Ethical Principles of Data Privacy and Security and how Healthcare Data Platforms Ensure the Confidentiality and Integrity of Patient Information, Safeguarding it Against Unauthorized Access and Cyber Threats. In the last years, there has been a considerable increase in the usage of electronic health records (EHRs). Credit card numbers, full name, bank account numbers, social security numbers, street addresses, phone numbers, passport numbers, treatments, and medical histories are all private patient information that may be found in health information systems. This information must be safeguarded against manipulation and fraud by other parties. EHRs are anticipated to boost healthcare delivery effectiveness, enhance the standard of care, and reduce mounting budgetary strain. Despite these advantages, there is a possibility that security issues with EHRs compromise patient data confidentiality and privacy. This research paper focuses on the ethical principles—privacy, ownership, transparency, data security, informed consent, data minimization, purpose limitation, and accountability—to help guarantee that patient databases maintain the confidentiality and integrity of patient information while protecting it from unapproved access and online threats. Additionally, numerous systems for privacy and integrity, such as vulnerability analyses and role-based access control, support the objectives of contemporary healthcare while preserving patient privacy.

Adult Patients' Experiences of Using a Patient Portal With a Focus on Perceived Benefits and Difficulties, and Perceptions on Privacy and Security: Qualitative Descriptive Study.

Patient portals can facilitate patient engagement in care management. Driven by national efforts over the past decade, patient portals are being implemented by hospitals and clinics nationwide. Continuous evaluation of patient portals and reflection of feedback from end users across care settings are needed to make patient portals more user-centered after the implementation. The aim of this study was to investigate the lived experience of using a patient portal in adult patients recruited from a variety of care settings, focusing on their perceived benefits and difficulties of using the patient portal, and trust and concerns about privacy and security. This qualitative descriptive study was part of a cross-sectional digital survey research to examine the comprehensive experience of using a patient portal in adult patients recruited from 20 care settings from hospitals and clinics of a large integrated health care system in the mid-Atlantic area of the United States. Those who had used a patient portal offered by the health care system in the past 12 months were eligible to participate in the survey. Data collected from 734 patients were subjected to descriptive statistics and content analysis. The majority of the participants were female and non-Hispanic White with a mean age of 53.1 (SD 15.34) years. Content analysis of 1589 qualitative comments identified 22 themes across 4 topics: beneficial aspects (6 themes) and difficulties (7 themes) in using the patient portal; trust (5 themes) and concerns (4 themes) about privacy and security of the patient portal. Most of the participants perceived the patient portal functions as beneficial for communicating with health care teams and monitoring health status and care activities. At the same time, about a quarter of them shared difficulties they experienced while using those functions, including not getting eMessage responses timely and difficulty finding information in the portal. Protected log-in process and trust in health care providers were the most mentioned reasons for trusting privacy and security of the patient portal. The most mentioned reason for concerns about privacy and security was the risk of data breaches such as hacking attacks and identity theft. This study provides an empirical understanding of the lived experience of using a patient portal in adult patient users across care settings with a focus on the beneficial aspects and difficulties in using the patient portal, and trust and concerns about privacy and security. Our study findings can serve as a valuable reference for health care institutions and software companies to implement more user-centered, secure, and private patient portals. Future studies may consider targeting other patient portal programs and patients with infrequent or nonuse of patient portals.

Digital transformation in healthcare using eagle perching optimizer with deep learning model

AbstractThe COVID‐19 epidemic accelerated the digital change of several services, including healthcare, and increased access to telemedicine. As a result, an increasing number of web tools were introduced to meet patient needs. A safe database can be created in the healthcare industry as a result of digital transformation. This database can be used to protect, store, and share private patient data with healthcare workers, labs, and medical specialists. Designing efficient decision‐making tools for COVID‐19 diagnostics is now possible thanks to recent developments in information technology and deep learning (DL) models. In this paper, a novel method for diagnosing COVID‐19 using deep learning‐enhanced eagle perching optimizer (DTH‐EPODL) model is presented. With the help of the IoT and the presented DTH‐EPODL model, patient information can be gathered and analysed for illness detection. The DTH‐EPODL model uses the Gaussian filtering (GF) method to remove noise in the initial step. Additionally, MixNet, a deep convolutional neural network‐based method, is used for feature extraction. Using the deep autoencoder (DAE) algorithm, COVID‐19 detection and categorization are accomplished. Finally, the DAE approach's associated hyperparameters can be best adjusted using the EPO method, which enhances categorization results. Benchmark chest x‐ray datasets can be used to evaluate the experimental validity of the DTH‐EPODL method. The experimental results showed that the DTH‐EPODL technique outperformed more modern methods.

Medicaid Insurance is Associated with Treatment Disparities for Proximal Humerus Fractures in a National Database Analysis.

Proximal humerus fractures (PHFs) are the third most common type of fragility fracture in the elderly and are increasing in incidence. Disparities in treatment type, time to surgery (TTS), and complications based upon insurance type have been identified for other orthopedic conditions. Given the incidence and burden of PHFs, we sought to evaluate if insurance type was associated with treatment received, TTS, and complications in the treatment of PHFs. We used PearlDiver, a national administrative claims database that consists of 122 million patient records. Patients diagnosed with an isolated PHF between 2010-2019 were identified by ICD-9/10 diagnostic codes and stratified by insurance type (Medicaid, private, or Medicare). Outcomes evaluated were rate of surgery within 3 months of diagnosis with open reduction and internal fixation, hemiarthroplasty, or reverse shoulder arthroplasty; average TTS; 90-day readmissions and medical postoperative complications (deep vein thrombosis, urinary tract infection, pneumonia, sepsis, acute respiratory failure, cerebrovascular event, and acute renal failure); and 1-year surgical postoperative complications (stiffness, non-infectious wound complications, dislocation, and infection). Multivariable logistic regressions adjusting for age, sex, and Elixhauser comorbidity index were utilized to determine the association between insurance type and surgery rate/complications. We included 245,396 patients for analysis. 14% of Medicaid patients (1,789/12,498) underwent surgery compared to 17% (25,347/149,830) of privately-insured patients and 16% (13,305/83,068) of Medicare patients (pairwise p < 0.001). TTS (Medicaid: 11.7 days, private: 10.6 days (p < 0.001), Medicare: 10.7 days (p = 0.003)) varied by insurance type. Private or Medicare-insured patients were less likely to be readmitted (adjusted odds ratio [OR]: 0.77 [95% confidence interval (CI): 0.63 - 0.93] for private vs Medicaid, and 0.71 [95% CI: 0.59 - 0.88] for Medicare vs Medicaid) and experienced fewer 90-day postoperative complications (adjusted ORs: 0.73 [95% CI: 0.62 - 0.85] for private vs Medicaid, 0.65 [95% CI: 0.55 - 0.77] for Medicare vs Medicaid), such as acute renal failure. TTS was also associated with differing rates of readmissions and complications. There are differences in rates of surgery, TTS, and complications after PHFs based on insurance type, representing opportunities for quality-improvement initiatives. Potential methods to address these disparities include implementing standardized PHF protocols and/or reimbursement models and quality metrics that reward equitable treatment. Further research and policy adaptations should be incorporated to decrease barriers patients face and minimize healthcare inequities seen in the treatment of PHFs based on insurance type.

Medicare Reimbursement Rates: Too Much or Too Little? What Are Our Options?

In recent decades, Medicare reimbursement rates have continued to fall behind general inflation rates while the number of beneficiaries has continued to rise. To compensate for lagging Medicare and Medicaid rates, cost shifts have increased the financial burden on private payers and patients. With impending increases in inflation caused by current historical events, reform is necessary. Otherwise, increasing number of physicians will likely be forced to limit the number of Medicare patients in their practices. However, the 2022 annual March Report released by MedPAC continued to recommend that Congress freeze physician payments in 2023. Various policy solutions have been considered, including single-payer systems, all-payer systems, and public options. Examples of such systems exist in specific states, including Maryland, Washington, and Colorado, and can provide insight on how these policies might fare if applied to the entire country. Overall, Medicare needs reform involving a stronger focus on a pay-for-value approach.

Cost of image-guided percutaneous nephrostomy among cervical cancer patients at Muhimbili National Hospital in Tanzania

BackgroundMost cervical cancer patients in developing countries seek care in health facilities with an advanced disease, often characterized by obstructive uropathy. This study aims to estimate the cost of an image-guided percutaneous nephrostomy (PCN), which was recently introduced at Muhimbili National Hospital to manage obstructive uropathy.MethodsThis was a cross-sectional study that was conducted between February and June 2021, from the provider’s perspective. The study involved forty-eight (n = 48) cervical cancer patients with obstructive uropathy. A micro-costing approach was used to identify, quantify and value both capital and recurrent cost items consumed by the patients. Cost data were collected in Tanzanian shillings and converted to USD with the relevant exchange rate. Analysis was performed in Microsoft Excel (Microsoft Excel®, Microsoft Corporation).ResultsThe unit cost of image-guided PCN at Muhimbili National Hospital was estimated at 380.4 USD. The main cost drivers were the single-use Nephrostomy catheters, Amplatz guide wire, and Micro-puncture set. The estimated unit cost is higher than the reimbursement price of 237.4 USD charged by the National Health Insurance Fund, and the 259.4 USD and 172.9 USD charged by the hospital for private and public patients, respectively.ConclusionImage-guided PCN for cervical cancer patients costs three times the minimum monthly government wage. The study underscores the importance of conducting costing studies to inform pricing and reimbursement decisions in Tanzania.

Intrusion Detection in Wireless Body Area Network using Attentive with Graphical Bidirectional Long-Short Term Memory

Recently developed low-power networked systems, wireless communications, and wireless sensors have all contributed to the rise of Wireless Sensor Networks (WSNs) as a potentially useful tool in the medical field. Securing Wireless Body Area Networks (WBANs) is essential for their widespread use in healthcare environments because the data they send frequently includes private and confidential patient health information. The study's goal is to create a system for detecting intrusions in WBAN. To best identify attacks in such systems, we present a novel “Attention-based Bi-directional Long Short-Term Memory with Graph Construction” (ABL-GC) here. The suggested approach ensures that the intrusion detection system uses only the features essential to detect a given attack, reducing the processing complexity.

Digitala arbetslivet

The virtual workplace&#x0D; This article examines what the digitalization of healthcare has come to mean for nurses as a professional group. Digitalization is understood in the article as a term that is concerned with everything from digital surveillance systems that partially take over the nurses’ attentive observation of their patients, to healthcare meetings that do not take place in the hospital but transpire with the help of cameras and monitors. Another dimension of digitalization is that which goes beyond healthcare meetings and concerns digital journal systems and how they change working life from writing on paper by hand to having all the care of the patient visible on a computer screen. The purpose of the article is therefore to culturally analyse and examine how the working life of nurses change when healthcare and medical care are digitized. What happens when digital technology enters the profession and when working nurses have to spend an increasing amount of time in a liaison with / association with the virtual environment?&#x0D; Four nurses, aged 46 years and over were interviewed based on a questionnaire with open questions. Based on the interviews, this article presents four key themes, namely (1) the actual digitalization of health and medical care and how it affects the nurses; (2) patients who via the Internet can be more apprised of their illness and treatment options and thus can also affect healthcare meetings in new ways, (3) the different contexts of digital technologies that are at risk of collapsing into each other and allowing the patient's private attitude/approach to come to the attention of the nurses, and (4) how the boundary between working life and leisure time is affected by the new technology.&#x0D; Digital technology thus creates various mediated platforms that transform the interactions in, for example, a healthcare meeting. These interactions can occur both in the virtual world as well as in face-to-face relationships in a healthcare meeting. It has been central to the article's argumentation to reveal how the impact can go both ways and that this fact affects nurses working life in new and unexpected ways. Based on this reasoning, the article also argues for ethnological work life research that focuses much more on the complexity that working individuals meet, both in their profession and in spare time. There is not always a clear boundary between these two worlds. If anything, ethnological research into working life has highlighted the importance of focusing on the entire life situation of the workforce; this is something which it is even more central to make evident in relation to the digitalized working life.

Does race influence the attainment of the principles of oncologic surgical resection in colon adenocarcinoma? A retrospective cohort analysis from the national cancer database.

The authors performed a retrospective cohort study of all cases of resectable colon adenocarcinoma who underwent surgical resection in the National Cancer Database between 2004 and 2018. The postoperative lymph node count and margins were grouped as 'principles of oncologic surgical resection'. A multivariate logistic regression analysis was performed to assess race and other demographic variables as independent factors influencing the attainment of the principles of oncologic resection. A total of 456746 cases were included. From this cohort, 377344 (82.6%) achieved an adequate oncologic resection and 79402 (17.4%) did not. On logistic regression, African American and Native American patients were less likely to attain an adequate oncologic resection. Similarly, patients with an elevated Charlson-Deyo score (2 or above), stage I cancer, and patients who underwent extended resection were less likely to achieve adequate oncologic resection. Resections performed in metropolitan areas, patients with private insurance, high-income quartiles, and patients diagnosed in more recent years were more likely to achieve adequate oncologic resection. There are significant racial disparities regarding the attainment of the principles of oncologic resection in colon cancer, which could be explained by unconscious biases, social discrepancies, and inadequate healthcare access. Early introduction and conscientization of unconscious biases are required in surgical training.

Multi Watermarking for Medical Images using Fractal Encoding and Concept of UNET

Abstract: The Internet of Medical Things, smart healthcare systems are becoming ubiquitous in our daily lives. Patients, doctors, and other medical personnel rely on the safe and efficient storage, transmission, and analysis of electronic health records , medical images such as scanning reports X-rays for successful treatment and management of different ailments. A Multi watermarking method is proposed for medical images based on quantum random walk and optimization algorithm. A logo image is used to verifying medical image integrity is embedding in region of interest and text data are embedded in the region of non interest to conceal private hospital and patient informations. This method improves the authenticity and integrity of medical images. A number of experiments are conducted to validate the security ,robustness and capacity of the proposed multi watermarking scheme.

Watermarking Technique for Verifying Medical Images in IOMT Using Fractal Encoding and Concept of UNET

The Internet of Medical Things, smart healthcare systems are becoming ubiquitous in our daily lives. Patients, doctors, and other medical personnel rely on the safe and efficient storage, transmission, and analysis of electronic health records , medical images such as scanning reports X-rays for successful treatment and management of different ailments. A Multi watermarking method is proposed for medical images based on quantum random walk and optimization algorithm. A logo image is used to verifying medical image integrity is embedding in region of interest and text data are embedded in the region of non interest to conceal private hospital and patient informations. This method improves the authenticity and integrity of medical images. A number of experiments are conducted to validate the security ,robustness and capacity of the proposed multi watermarking scheme.

Watermarking In Medical Images

Abstract—The Internet of Medical Things, smart healthcare systems are becoming ubiquitous in our daily lives. Patients, doctors, and other medical personnel rely on the safe and efficient storage, transmission, and analysis of electronic health records , medical images such as scanning reports X-rays for successful treatment and management of different ailments. A Multi watermarking method is proposed for medical images based on quantum random walk and optimization algorithm. A logo image is used to verifying medical image integrity is embedding in region of interest and text data are embedded in the region of non interest to conceal private hospital and patient informations. This method improves the authenticity and integrity of medical images. A number of experiments are conducted to validate the security ,robustness and capacity of the proposed multi watermarking scheme. Keywords—medical image, quantum random walk, optimization algorithm, Internet of Medical Things

Risk factors for inpatient hospital admission following isolated orbital floor fractures

Orbital floor fractures are common injuries seen in the emergency department (ED). In this study, the National Trauma Data Bank (NTDB, 2016–2017) was used to identify patients presenting with isolated orbital floor trauma. Patient-specific factors were analyzed to determine associations with management. The sample comprised 912 patients; 285 (31.3%) of these patients were discharged from the ED, 541 (59.3%) were admitted to the hospital but did not undergo an operation, and 86 (9.4%) underwent operative treatment. Pediatric patients and older patients (<18 years and>55 years) were more likely to be admitted than those aged 18–55 years, and pediatric patients were more likely to undergo an urgent operative intervention than those in the other age groups (all P < 0.001). Patients with alcohol use disorder (P = 0.002) and hypertension (P = 0.004) had increased odds of admission. Private and Medicare insurance patients were more likely to be admitted, and self-pay patients less likely (P < 0.001). Older age and Medicaid payor status showed increased odds of a greater hospital length of stay. Biological sex, race/ethnicity, functionally dependent health status, myocardial infarction, steroid use, and substance use disorder were not associated with discharge disposition. There are non-injury related, patient-specific factors that may influence the management of orbital floor fractures.

Is the use of IVF add-on treatments driven by patients or clinics? Findings from a UK patient survey

There are conflicting narratives over what drives demand for add-ons. We undertook an online survey of IVF patients to determine whether patients perceive that use of IVF add-ons is driven by patients or practitioners. People who underwent IVF in the UK in the previous five years were recruited via social media Survey questions focussed on the roles of clinician offer and patient request, including who first suggested use of add-ons in IVF consultations, where patients first heard about them, and which information sources they trusted. From a total of 261 responses, 224 met the inclusion criteria. Overall, 67% of respondents had used one or more IVF add-ons, most commonly: time-lapse imaging (27%), EmbryoGlue (27%), and endometrial scratching (26%). Overall, 81% of the add-ons used were offered to participants by clinicians (compared to 19% requested by themselves). Half (54%) reported being offered add-ons during consultations, compared to 24% who initiated discussion about add-ons. Higher proportions of private patients reported being offered (90%), requesting (47%) and using (74%) add-ons than those with NHS funding (74%, 29%, 52%, respectively). The main limitations of this study are the small sample size, recruitment via a convenience sample, and the self-reported data capture which is subject to recall bias.