Practice Style Research Articles

Evidence-based veterinary medicine-potential, practice, and pitfalls.

Understanding and incorporating evidence-based veterinary medicine (EBVM) into clinical practice and research continues to pose a challenge for our profession despite over 2 decades of increasing awareness of this concept. Reasons for this include a lack of understanding of its importance to the practice of medicine, veterinary literature that often fails to adhere to evidence-based standards, inadequate attention to teaching EBVM at the university level, and the inherent reluctance of clinicians to alter historical practice styles. For many practitioners, EBVM continues to be an abstract concept they believe requires advanced training in statistics and epidemiology resulting in them relying on less robust sources for clinical guidance. This unfortunately results in suboptimal care for our patients and delayed medical advancements for our profession. As part of the 20th anniversary of the founding of the Evidence-Based Veterinary Medicine Association (EBVMA), we are refocusing our efforts to highlight the need for dedicated teaching of EBVM at the university level, for rigorous adherence to established research reporting guidelines, for expansion of EBVM infrastructure, and for the provision of easily accessible tools that permit clinicians to incorporate EBVM into their daily practice. As the quality of veterinary literature improves, so too will development of more effective clinical practice guidelines that ultimately can be widely adopted if they are flexible enough to support the triadic relationship between veterinarians, our clients and our patients. Ultimately, EBVM is not an end unto itself, but rather a means to improve the quality of care we provide our patients.

Influence of Leadership Styles on Performance of Local Government Agencies: Case of Central Equatoria State Local Government in South Sudan

An organization's success depends on successful leadership and good organizational culture. This study investigates the influence of various leadership styles on the performance of local government agencies in Central Equatoria State, Juba, South Sudan. It explores how transformational, transactional, and laissez-faire leadership styles influence the performance of the central Equatoria state local government. The general objective of the study was to examine the influence of various leadership styles under the long-range leadership model on the performance of the central Equatoria state local government. The specific objectives of the study include the following: To assess the influence of transformational leadership style on performance of the central Equatoria state Local Government, to establish the influence of transactional leadership style on performance of the Central Equatoria state Local Government and to examine influence of laisses-faire leadership style on performance of the Central Equatoria state Local Government. The research employed a descriptive design, targeting 791 individuals, including local government officers and leaders from public institutions. A sample of 138 respondents was selected through stratified random sampling, and data was collected via questionnaires, interviews, and document analysis. To ensure validity of the finding, the researcher performed a pilot study on the data collection and analysis instruments in Juba County. This was done to guarantee the instrument's content coverage and authenticity by enhancing problems, the format, and the measuring scales. the researcher ensured protection of the research process to ensure reduction of anomalies, inaccuracy and scoring in the measurements to guarantee reliability of the data obtained. This research was focused on both primary and secondary data. Questionnaires was used as the main tool of data collection supported by both physical and telephone interview. Analysis of reports published on newspapers and internet was as well done. The study utilized the full range leadership model by James MacGregor Burns (1985) and Bernard M. Bass (1985), which encompasses transformational, transactional, and laissez-faire leadership styles. The findings revealed that both transformational and transactional leadership styles are not widely practiced by the CESLG Leaders and had limited impact on performance of the central Equatoria state local government while laissez-faire leadership being the most practiced style, significantly influenced poor performance outcomes of the central Equatoria state local government and it’s one of the reasons for the poor performance of the CESLG institutions. As such the researcher recommend among others, the following to both the CESLG leaders and other stake holders for implementation; The CESLG leaders need to consider recruiting young and well-educated local government officer as the study revealed that majority 48.8% of the local government officials are aged between 51 to 60 years whose performance are average , the local government leaders need to consider initiating executive training and development Programme for local government officers, The CESLG leadership is advised to conduct regular performance review for its institutions and staff. the CESLG leaders and other stakeholders/institutions are encouraged to adopt modern leadership styles such as transformational and transactional in their management styles.

Total knee arthroplasty reimbursement is declining overall and at a marginally faster rate amongst female orthopaedic surgeons: A Medicare analysis

BackgroundWhile the prevalence of total knee arthroplasty (TKA) is increasing, reimbursement is declining. The purpose of this study was to determine how surgeon gender influences procedure volume, reimbursement, practice style, and patient demographics for TKAs nationally and regionally between 2013 and 2021. MethodsThe Medicare Physician and Other Practitioners database was queried from 2013 to 2021 for procedure volume, TKA reimbursement, surgeon characteristics, and patient demographics for any surgeon who performed at least ten primary TKAs per year. Statistical tests were conducted to analyze differences based on surgeon gender, geography, and year. ResultsOf the 2,415,802 TKAs performed between 2013 and 2021, 1.5 % were billed by female surgeons. The number of TKAs performed annually increased by 29.1 % for female surgeons and decreased by 2.6 % for male surgeons. Between 2013 and 2021, reimbursement for TKAs decreased by 23.9 % for male surgeons and 26.2 % for female surgeons. In 2021, male surgeons were reimbursed $1017 per TKA while female surgeons were reimbursed $964 (p = 0.049). Male surgeons performed more TKAs annually in 2021 (Male: 39.3, Female: 30.9, p < 0.001), more total billable services (Male: 4148.0, Female: 2719.3, p < 0.001), and more unique billable services (Male: 70.7, Female: 55.3, p < 0.001) than female surgeons. ConclusionsFemale representation among surgeons who perform TKAs is increasing nationally. However, male surgeons treat more patients, perform more total billable services, and perform more unique billable services than female surgeons. TKA reimbursement is decreasing at a faster rate for female surgeons than male surgeons, although this is likely due to geographical differences.

Differences in Primary Total Shoulder Arthroplasty Volume, Reimbursement, Practice Styles, and Patient Populations Based on Surgeon Gender: A Temporal Analysis

BackgroundOrthopedic surgery has previously been shown to have a shortage of female physicians and a gender pay gap. However, this has not been thoroughly evaluated in the setting of shoulder surgery. The primary purpose of this study was to evaluate differences in total shoulder arthroplasty (TSA) volume, reimbursement, surgeon billing practices, and patient populations between male and female surgeons from 2013 to 2021. MethodsThe Medicare Physician and Other Practitioners database, a publicly available dataset that includes 100% of services billed to Medicare Part B was utilized. The database was queried for all billing episodes of Current Procedural Terminology (CPT) code 23472, which encompasses both anatomic and reverse primary TSA. Procedural volume, average inflation-adjusted reimbursement per TSA, physician billing information, and the patient demographics of each surgeon who performed TSAs were collected. Welch’s t-test and Kruskal-Wallis were utilized to compare male and female surgeons each year between 2013 and 2021. ResultsBetween 2013 and 2021, the proportion of TSAs performed by female surgeons nationally increased from 1.8% to 2.9% (+1.1%). This increase was greatest in the Northeast (2.0% to 6.1%), while a decrease was seen in the Midwest (1.9% to 1.6%). In 2021, there was no significant difference between male and female surgeons in the average inflation-adjusted reimbursement per TSA ($1,144.00 vs $1,143.00, p=0.792) and the average number of TSAs performed per surgeon (26.6 vs 23.1, p=0.105). Female TSA surgeons, on average, had less Medicare beneficiaries (348 vs 462, p<0.001), performed fewer annual services (1,817 vs 3,630, p<0.001), and performed fewer unique services (60 vs 76, p<0.001) compared to male surgeons. A higher proportion of female surgeon’s patient populations were non-White (24% vs 22%, p=0.028), female (61% vs 59%, p=0.001), and dual enrolled Medicare-Medicaid patients (13% vs 10%, p<0.001). However, there was no difference in the average patient complexity between male and female TSA surgeons based on hierarchical condition category (HCC) score (1.0783 vs 1.0732, p=0.228). ConclusionFemale representation within TSA surgery is increasing nationally, with the greatest representation in the Northeast and West and the lowest representation in the South and Midwest. Although female TSA surgeons perform a similar number of TSAs, receive comparable reimbursement per TSA, and have a similarly complex patient population as their male counterparts, they perform significantly fewer total and unique billable services annually. Additionally, female TSA surgeons tend to see more non-White, women, and dual Medicare-Medicaid enrolled patients.

Five guidelines to improve context-aware process selection: an Australian banking perspective

PurposeSelecting which processes to improve plays a critical role in the first phase of the business process management lifecycle, but it is a step with known pitfalls. Decision-makers rely on subjective criteria and their knowledge of the alternative processes put forward for selection is often inconsistent. This leads to poor quality decision-making and wastes resources. The purpose of this paper is to examine the proposition that decision-makers armed with context-enriched criteria make more logical, better-quality decisions. The context in question is qualitative, sensitive to decision-making bias and politically charged.Design/methodology/approachWe applied a design-science approach, engaging 70 industry decision-makers through a combination of research methods to assess how different contextual configurations, in a hypothetical scenario adapted from the Australian banking industry, influenced and ultimately improved the quality of the process selection step.FindingsThe study highlights the impact of framing effects on context, and the need to adapt framing to decision-maker behavior and provides five guidelines to improve process selection effectiveness.Originality/valueProcess selection research to date has largely focused on quantitative evaluation techniques, with little attention paid to the role of context and the behavioral interplay of decision-making styles in practice.

Educational and personal impacts of the COVID-19 pandemic on emergency medicine resident physicians: a qualitative study

BackgroundThe COVID-19 pandemic had a significant impact on both the clinical practice and the psychological states of frontline physicians in the emergency department. Trainees, at the beginning of their careers and thus still developing their practice styles and identities as physicians, were uniquely affected.ObjectiveIn this qualitative study, we sought to explore how the pandemic environment shaped the experiences of emergency medicine resident physicians.MethodsThis was a qualitative study. We conducted in-depth interviews with emergency medicine faculty, resident physicians, and staff at a single emergency department based at an urban academic institution in the northeastern United States. Interviews were audio recorded and transcribed, and transcripts were then analyzed in an iterative process by our coding team for recurring themes related to the resident experience.ResultsWe reached data saturation with 27 individuals. Of those who were interviewed, 10 were resident physicians [6 senior residents (PGY-3 or PGY-4) and 4 junior residents (PGY-1 or PGY-2)]. Three major recurring themes regarding resident physician experience emerged during our analysis of the interviews: (1) novel educational experiences dampened by negative structural forces from the pandemic, (2) fracturing of social interactions and mitigation through ad-hoc support systems and community of practice, and (3) development of negative emotions and psychological trauma including fear, resentment, and moral injury causing lasting harm.ConclusionsOur results suggest that emergency medicine resident physicians training during the COVID-19 pandemic faced unique experiences concerning their education, social support systems, and emotional states. While the educational and social experiences were described as having both negative and positive impacts, the emotional experiences were largely negative. Residency program leadership may use these insights to improve resident preparation, wellness, and resilience in the face of future adverse events.

GENDER-RELATED FACTORS AND ENTREPRENEURIAL INTENTIONS OF UNDERGRADUATES IN SELECTED FEDERAL UNIVERSITIES IN SOUTHWEST, NIGERIA

Purpose: The study assesses the gender related factors and entrepreneurial intentions of undergraduate students of selected Federal Universities in Southwest, Nigeria. It specifically, examined barriers to male and female entrepreneurial activities in the selected Universities; assessed how entrepreneurship education has impacted entrepreneurial intentions of female and male undergraduates in the study area; and evaluated how entrepreneurial intentions of male and female undergraduates differ in the study area. Theoretical Framework: The study's foundation was Social Feminist Theory (SFT), which clarified the widely held stereotype that women are subservient to men. This stereotype is said to conflict with the innate desire for entrepreneurship, and female students' inclination to start their own businesses may be viewed as a hindrance. In this regard, the study has attempted to conduct a methodical assessment of several publications concerning the relationship between gender and the entrepreneurial intentions of students at particular Federal Universities in the Southwest region of Nigeria. Design/Methodology/Approach: To guide the investigation, three research questions were developed. Similarly, three objectives and three null hypotheses were generated for the study. The study adopted the use of a cross-sectional survey approach, and structured questionnaire administration was made use of, to gather data. A total of 1,820 questionnaires were distributed to the respondents and were all recovered for the study. The study made use of a well-structured and validated “Gender Related Factors and Entrepreneurial Intentions Questionnaire” as the instrument for data collection. The data analysis included both inferential and descriptive statistics, such as; Mann-Whitney U Test, Multiple Linear Regression and basic percentages, counts, mean, and standard deviation.. Findings: The study found that female students faced more barriers to entrepreneurial activities than male students. The distribution of barriers is not the same across the two categories of gender. Entrepreneurship education is positively related to entrepreneurial intention and explains a variation in the level of entrepreneurial intention of undergraduate students in the selected Federal universities. Female students showed less entrepreneurial intention than male students and suggests that the distribution of entrepreneurial intention is not the same across the two categories of gender. Originality/Value: The study, recommended among others that; Policymakers and stakeholders in entrepreneurship matters should give adequate consideration and preference to the female gender in terms of training and other forms of entrepreneurial education to foster better intention with them. Nevertheless, the male gender must not be ignored completely as this may result in a viscous cycle; University management, facilitators and lecturers should also improve on the techniques and methods used in teaching entrepreneurship in Nigerian universities to positively impact the entrepreneurial intention of university students; and Management should also use attractive methods and practical styles that will raise the curiosity of students to the field of entrepreneurship..

Transitions of care for adolescents with disorders of gut-brain interaction.

Little is known about the experience of adolescents and young adults (AYA) with disorders of gut-brain interaction (DGBI) who transition from pediatric to adult gastroenterology care. In this two-part study, we used quantitative and qualitative methods to: (1) assess incidence of optimal versus suboptimal transitions of care for AYA with DGBI, (2) characterize health and quality of life effects of the transition, and (3) identify barriers and facilitators for optimal transition of care. In Part 1, we conducted a retrospective review of AYA referrals to our adult neurogastroenterology clinic who had transitioned from pediatric gastroenterology care (N = 109, 17-23 years, 72% female). We collected demographic, psychosocial, and healthcare utilization data to determine rate and risk factors for suboptimal transitions. In Part 2, we recruited 24 AYA and parents (n = 19 AYA, n = 5 parents) for completion of a survey and semistructured interview, which was analyzed using validated rapid qualitative analysis method. In Part 1, 20% (22/109) of AYA met the criteria for suboptimal transition of care, which was associated with treatment adherence concern and functional impairment. In Part 2, we identified two principal themes: (1) AYA's health and quality of life are impacted during the transition, and (2) parental involvement and collaboration with pediatric gastrointestinal (GI) are facilitators to successful transitions, whereas access to care and practice style change are barriers. AYA with DGBI have high rates of suboptimal care transitions, affecting their health and quality of life. Our study highlights the need for a comprehensive approach that incorporates parents and pediatric providers.

A Brief Discussion of the Impact of Service- Learning Experience on Physicians´ Manner of Practice

Background: Service-learning combines student education with volunteer activities which benefit the community. The authors examined how service-learning through a Canadian medical student-run clinic for refugee newcomers shapes the subsequent practice style of physicians. The clinic (known as “The Gateway Program”) aims to improve access to medical care for refugees in the urban center in which the medical schoolis located, while teaching students about cross-cultural medicine. The connection between current practice styles and prior service-learning has not been well documented in the literature, despite value existing in examining the impact this educational tool has on physicians. The research question was: How does participation in service-learning shape the manner in which physicians subsequently deliver healthcare? Methods: The study qualitatively examines the experiences of former student coordinators of The Gateway Program who are now practicing Canadian physicians. Eight participants were interviewed. Data was subjected to thematic analysis. Results: Three key themes were identified: Advocacy, Social Determinants of Health, and Transferable Skills for Underserved Populations. Conclusion: Time served in the clinic is reported to have had a profound impact on participants’ current style of practice. The clinic exposed students early in their medical education to a functional model of care for the underserved which valued physician advocacy. As practicing professionals, they were able to draw upon this learning to inform their professional morals and style of practice.

Effectiveness of the uChicago Health Inequity Classification System on surgical morbidity and mortality conference: A pilot study

BackgroundAcross surgery, marginalized individuals experience worse postoperative outcomes. These disparities stem from the interplay between multiple factors. MethodsWe introduced a novel framework to assess the role of barriers to access and bias in surgical complications (the uChicago Health Inequity Classification System, CHI-CS) in the setting of morbidity and mortality conference and assessed impact through pre and post implementation surveys. ResultsAccess and bias were related to surgical complications in 14 ​% of cases. 97 ​% reported enhanced M&M presentations with the grading system, and 47 ​% reported a change in decision-making or practice style. Although post-implementation response rate was low, there were improvements in self-reported confidence and comfort in recognizing and discussing these issues. ConclusionsImplementation of the CHI-CS framework to discuss bias and access to care positively impacted the way providers view, discuss, and process health inequities.

Development and Implementation of a Novel Approach to Dietary Education for People With Inadequate Health Literacy and Advanced Kidney Disease

To describe the process of developing and implementing a novel approach to renal diet education by changing from a nutrient-based food list to a pictorial meal compilation approach through the skill steps: plan, select, cook, eat. The skill-based teaching method accommodates low literacy levels and respects cultural values. This teaching style aligns the complex renal diet guidelines with family living. Each meal plan is based on a balanced diet and includes family preferences. Appropriate cooking methods and food swaps that match renal diet specifications are included. The accompanying Cook for Life cookbook demonstrates how to prepare the new kidney-friendly family meal. Recipes were supplied by a local Māori elder and his whānau and tested by the dietitian. The cookbook is provided to all patients receiving renal dietetic education. The teaching method has undergone several iterations to accommodate feedback from dietitians, nurses, doctors, and patients. This included patient engagement to develop the Storybook, a pictorial representation of typical meals consumed in the community with a corresponding food substitution to illustrate how to compile kidney-friendly meals. Analysis of feedback regarding this approach indicates high levels of acceptance and engagement with this new teaching style. This practical skill-based dietary education teaching style appears to be a feasible, acceptable, culturally sensitive, and appropriate approach to dietary education for people who live with kidney disease. Patient engagement in the design of this approach supports effective learning and behavior change.

Fitting in? Physician practice style after forced relocation.

This study aims to examine how variation in physicians' treatment decisions for newborn deliveries responds to changes in the hospital-level norms for obstetric clinical decision-making. All hospital-based births in Florida from 2003 through 2017. Difference-in-differences approach is adopted that leverages obstetric unit closures as the source of identifying variation to exogenously shift obstetricians to a new, nearby hospital with different propensities to approach newborn deliveries less intensively. Births attributed to physicians continuously observed 2 years before the closure event and 2 years after the closure event (treatment group physicians) or for identical time periods around a randomly assigned placebo closure date (control group physicians). All of the physicians meeting our inclusion criteria shifted their births to a new hospital less than 20 miles from the hospital shuttering its obstetric unit. The new hospitals approached newborn births more conservatively, and treatment group physicians sharply became less aggressive in their newborn birth clinical management (e.g., use of C-section). The immediate 11-percentage point (33%) increase in delivering newborns without any procedure behavior change is statistically significant (p value <0.01) and persistent after the closure event; however, the physicians' payer and patient mix are unchanged. Obstetric physician behavior change appears highly malleable and sensitive to the practice patterns of other physicians delivering newborns at the same hospital. Incentives and policies that encourage more appropriate clinical care norms hospital-wide could sharply improve physician treatment decisions, with benefits for maternal and infant outcomes.

The Automation of Style

In histories of photography, the notion of ‘seeing photographically’ is associated with so-called ‘straight’ photographers such as Edward Weston. It means to train the human-camera eye – to ‘previsualise’ – by conforming to the conditions of what Vilém Flusser calls the “photographic program”. At the same time, seeing photographically is a constant dynamic between a protean technical practice and aesthetic conventions or styles. This paper revisits the notion of seeing photographically to contextualise how notions of photographic style operate in generative imaging practices and AI discourse. We argue that since not only photorealism but the look of photographs from any period or style can be generated with the right combination of prompts and parameters, it has become possible to ‘previsualise’ and ‘see photographically’ by treating the history of photography as a style market. The concept of ‘style’, outdated in art history, becomes newly important and photography becomes a memory to be evoked in ahistorical stylistic evocations.

Crip curation and the aesthetics of the undeliverable

In this article, the author argues how the conceptual curatorial work of Lucy Lippard imbued similar qualities to those that are embodied in the curatorial work of the ‘aesthetics of the undeliverable’. The aesthetics of the undeliverable is a new genre of disability curating that centers the realities of disability and access within curatorial and artistic practice, alongside exhibition design. The line that runs through both styles of curatorial practice, that is, Lippard’s work, and the aesthetics of the undeliverable, is political intent, where the behind-the-scenes labor of the curator is revealed. Specifically, in Lippard’s projects, errors, gaps, and professional time-frames were revealed, whilst the aesthetics of the undeliverable points out inequities towards disabled artists and audiences, yet insisting on time-lines that defy normative frameworks. The author examines these generative comparisons through Lippard’s ‘numbers’ exhibitions curated in the 1960s–1970s, alongside a case study of the exhibition, Undeliverable, curated by artist Carmen Papalia, which was held at Tangled Art + Disability Gallery in Toronto, followed by the Robert McLaughlin Gallery in Oshawa, Ontario in 2021. In doing this, she aims to show how the aesthetics of the undeliverable is a form of institutional critique within disability arts and culture that has its roots in the proponents of conceptual art of the 1960s and Lippard, to which crip curating is aligned through its oppositional handling of curatorial norms. This dovetails powerfully with a call by Disability Studies scholars to move towards crip methodology, and this article will show how crip curation and the aesthetics of the undeliverable heeds this call.

A comprehensive analysis of leadership attributes, discrepancies, and implications for gender equity in vascular surgery

ObjectiveWell-developed leadership skills have been associated with a better understanding of health care context, increased team performance, and improved patient outcomes. Surgeons, in particular, stand to benefit from leadership development. Although studies have focused on investigating knowledge gaps and needs of surgeons in leadership roles, there is a noticeable gap in the literature concerning leadership in vascular surgery. The goal of this study was to characterize current leadership attributes of vascular surgeons and understand demographic influences on leadership patterns. MethodsThis retrospective cohort study was a descriptive analysis of vascular surgeons and their observers who took the Leadership Practices Inventory (LPI) from 2020 to 2023. The LPI is a 30-question inventory that measures the frequency of specific leadership behaviors across five practices of leadership. ResultsA total of 110 vascular surgeons completed the LPI. The majority of participants were White (56%) and identified as male (60%). Vascular surgeons most frequently observed the “enabling others to act” leadership practice style (8.90 ± 0.74) by all evaluators. Vascular surgeons were most frequently above the 70th percentile in the “challenge the process” leadership practice style (49%) compared with the average of other leaders worldwide. Observers rated vascular surgeons as displaying significantly more frequent leadership behaviors than vascular surgeons rated themselves in every leadership practice style (P < .01). The only demographic variable associated with a significantly increased occurrence of achieving 70th percentile across all five leadership practice styles was the male gender: a multivariable model adjusting for objective experience showed that men were at least 3.5 times more likely to be rated above the 70th percentile than women. ConclusionsVascular surgeons under-report the frequency at which they practice leadership skills across all five leadership practice styles and should recognize their strengths of enabling others to act and challenging the process. Men are recognized as exhibiting all five leadership practices more frequently than women, regardless of current position or experience level. This observation may reflect the limited leadership positions available for women, thereby restricting their opportunities to demonstrate leadership practices as frequently or recognizably as their male counterparts.

Harmonizing leadership: Blending transactional and transformational styles in pharmacy practice.

Harmonizing leadership: Blending transactional and transformational styles in pharmacy practice.

Frequent Lucid Dreaming Is Associated with Meditation Practice Styles, Meta-Awareness, and Trait Mindfulness.

Lucid dreaming involves becoming aware that one's current experience is a dream, which has similarities with the notion of mindfulness-becoming aware of moment-to-moment changes in experience. Additionally, meta-awareness, the ability to explicitly notice the current content of one's own mental state, has also been proposed to play an important role both in lucid dreaming and mindfulness meditation practices. However, research has shown conflicting strengths of associations between mindfulness, meditation, and lucid dreaming frequency, and the link between lucid dreaming and meta-awareness has not yet been empirically studied. This study evaluated the associations between lucid dreaming frequency and different meditation practice styles, mindfulness traits, and individual differences in meta-awareness through an online survey (n = 635). The results suggest that daily frequent meditators experience more lucid dreams than non-frequent meditators. However, weekly frequent meditators did not have a higher lucid dreaming frequency. A positive association was observed between open monitoring styles of meditation and lucid dreaming. The findings also indicate that meta-awareness is higher for meditators and weekly lucid dreamers. Furthermore, frequent lucid dreaming was commonly associated with a non-reactive stance and experiencing transcendence. Overall, the findings suggest a positive relationship between specific meditation practices and lucid dreaming as well as the importance of meta-awareness as a cognitive process linking meditation, mindfulness, and lucid dreaming.

Regional variation from 2013 to 2021 in primary total shoulder arthroplasty utilization, reimbursement, and patient populations

BackgroundTotal shoulder arthroplasty (TSA), encompassing both anatomical and reverse total shoulder arthroplasty, has increased in popularity worldwide. The purpose of this study was to assess how TSA utilization, reimbursement, surgeon practices, and patient populations have evolved within the Medicare population from 2013 to 2021 at a national and regional level. MethodsThe Medicare Physician and Other Practitioners dataset was queried for all episodes of primary TSA (CPT-23472), both anatomic and reverse, between years 2013 and 2021. TSA utilization was assessed as volume per 10,000 Medicare beneficiaries. Average inflation-adjusted reimbursement, physician practice styles, and patient demographics of each TSA surgeon were extracted each year. Data was stratified geographically based on US census classifications and rural-urban commuting codes. Kruskal-Wallis and multivariate regressions were utilized to determine differences between regions. ResultsBetween 2013 and 2021, TSA utilization increased by 121.8% nationally. The increase was greatest in the Northeast (+147.2%) and least in the Midwest (+115.5%). Average TSA reimbursement declined by 8.8% nationally, with the least decline in the Northeast (6.4%) and the greatest decline in the Midwest (-11.9%). In 2021, the Midwest had the highest TSA utilization (18.1/10,000), while having the lowest average reimbursement ($1,108.59; p<0.001). The Northeast had the lowest utilization (11.5/10,000) and highest reimbursement ($1,223.44; p<0.001) in 2021. Nationally, the number of Medicare beneficiaries per surgeon performing shoulder arthroplasty declined by 5.9%, while the average number of TSAs per surgeon (+8.5%) and average number of billable services per beneficiary (+16.6%) both increased. Surgeons in the South performed the most services per beneficiary in 2021 (9.0; p<0.001). The average comorbidity burden of patients decreased by 4.8% between 2013 and 2021, with the West having the healthiest patients in 2021. Higher patient comorbidities were associated with lower physician reimbursement nationally (p<0.001). ConclusionThis study demonstrates that TSA utilization in the Medicare population has more than doubled between 2013 and 2021, while average inflation-adjusted reimbursement has declined by nearly 10%. The Midwest has the highest per-capita TSA utilization, while simultaneously having the lowest average reimbursement per TSA. Over time, TSA surgeons are seeing fewer and healthier beneficiaries but performing more services per beneficiary. Additionally, increased patient complexity may be associated with lower reimbursement. Together, these findings are concerning for long-term equitable access to care within shoulder surgery.

Spillovers and Training Effects on Mental Health Prescribing for Children

We use data on all prescriptions filled at U.S. retail pharmacies from 2006-2018 to examine deviations from best practice in the prescription of psychiatric medications to children. The results demonstrate the importance of spillovers from other doctors in the same area. However, individual doctor fixed effects remain extremely important. We also show that the practice styles of doctors who graduated in the same year from schools of the same rank evolve in a similar way across the country. Psychiatrists are less affected by area-level prescribing than general practitioners suggesting that specific training can reduce spillovers in questionable prescribing practices.

Effect of a physical education program in early childhood education on the performance of fundamental movement skills based on teaching styles: divergent discovery and practical

Background and Study Aim. Various proposals suggest that Physical Education classes (PE) should prioritize the development of fundamental movement skills (FMS), particularly in preschool children. Despite the crucial nature of mastering FMS, there is a paucity of evidence regarding the impact of PE classes on FMS development. The primary objective of this study is to investigate the effect of a physical education program on the performance of preschool students with varying levels of development in fundamental movement skills, employing divergent discovery and practical teaching styles. Material and Methods. Seventy-seven children (35 boys), aged between 4.5 and 6 years were divided into three groups: Control Group (CG) with 25 participants, Divergent Discovery Group (DDG) with 24 participants, and Practice Group (PG) with 28 participants. The intervention program spanned six months, with two 50-minute classes per week for the experimental groups. Conversely, the control group participated in the Classroom Program proposal. All three groups underwent the TGMD-3 motor test. Performance measurement involved the sum of the raw score in the locomotor and object control classes. Results. The findings revealed that the Control Group, Divergent Discovery Group, and Practice Group exhibited improved FMS performance from pre to post. Concerning intergroup differences, no significant disparities were observed in the pre-test. However, post-intervention results indicated that both the Divergent Discovery Group and Practice Group demonstrated superior FMS performance compared to the Control Group. Conclusions. Physical Education classes for Early Childhood Education play a crucial role in fostering significant effects on children's motor development when offered in an appropriate context and through a systematically structured intervention.