Individual Registration Research Articles

Surgery program directors' knowledge of opioid prescribing regulations: a survey study

BackgroundOpioid misuse is a public health crisis that stems in part from overprescribing by health-care providers. Surgical residents are commonly responsible for prescribing opioids at patient discharge, and residency program directors (PDs) are charged with their residents' education. Because each hospital and state has different opioid prescribing policies, we sought to assess PDs' knowledge about local controlled substance prescribing polices. MethodsA survey was emailed to surgery PDs that included questions regarding residency characteristics and knowledge of state regulations. ResultsA total of 247 PDs were emailed with 110 (44.5%) completed responses. One hundred and four (94.5%) allow residents to prescribe outpatient opioids; one was unsure. Sixty-three (57.3%) respondents correctly answered if their state required opioid prescribing education for full licensure. Twenty-two (20.0%) were unsure if their state required opioid prescribing education for licensure. Sixty-four (58.2%) respondents answered correctly if a prescription monitor programs use is required in their state. Twenty-nine (26.4%) were unsure if a state prescription monitor programs existed. Seventy-six (69.1%) PDs answered correctly about their state's requirement for an additional registration to prescribe controlled substances; 10 (9.1%) did not know if this was required. Twenty-nine (27.9%) programs require residents to obtain individual drug enforcement agency registration; 5 (4.8%) were unsure if this was required. ConclusionsMost programs allow residents to prescribe outpatient opioids. However, this survey demonstrated a considerable gap in PDs' knowledge about controlled substance regulations. Because they oversee surgical residents' education, PDs should be versed about their local policies in this matter.

COMPARATIVE ANALYSIS OF HOSPITAL PHARMACOTHERAPY OF CHRONIC HEART FAILURE WITH REDUCED LEFT VENTRICULAR EJECTION FRACTIONS IN 2009-2010 AND 2014-2015

Aim. To compare features of pharmacotherapy of patients with chronic heart (CHF) with a reduced ejection fraction of the left ventricle (LV EF) who were admitted in a specialized department of the multidisciplinary hospital in Saratov before and after the publication of the Russian National Recommendations (4 revision) on the diagnosis and treatment of CHF (2012). Material and methods . A pharmacoepidemiological retrospective study was conducted. The object of the study was the medical records of inpatients (form 003/y) with the diagnosis Heart failure (ICD-I50), that consecutively admitted to the cardiology department of the multidisciplinary hospital in Saratov from April 28, 2009 to January 19, 2010 (n=52) and from February 19, 2014 to May 20, 2015 (n=95). Patients over 18 years of age with diagnosis of CHF (NYHA II-IV) and LV EF <45% were enrolled into the analysis. For each patient, an individual registration card was filled in which the patient's clinical and demographic characteristics, prescribed medications, their daily dose, the frequency of administration, the route of administration were indicated. Pharmacoepidemiological analysis was carried out for the drugs prescribed at the 1st day of hospitalization, at the 3rd-6th day (the time of stabilization of the patient's condition, which was evaluated by the reduction in dyspnea and increase in the tolerance to physical loads). The recommendations given by the physicians at discharge of the patients from the hospital were also considered. Results . In 2014-2015 years, compared to 2009-2010 years, the number of identified arrhythmias and severe forms of arterial hypertension significantly (82.1 vs 77%; р<0.05) increased. In 2014-2015 the frequency of the prescriptions of ACE inhibitors decreased (77.8 vs 86.5%; p<0.05). The frequency of the prescriptions of angiotensin II receptor blockers, antagonists of mineralocorticoid receptors (AMCR), diuretics, oral anticoagulants, clopidogrel increased (p<0.05). In the structure of combination therapy in 2014-2015, the frequency of the prescription of the ACE inhibitor+beta-blocker and ACE inhibitor+beta-adrenoblocker+AMCR combinations decreased significantly (18.9 vs 26.9%, p<0.05 and 22.1 vs 42.3%, p<0.05, respectively). At the same time prescription frequency of the ACE inhibitor+beta-blocker+AMCR+diuretic combination increased (25.2 vs 11.5%, p<0.05). Conclusion . Pharmacotherapy of CHF in hospital in 2014-2015 is consistent with the Russian National Recommendations (4 revision) and is significantly different from the CHF therapy in 2009-2010. Keywords: pharmacoepidemiology, chronic heart failure, treatment.

Potential solutions to improve the governance of multicentre health services research

From January 2012, all MJA research articles are freely available from their website to all registered users who login to the site. Individual registration is free.

The Tendencies of Prevalence of Diseases of Musculoskeletal System and Connective Tissue in Moscow Adult Population

The article presents the results of analysis of trends in morbidity and dispensary observation of Moscow adult population with diseases of musculoskeletal system and connective tissue. The analysis was applied to data from statistical report forms # 12 of the Moscow Health Care Department in 2012-2016. The stability of percentage of diseases of musculoskeletal system in the structure of total and primary morbidity during last 5 years was established. The significant dynamics of indices of total morbidity is absent. The statistically significant descending trend if primary morbidity at the expense of deforming dorsopathies in the age group older than 55 years was established. The deforming dorsopathies hold first place in the structure of diseases of musculoskeletal system. The dynamics of decreasing of indices of total morbidity of the given pathology in the age group of 18-55 years and older than 55 years is statistically non-significant. The statistically significant ascending tendency of indices of total morbidity of arthroses of adult population and primary morbidity of synovial membranes and tendons in the age group of 18-55 years is established. The established in adult population and individuals aged 18-55 years both decreasing of number of being dispensary registered on the subject of pathology of musculoskeletal system and its increasing among individuals older than 55 years are statistically non-significant. The trend of dropping of indicator of being on dispensary registration of individuals with primarily diagnosed pathology is also insignificant. The correlation between rate of dispensary registration and primary morbidity, including particular pathologies, is absent.

Challenges of identifying unpublished data from clinical trials: Getting the best out of clinical trials registers and other novel sources.

Clinical trial data are essential for assessments of the effectiveness of health care interventions. Information about ongoing or completed, but not yet formally published, trials has been more difficult to identify until the development of clinical trials registers and portals. This paper summarises research evidence on identifying sources of trial data, how and when to search those sources, and which future developments may enhance access to and retrieval of unpublished trial evidence. We conducted a literature search for relevant studies and provide a narrative review of the evidence from these studies. Clinical trial data can be found in resources including clinical trials registers, regulatory agency sources, health technology assessment websites and manufacturers' websites, and submissions for regulatory approval. The challenges of searching these resources are described. Trials registers are relatively unsophisticated in terms of their search interfaces, and searchers need to adapt to each individual register. There is overlap across registers, but little research on the degree and nature of overlap and how best to search. Despite these challenges, trials registers and other resources can be rich sources of additional unique trial data, which may not be available from journal reports. New initiatives, such as OpenTrials, aim to consolidate and link all structured data and documentation related to clinical trials. No single resource gives access to all trials, and multiple registers should be searched as sensitively as possible. Searching is challenging and should be adequately resourced. Information specialists should monitor new developments which may reduce the challenges over the coming years.

CASPIR trial: Using prostatic calculi as an alternative to fiducial markers for IGRT in for localized prostate cancer.

60 Background: Image guided Radiotherapy (IGRT) for prostate cancer (PCA) frequently employs surgically implanted fiducial markers (FMs). However, it is estimated that up to 35% of prostate radiotherapy patients have prostatic calculi (PC) visible on treatment cone beam CTs (CBCT). The purpose of this clinical trial is to directly compare FMs with PCs as an aid to prostate IGRT. Methods: We report data from a single institution prospective clinical trial investigating the feasibility of using prostate calcifications as natural FMs for IGRT. Patients planned for standard prostate radical EBRT +/- brachytherapy were eligible. Prior to CT planning, 3 gold fiducial markers are inserted into the prostate by the trans-perineal route under TRUS guidance. PCs visible within the PTV were contoured. Participants were aligned to FMs for EBRT using daily CBCT image guidance on a Varian TrueBeam linac. Off-line, a single experienced user analyses CBCTs using Image Registration in Eclipse (version 13.6). Random and systematic set-up errors are determined based on FMs, PCs (where present), prostate gland (PG) and bony landmarks (BL) and CTV-PTV margins derived for each data set. Results: 30 participants with PC have been recruited. Data from the first 19 patients (365 fractions), resulted in 2555 individual image registrations (7665 individual data points). The PTV margins required based on each reference structure are summarised in Table 1. The maximum difference between the CTV-PTV(PC) margin and CTV-PTV(FM) margin is 2.2mm in the X or L/R dimension. Margins required for FM, PG and PC in the Y and Z dimensions are comparable, with a maximum difference of 0.5mm between CTV-PTV(PC) and CTV-PTV(PG). Conclusions: Preliminary results from this study demonstrate some evidence to support the use of PCs as an alternative to FMs for prostate IGRT. Future analysis will include location of PC according to the PIRADs schema and patient feedback in relation to FM implantation. Clinical trial information: NA. [Table: see text]

The governance of poverty: Welfare reform, activation policies, and social assistance benefits and caseloads in Nordic countries

Social assistance benefits are the last resort in national social protection systems, and decentralizing reforms leading to increasing local discretion over implementation of national legislation was an international trend frequently referred to as devolution. More recent reforms have instead often implied recentralization and/or involved mandatory institutional cooperation between welfare agencies located at different hierarchical levels. In contrast to North America, there is little European evidence on the extent to which shifting responsibilities influence benefit levels and benefit receipt. Using individual level register data from Denmark, Finland, Norway and Sweden and applying a difference-in-difference approach, we link changes in legislation to changes in municipal benefits as well as caseloads during the period 1990–2010. We only find indications of reform effects linked to distinct benefit centralization, concluding that other reforms were too insubstantial to have an impact. Combined with earlier evidence, this suggests that in order to have an impact, welfare reform requires marked changes in authority.

Структурні зміни Луцької міської ради в умовах демократичної трансформації України.

The analysis of the evolution of structural changes in Lutsk City Council at the stage of the democratic transformation of Ukraine in 1990–2017 has been carried out. Quantitative and qualitative changes in the parliamentary body of the council, its executive committee, permanent commissions, departments, administrations, departments and commissions, depending on social-economic development of the country and central government policies have been demonstrated. The emphasis was placed on the processes that took place after the regular local elections, when the quantitative and qualitative composition of the council changed every time. Focused attention has been paid to the processes of decentralization, which are being accompanied by the transfer of powers of state authorities to the local level. The process of realization of the tasks of the «Concept of reformation of local self-government and organization of territorial power in Ukraine», requirements of the laws of Ukraine «On Access to Public Information», «On Regulation of Urban Development Activities», «On State Registration of Legal Entities and Individuals», «On the Licensing System in the Sphere of Economic Activities», the Cabinet’s Resolution «On the City-Planning Cadastre», etc. has been revealed. It has been indicated that the increase of the staffs took place in the secretariat and the appeal department, in the management of city planning and the newly created department of transport of the city council, land resources management, the licensing center and the department of state registration of business entities of the city council. The positive changes that had occurred in the investigated period in the activity of Lutsk City Council in the direction of greater transparency and accountability to territorial communities were demonstrated. The positive experience of the city council regarding the approaching of services to the city population has been certified through a specially created department – the Center for the Provision of Administrative Services of the executive committee of the Lutsk City Council.

Fellowship exit examination in orthopaedic surgery in the commonwealth countries of Australia, UK, South Africa and Canada. Are they comparable and equivalent? A perspective on the requirements for medical migration

ABSTRACTInternational migration of healthcare professionals has increased substantially in recent decades. In order to practice medicine in the recipient country, International Medical Graduates (IMG) are required to fulfil the requirements of their new countries medical registration authorities. The purpose of this project was to compare the final fellowship exit examination in Orthopaedic Surgery for the UK, Australia, Canada and South Africa.The curriculum of the Australian Orthopaedic Association (SET) was selected as a baseline reference. The competencies and technical modules specified in the training syllabus, as well as the specifics of the final fellowship examination as outlined in SET, were then compared between countries.Of the nine competencies outlined in SET, the curricula of the UK, South Africa and Canada were all compatible with the Australian syllabus, and covered 97.7%, 86% and 93%, respectively, of all competencies and sub-items. The final fellowship examinations of Australia, South Africa and the UK were all highly similar in format and content. The examination in Canada was substantially different, and had two written sessions but combined the oral and clinical component into a structured OSCE using standardized patients and the component included unmanned stations. There were no significant differences for completion certificate of training and/or board certification observed between these countries.The results of this study strongly suggest that core and technical competencies outlined in the training and education curriculum and the final fellowship examination in Orthopaedic Surgery in Australia, South Africa and the UK are compatible. Between country reciprocal recognition of these fellowship examinations should not only be considered by the relevant Colleges, but should also be regulated by the individual countries health practitioner registration boards and governing bodies.

Assessment of role of mandibular third molar position in lower anterior crowding- A cross sectional study

Objective: To assess the relationship of mandibular third molar position and lower anterior crowding in adult patients. Methodology: A sample of 90 pretreatment casts were divided on the basis of lower third molar position into three groups: erupted, unerupted, and agenesis. Orthopantomograms and dental casts of all 90 samples were procured from the archives of department of orthodontics. The individual quantitative analytical registration of crowding was based on modified arch analysis proposed by Lundstorm. The length of the lower anterior segment was measured with the help of brass wire. Results: Chi-square test and ANOVA statistical tests revealed that there was no statistically significant difference in lower anterior crowding between the groups with erupted, unerupted, and agenesis of third molars on both right and left sides. Conclusion: The third molars do not create statistically significant difference in lower anterior crowding. The recommendation to extract lower third molar to minimize future anterior crowding is thus not justified.

Do Digital Information Technologies Help Unemployed Job Seekers Find a Job? Evidence from the Broadband Internet Expansion in Germany

This paper studies effects of the introduction of a new digital mass medium on reemployment of unemployed job seekers. We combine data on high-speed (broadband) internet availability at the local level with individual register data on the unemployed in Germany. We address endogeneity by exploiting technological peculiarities in the network that affected the roll-out of high-speed internet. The results show that high-speed internet improves reemployment rates after the first months of the unemployment spell. This is confirmed by complementary analysis with individual survey data suggesting that online job search leads to additional formal job interviews after a few months in unemployment.

Do Digital Information Technologies Help Unemployed Job Seekers Find a Job? Evidence from the Broadband Internet Expansion in Germany

This paper studies effects of the introduction of a new digital mass medium on reemployment of unemployed job seekers. We combine data on high-speed (broadband) internet availability at the local level with individual register data on the unemployed in Germany. We address endogeneity by exploiting technological peculiarities in the network that affected the roll-out of high-speed internet. The results show that high-speed internet improves reemployment rates after the first months of the unemployment spell. This is confirmed by complementary analysis with individual survey data suggesting that online job search leads to additional formal job interviews after a few months in unemployment.

Landowner participation in forest conservation programs: A revealed approach using register, spatial and contract data

Incentive based voluntary conservation programs have gained prominence as a regulation mechanism to protect ecosystem services on private land either through the set-aside of land for reserves or by altering land management practices. A crucial challenge for voluntary approaches is however to ensure private landowner involvement and get the ecosystem services delivered where they are most demanded by society. To promote participation and ensure an instrumental design of voluntary initiatives that is coherent with this, there is a need to understand the motivations of the landowners and determinants of their participation choice. We investigate landowners’ willingness to participate in protecting oak scrub sites in Denmark. Combining contract data of the landowners’ actual choices, GIS information on area specific characteristics and detailed individual level register data, we develop and implement a framework for analysing revealed choice of private landowners’ in voluntary conservation programs. We find that both the physical characteristics of the property and the sociodemographic characteristics of landowner in question matter, along with the information flow provided from the regulator. Results provide impetus into the design of future conservation policies, in terms of how, to whom and where to target efforts.

Clinical protocol for the registration of individual translucent zones of frontal teeth

In contemporary dentistry, a successful restoration should not only restore the shape and function of the impaired dentition, but also contribute to the overall aesthetic appearance. In order to achieve this goal, the dental team should possess complete information about the different optical dimensions of the tooth structure. Besides the standard properties of the color, it is important to define, register and interpret the shape and position of the individual translucent zone.With the help of a device and software developed by the authors, a five step clinical protocol has been developed by the authors for individual translucent zone registration, with the help of trans-illumination. The translucent areas are then shown in a digital photograph of the teeth, analyzed and interpreted. The translucent zone is finally visualized as a ‘translucent map’, which is clearly defined, and is easily interpreted and used by the dental team.

Development and progress of the National Congenital Anomaly and Rare Disease Registration Service

Public Health England (PHE) was formed in April 2013; at that time, regional congenital anomaly registers covered just 49% of births in England.1 A national congenital anomaly surveillance system managed...

The Safety and Accuracy of Surgical Navigation Technology in the Treatment of Lesions Involving the Skull Base.

As compared with the normal anatomy, structures of the skull base and its surroundings have been dramatically altered of the lesion near the skull base. How to remove the lesion at the skull base was mainly depending on surgeon's personal experience during past years. In this study, the authors explored the safety and accuracy of the surgical navigation system in resecting lesions near the skull base. The surgical cases consisted of 15 patients who underwent surgery involving the skull base with the using of surgical navigation technology. Five patients had adenoid cystic carcinoma at minor salivary glands of the palate extending to the skull base and 10 patients were suffered from bony ankylosis of temporomandibular joint. After the system converted patient's computed tomography scans into three-dimensional reconstructive images, preoperative planning and simulation of the operation process could be made by surgeons. During the operation, the virtual images were matched with the patient through individual registration. The system provided surgeon with feedback about the operation on the screen instantly with moving the navigated pointer. The application of surgical navigation system was safe and reliable for resecting the ankylotic bone and identifying the extent of tumors resection near the skull base. No complications including cerebrospinal fluid leak, cranial nerve injuries, severe bleeding happened to those patients. Given the safety and accuracy of the surgical navigation system, surgery near the skull base appeared to be an ideal field for using with its complex anatomy.

COMPOSIÇÃO E ESTRUTURA FLORÍSTICA EM BOSQUES DE MANGUEZAIS PARAENSES, BRASIL

Este estudo objetivou caracterizar a composição florística e a estrutura em bosques de manguezais nos municípios de Soure, Maracanã e Salinopólis no estado do Pará. Em cada município foram delimitadas três parcelas de 10 x 50 m totalizando 0,15 ha, registrando-se as espécies e medindo-se o DAP e altura. Foram calculadas a densidade, frequência e do­minância relativas, índice de valor de cobertura e de importân­cia. As espécies típicas encontradas foram Rhizophora mangle L., Rhizophora racemosa G.F.W. Meyer, Avicennia germinans (L.) Stearn. e Laguncularia racemosa (L.) Gaertn. Rhizophora racemosa foi encontrada somente em Soure e, Laguncularia racemosa apenas em Salinópolis. O bosque de Soure apresentou maior valor médio em diâmetro e altura. Nos três municípios Avicennia germinans obteve maior diâmetro e altura. A maior área basal para indivíduos vivos ocorreu em Soure e Salinas, e para indivíduos mortos, em Maracanã, ambos para a classe &gt; 10,0 cm de DAP. Em Soure não foram registrados indivíduos mortos. Os bosques apresentaram alto grau de desenvolvimento estrutural e ajustado ao padrão encontrado na costa norte brasileira. Informações conjuntas acerca da composição florística, abundância, densidade e parâmetros que demonstrem o grau de estrutura dos mesmos, além do registro e análise de indivíduos mortos, são bons indicadores do estado de conservação desse ecossistema. Conclui-se que os manguezais estão em bom estado de conservação. Entretanto, ações preventivas de manejo e conservação são fundamentais para garantir a manutenção de seus recursos.

ESCRITAS DE SI NA OBSERVAÇÃO DO OUTRO

Este artigo apresenta experimentos realizados em pesquisa sobre a produção de conhecimentos em dança através de práticas performativas conduzidas por ferramentas de análise de movimento de LMA/BF através de improvisações mais ou menos estruturadas. Os experimentos aqui apresentados não representam o todo da pesquisa, mas ilustram como calouros de cursos superiores de dança entraram em contato com procedimentos que articulam prática e teoria através de proposições dançantes e alternâncias entre prática, observação e registro. A mediação dos fluxos das improvisações e as ferramentas oferecidas aos experimentos, ainda que não explicitamente nomeadas como um sistema de análise de movimento tornam-se estratégias de relação e cercam metodologicamente o tratamento dado aos experimentos. Conclui-se questões sobre a ampliação de noções de dança, bem como sobre a reflexividade das impressões da observação e leitura de movimento na escolha do que e como são registrados graficamente os movimentos pelos quais cada participante é afetado ao longo de uma improvisação.

Social inequality in diabetes patients' morbidity patterns from diagnosis to death - A Danish register-based investigation.

Measuring socioeconomic inequalities in health and health care, and understanding determinants of such inequalities, are critical for achieving higher equity in health. Equity in health is a prerequisite for public health and welfare. The aim of the paper is (1) to quantify inequality in diabetes morbidity patterns over patients' entire life span, and (2) to compare levels of inequality measured through income and educational level, respectively, as proxies for socioeconomic status (SES). Historic individual register data on the entire Danish diabetes population alive in 2011 were gathered. Cox survival analysis and a concentration index decomposition approach were applied to analyse relevant morbidity indicators reflecting patients' health state at diagnosis and throughout their lives with diabetes. Patients with high education have approximately 26% lower mortality hazard when diagnosed with diabetes and 10-15% lower hazard of developing complications as compared with patients with short education. The outcome variables: 'severe complications at diagnosis' and 'years with severe complications' inhibit the highest negative concentration index value, indicating that morbidity is concentrated among the lower SES groups, whereas the outcome variables 'years without complications' and 'duration of diabetes' concentrate among the socioeconomically better-off patients. Significant differences in diabetes patients' morbidity patterns and survival indicate that diabetes impacts harder on patients of lower SES; these patients experience more severe complications and die earlier. Hence to reduce inequality in health, it is important to invest in efforts targeted towards socially vulnerable groups.

Does partial coating with titanium improve the radiographic fusion rate of empty PEEK cages in cervical spine surgery? A comparative analysis of clinical data

BackgroundAnterior cervical diskectomy and fusion (ACDF) is a well-established surgical treatment. Several types of intervertebral spacers can be used, but there is increasing evidence that PEEK cages yield insufficient fusion and thus less clinical improvement. The study aim was to assess the outcomes of single-level ACDF with an empty PEEK cage partially coated with titanium.MethodsThis prospective multicenter single-arm clinical study collected follow-up data at 6, 12, and 18 months. A post hoc comparison was made to closely matched patients from another similar trial treated with identically designed, empty, uncoated PEEK cages.ResultsThere were 49 of 50 patients (98%) who met the MCID of 3+ points of improvement on VAS pain or had an 18-month VAS ≤ 1. Yet even by 18 months post-op, only 40 of 50 (80%) PEEK + Ti patients achieved complete bony fusion. The PEEK + Ti group (n = 49) seemed to have somewhat better fusion scores and significantly better pain relief at 6 M than the matched controls (n = 49), but these differences did not persist at 12 M or 18 M. Patients (with either implant) who achieved complete bony fusion had significantly better improvement of pain at 6 M and disability at 6 M and 12 M than patients that remained unfused.ConclusionsACDF is effective treatment for cervical myelopathy and radiculopathy. Although this and other studies show that titanium fuses better, partial coating of a PEEK cage does not improve the fusion rate sufficiently or confer other lasting clinical benefit. PEEK cages fully coated with titanium should be tested in prospective randomized comparative trials.Trial registrationProspective, multicenter, single-arm clinical observational study without an individual Trial registration number. Study design and post hoc data analysis according to the “PIERCE-PEEK study”, ISRCTN42774128, retrospectively registered 14 April 2009.