Type Of Medical Practice Research Articles

Blepharospasm: an analysis of typical medical practice and the effectiveness of therapy

Introduction. Blepharospasm (BS) is a form of focal dystonia in which botulinum therapy (BT) has been used successfully, however, data on typical practice of patient management and the effectiveness of long-term BT in BS in our country are insufficient.Aim. To analyse the typical medical practice of management of patients with BS and the effectiveness of long-term BT.Materials and methods. A total of 50 patients with idiopathic BS, mean age 58 years (of which 37 were women) were included in the study. All patients were treated with botulinum toxin type A. Typical medical practice, erroneous diagnosis, time required to reach a correct diagnosis, severity of dystonia, and quality of life before BT and during a three-year prospective observation were analysed. The severity of dystonia was determined using the BS Disability Index (BSDI), and the quality of life was measured using the EQ-5D questionnaire.Results. The correct diagnosis was reached, on average, in 3 years. Upon onset of symptoms the majority of patients (84%) visited an ophthalmologist. Eye diseases and myasthenia gravis were the most common primary erroneous diagnosis in BS, which were treated with inadequate symptomatic therapy. After one-month BT, it was noted that the disability index decreased from an average of 13.6 ± 5.1 to 2.7 ± 2.3 scores (p < 0.001) according to BSDI and the quality of life increased from 59.9 ± 8.2 to 82.6 ± 6.4 scores (p < 0.001) according to the results of EQ-5D. Repeated BT injections (2–6 times a year) conducted for 3 years also resulted in essentially positive effect without significant adverse events. At the end of three years, the disability index decreased to 10.7 ± 4.7 scores, and the improvement in the quality of life reached 81.8 ± 5.9 scores according to the results of EQ-5D (p < 0.001).Conclusion. The low awareness of doctors, especially ophthalmologists, about the symptoms of BS and the widespread use of ineffective drugs was noted. The long-term regular (2–6 times a year) use of BT reduces the symptoms of the disease, improves the quality of life of patients and has no significant side effects.

Typical practice for managing patients with fibromyalgia

Background. Fibromyalgia (FM) is manifested by chronic widespread pain syndrome, sleep disorders, fatigue and subjective cognitive impairment. There is a late diagnosis of FM in different countries; there is no data on the typical medical practice of managing patients with FM in our country.
 Aim. To analyse the previous typical practice of managing patients with FM.
 Materials and methods. Fifty three patients with FM (47 women and 6 men) were under observation; the average age was 46.814.6 years. The duration of FM symptoms (years), the intensity of pain syndrome according to a Numerical Rating Scale (NRS), quality of life using The Revised Fibromyalgia Impact Questionnaire (FIQR), emotional state according to the Hospital Anxiety and Depression Scale (HADS), and treatment were evaluated.
 Results. The duration of symptoms before the diagnosis of FM was 7.0 (2.015.0) years. The intensity of pain during the initial examination in patients with FM according to NRS 7.11.9 points, the effect on the quality of life of patients with FM according to FIQR 54.918.4 points. The majority of patients (85%) were not diagnosed with FM before hospitalization. There were no statistically significant differences in the intensity of pain (p=0.478), the level of quality of life (p=0.611), the level of anxiety (0.159) and depression (0.347) in the groups of patients who had or did not have a diagnosis of FM.
 Conclusion. FM is rarely diagnosed in our country, even in cases of diagnosis, patients in many cases do not receive effective treatment, which reflects the low awareness of doctors about modern methods of diagnosis and treatment of FM.

How Accessible Is Genital Gender-Affirming Surgery for Transgender Patients With Commercial and Public Health Insurance in the United States? Results of a Patient-Modeled Search for Services and a Survey of Providers.

IntroductionIn the United States, 1.4–1.65 million people identify as transgender, many of whom will seek genital gender-affirming surgery (GAS). The number of surgeons, geographic proximity thereof, and exclusionary insurance policies has limited patient access to genital GAS.AimTo assess the accessibility of both feminizing and masculinizing genital GAS (vaginoplasty, metoidioplasty, and phalloplasty) by identifying the location of GAS surgeons, health insurance, or payment forms accepted.MethodsBetween February and April 2018, genital GAS surgeons were identified via Google search. Surgeons’ offices were contacted by telephone or e-mail.Main Outcome MeasureWe queried the type of genital GAS performed, the health insurance or payment forms accepted, and the type of medical practice (academic, private, or group managed-care practice).ResultsWe identified 96 surgeons across 64 individual medical centers offering genital GAS. The survey response rate was 83.3%. Only 61 of 80 (76.3%) surgeons across 38 of 53 (72%) locations confirmed offering genital GAS. Only 20 (40%) U.S. states had at least one genital GAS provider. 30 of 38 (79%) locations reported accepting any form of insurance. Only 24 of 38 (63%) locations (14 academic; 10 private/group) accepted Medicaid (P = .016); 18 of 38 (47%) locations (13 academic; 5 private/group) accepted Medicare (P = .001).Clinical TranslationReconciliation of the public policies regarding insurance coverage for GAS with the actual practices of the providers is necessary for improving access to GAS for transgender individuals.Strengths & LimitationsWe purposefully used a methodology mirroring how a patient would find GAS surgeons, which also accounts for key limitations: only surgeons whose services were featured on the internet were identified. We could not verify the services or insurance-related information surgeons reported.ConclusionThis study suggests that access to genital GAS is significantly limited by the number of providers and the uneven geographic distribution across the United States, in which only 20 of 50 U.S. states have at least one genital GAS surgeon.Feldman AT, Chen A, Poudrier G, et al. How Accessible Is Genital Gender-Affirming Surgery for Transgender Patients With Commercial and Public Health Insurance in the United States? Results of a Patient-Modeled Search for Services and a Survey of Providers. Sex Med 2020;8:664–672.

Population genetic screening efficiently identifies carriers of autosomal dominant diseases

Three inherited autosomal dominant conditions-BRCA-related hereditary breast and ovarian cancer (HBOC), Lynch syndrome (LS) and familial hypercholesterolemia (FH)-have been termed the Centers for Disease Control and Prevention Tier 1 (CDCT1) genetic conditions, for which early identification and intervention have a meaningful potential for clinical actionability and a positive impact on public health1. In typical medical practice, genetic testing for these conditions is based on personal or family history, ethnic background or other demographic characteristics2. In this study of a cohort of 26,906 participants in the Healthy Nevada Project (HNP), we first evaluated whether population screening could efficiently identify carriers of these genetic conditions and, second, we evaluated the impact of genetic risk on health outcomes for these participants. We found a 1.33% combined carrier rate for pathogenic and likely pathogenic (P/LP) genetic variants for HBOC, LS and FH. Of these carriers, 21.9% of participants had clinically relevant disease, among whom 70% had been diagnosed with relevant disease before age 65. Moreover, 90% of the risk carriers had not been previously identified, and less than 19.8% of these had documentation in their medical records of inherited genetic disease risk, including family history. In a direct follow-up survey with all carriers, only 25.2% of individuals reported a family history of relevant disease. Our experience with the HNP suggests that genetic screening in patients could identify at-risk carriers, who would not be otherwise identified in routine care.

Usage of antiepileptic drugs in different diseases in Germany – A retrospective study

AimThe goal of this study was to analyze and quantify the usage of antiepileptic drugs (AEDs) in different diseases and settings in Germany. MethodsThis retrospective study, based on data from the Disease Analyzer database (IQVIA), included patients from 550 general practices (GP) and 73 neurological practices. Patients who had received at least one prescription for AED from one of these practices between January 2009 and December 2011 (time period 1, n = 39,434) or between January 2016 and December 2018 (time period 2, n = 49,128) were analyzed. ResultsIn patients who received AED prescriptions from neurologists, epilepsy (43%) was the most common diagnosis and did not change over time. The proportion of pain diagnoses slightly decreased from 35% in the period from 2009 to 2011 to 34% in the period from 2016 to 2018, while psychiatric disorders increased from 13% to 15%. In GPs, 58% of patients received their AED prescriptions for pain disorders, followed by epilepsy (29%) in the period from 2009 to 2011. The proportion of pain patients slightly increased to 60%, while that of patients with epilepsy slightly decreased to 27%. ConclusionsThe main indications for which AEDs are prescribed vary with the type of medical practice. The different indications for different AEDs changed between the two time periods, which is in line with the state of the research.

What Physicians Wished They Would Have Learned in Medical School: a Survey.

Medical students must be provided the basic science knowledge appropriate and applicable for preparing them for best-practice medicine. To date, there have been no documented studies in the USA that have directly surveyed practicing physicians on their perspectives of their basic science/preclinical medical school education and how it could be modified to help them deliver best patient care. This study was the first to examine this information. A survey was administered to the alumni of Touro College of Osteopathic Medicine, Harlem, NY (2011-2018), with questions on examining perspectives on basic science disciplines, the need for a basic science refresher course, and other educational topics. In addition, questions relating to demographics and type of medical practice were also asked. Statistical analysis was performed using SPSS. (1) Gender (N= 122): 55% male and 44% female; (2) medical specialty (N= 107): 51.40% Primary Care physicians (Family medicine, Internal medicine, Pediatrics), 48.60% Other Specialties; (3) top Disciplines that "should have more": Physiology (41.1%), Pharmacology (39.3%), and Preventative Medicine/Public Health (39.3%); Top disciplines that "should have less": Histology Laboratory (38.32%), Embryology (35.51%), Histology (didactic) (28.30%) (N= 107); (4) top topics "most important" to be included in curriculum: Analysis of Journal Articles (70.10%), Clinical Cases (70.1%), and Early Patient Exposure (64.5%) (N= 107); (5) presentation of a clinically relevant Basic Science refresher course had a positive response (84.4%) (N= 107). Pharmacology, Physiology, Clinical Cases, Journal Article Analysis, and Early Patient exposure were among topics requiring "more" in preclinical education. A clinically relevant basic science course was deemed useful. The perspectives of practicing physicians should be included when designing future medical school curriculums.

The Belmont Report and Innovative Practice.

One of the Belmont Report's most important contributions was the clear and serviceable distinction it drew between standard medical practice and biomedical research. A less well-known achievement of the Report was its conceptualization of innovative practice, a type of medical practice that is often mistaken for research because it is new, untested, or experimental. Although the discussion of innovative practice in Belmont is brief and somewhat cryptic, this does not reflect the significant progress its authors made in understanding innovative practice and the distinctive ethical issues it raises. This article explores the history and broader context of Belmont's conception of innovative practice, its strengths and weaknesses, and its contemporary relevance for scholars working in bioethics and health policy. While this conception of innovative practice deserves our attention, it is inherently limited in some important ways.

The determinants of patients’ opinions about physicians’ services in the Internet-based ranking site

Abstract Background The rankings of physicians’ services constructed on the basis of the feedback from patients became a popular form of the appraisal of their work. The main objective of the study was the assessment of predictors of the patients’ satisfaction with services provided by physicians of selected specialities. Methods The opinions about physicians of three specialties (paediatricians (P), gynaecologists (G) and family medicine physicians (FM)) who accumulated the highest numbers of opinions, were extracted from the rankinglekarzy.pl website. Only 100 physicians of each specialty who were the most frequently scored were included. Apart from the scores on six individual criteria, the data reflecting the number of opinions (NOO), the type of medical practice (TMP), number of specialties (NS) and PhD title (PhD), as well as the location of the practice (LOP) were collected. The total score was calculated as the sum of scores assigned to individual criteria. Results The final data set consisted of 9482 opinions (4234 for P, 2057 for FM, and 3191 for G). The multivariate regression model revealed that odds of obtaining the maximum total score (MTS) depended on S, NOO, LOP, and TMP. G had higher odds of receiving the MTS than P and FM (OR, 95%CI, 0.75, 0.68-0.83, and 0.72, 0.64-0.82, respectively). MTS was less frequently received by physicians practicing in medical centres (0.56, 0.49-0.62) and hospitals (0.55; 0.44-0.70) than in private practices, but not by those practicing in more than one place (3.81, 2.78-4.21). Higher NOO was related to lower odds of receiving MTS (0.992; 0.990-0.995). Conclusions There are significant differences in patients’ assessment of services provided by physicians of three analysed specialties. The type of practice has a considerable impact on the satisfaction of patients. Interestingly, it seems also that the number of specialties and PhD title do not influence patients’ opinions about the quality of the medical doctor’s services. Key messages Internet-based rankings of physicians may be an important source of information about provided medical services. Key factors influencing patients’ opinions include specialty, the type and the location of medical practice, but not scientific a scientific title and number of specialities.

Carpal tunnel syndrome: issues of diagnosis and treatment

Objective: to analyze the typical medical practice management of patients with carpal tunnel syndrome (CTS), to evaluate the efficiency of surgical treatment, and to identify factors influencing the successful outcomes of surgical treatment.Patients and methods. The investigation enrolled 85 patients (14 men and 71 women; mean age, 62±10.8 years). Previous diagnosis and treatment of patients were assessed in other healthcare facilities. All patients underwent median nerve decompression. The efficiency of surgical treatment was assessed according to the Boston Carpal Tunnel Questionnaire (BCTQ) and a visual analogue scale for pain before and 1, 3, 6, and 12 months after surgery.Results and discussion. Informative diagnostic tests are rarely performed in patients with CTS, but cervical spine neurovisualization is often unreasonably prescribed. Erroneous diagnoses (predominantly those of cervical spine osteochondrosis (46%), and diabetic neuropathy (6%)) are made frequently (60%) in patients with CTS; the latter receive ineffective treatment for a long time. Surgical treatment in reducing pain and improving hand functionality is noted to be highly effective. The mean BCTQ score decreased from 2.81±0.68 to 1.62±0.55 and 1.24±0.41 at 1 and 12 months, respectively (p<0.05), the mean functional state score dropped from 2.92±0.78 to 2.4±0.72 and 1.46±0.57, respectively (p<0.05). Permanent numbness, subjective weakness, thenar muscle atrophy, Stage III CTS, and diabetes mellitus are predictors for less pronounced improvement in BCTQ scores after surgery (p<0.05).Conclusion. Physicians are noted to be unaware of the manifestations of CTS and effective methods for its diagnosis and treatment. Decompression surgery is shown to be a highly effective procedure in patients with CTS following 1 and 12 months.

When and how to discontinue bracing treatment in adolescent idiopathic scoliosis: results of a survey

BackgroundCurrently, there is little consensus on how or when to discontinue bracing in adolescent idiopathic scoliosis (AIS). An expert spine surgeon national survey could aid in elucidate discontinuation of the brace.Few data have been published on when and how to discontinue bracing treatment in patients with AIS resulting in differences in the management of the condition. The aim of this study was to characterize decision-making of surgeons in the management of bracing discontinuation in AIS.MethodsAn original electronic survey consisting of 12 multiple choice questions was sent to all the members of the National Spine Surgery Society (497 surveyed). Participants were asked about their type of medical practice, years of experience in the field, society memberships, type of brace they usually prescribed, average hours of daily brace wearing they recommended, and how and when they indicated bracing discontinuation as well as the clinical and/or imaging findings this decision was based on. Exclusion criteria include brace discontinued because of having developed a curve that warranted surgical treatment.ResultsOf a total of 497 surgeons, 114 responded the survey (22.9%). 71.9% had more than 5 years of experience in the specialty, and 51% mainly treated pediatric patients. Overall, 95.5% of the surgeons prescribed the thoracolumbosacral orthosis (TLSO), indicated brace wearing for a mean of 20.6 h daily. Regarding bracing discontinuation, indicated gradual brace weaning, a decision 93.9% based on anterior-posterior (AP) and lateral radiographs of the spine and physical examination, considered a Risser ≥ IV and ≥ 24 months post menarche.ConclusionsThe results of this study provide insight in the daily practice of spine surgeons regarding how and when they discontinue bracing in AIS. The decision of bracing discontinuation is based on AP/lateral spinal radiographs and physical examination, Risser ≥ IV, regardless of Tanner stage, and ≥ 24 months post menarche. Gradual weaning is recommended.

Small talk in medical conversations: Data from China

Although small talk has conventionally been treated as marginal and unimportant compared with core business talk, its value in understanding institutional norms and power relations has been recognized in many workplace contexts. However, in-depth analysis of the dynamics of small talk is still under-researched in clinical contexts. This paper explores where and how small talk is positioned, initiated, and closed between participants in two types of medical practices that co-exist in China: Traditional Chinese Medicine and Western Medicine. Analysis of 69 consultations suggests that small talk permeates into the boundaries of talk. The findings also demonstrate a marked clinical difference in relation to the distribution and discourse functions of small talk.

Patient Satisfaction Measurement in Occupational and Environmental Medicine Practice.

: High patient satisfaction is a desirable goal in medical care. Patient satisfaction measures are increasingly used to evaluate and improve quality in all types of medical practices. However, the unique aspects of occupational and environmental medicine (OEM) practice require development of OEM-specific measures and thoughtful interpretation of results. The American College of Occupational and Environmental Medicine has developed and recommends a set of specific questions to measure patient satisfaction in OEM, designed to meet anticipated regulatory requirements, facilitate quality improvement of participating OEM practices, facilitate case-management review, and offer fair and accurate assessment of OEM physicians.

Problems of the diagnosis and treatment of compression neuropathy of the median nerve: an analysis of typical medical practice

An analysis of typical medical errors in the diagnosis and treatment of compression neuropathy of the median nerve at the level of the wrist (carpal tunnel syndrome - CTS). Previous diagnoses and treatment of 85 patients with CTS (14 men and 71 women), aged from 36 to 84 years (middle age 62±10.6 years), who underwent surgery in our clinics were evaluated. The wrong diagnosis was made in most of patients (60%). The osteochondrosis of cervical spine (45.8%) and diabetic polyneuropathy (5.8%) were the most common mistaken diagnoses. Proper neurophysiological measurements using the Phalen's test and Tinel's sign were not performed in the majority of patients. Magnetic resonance imaging (MRI) of the cervical spine was often unreasonably made, the electroneuromyography was not used. Nonsteroidal anti-inflammatory drugs (NSAIDs), vitamin B group were improperly prescribed to the patients diagnosed with CTS. Local corticosteroids injections were not prescribed to most of patients, immobilization of the wrist was not recommended at the early stage of disease and decompressive surgery at the advanced stage of disease. Clinical observation of the patient with long period of misdiagnosing is presented. Despite the long-standing history of CTS, surgical decompression led to regression of symptoms and complete professional rehabilitation. It is necessary to inform physicians about manifestations, diagnostic criteria and effective methods of treatment of CTS.

Accountability: a missing construct in models of adherence behavior and in clinical practice.

Piano lessons, weekly laboratory meetings, and visits to health care providers have in common an accountability that encourages people to follow a specified course of action. The accountability inherent in the social interaction between a patient and a health care provider affects patients’ motivation to adhere to treatment. Nevertheless, accountability is a concept not found in adherence models, and is rarely employed in typical medical practice, where patients may be prescribed a treatment and not seen again until a return appointment 8–12 weeks later. The purpose of this paper is to describe the concept of accountability and to incorporate accountability into an existing adherence model framework. Based on the Self-Determination Theory, accountability can be considered in a spectrum from a paternalistic use of duress to comply with instructions (controlled accountability) to patients’ autonomous internal desire to please a respected health care provider (autonomous accountability), the latter expected to best enhance long-term adherence behavior. Existing adherence models were reviewed with a panel of experts, and an accountability construct was incorporated into a modified version of Bandura’s Social Cognitive Theory. Defining accountability and incorporating it into an adherence model will facilitate the development of measures of accountability as well as the testing and refinement of adherence interventions that make use of this critical determinant of human behavior.

Diagnosis and treatment of benign paroxysmal positional vertigo in common clinical practice

To analyze typical medical practice in managing patients with benign paroxysmal positional vertigo (BPPV). 33 patients (5 men and 28 women; mean age, 58 years) with BPPV who had been referred for consultation to the Medical Diagnostic Department, Clinic of Nervous Diseases, I.M. Sechenov First Moscow State Medical University, regarding for vertigo, were examined. Information about the disease before visiting the clinic, such as the duration of vertigo, its pattern, and triggers, previously established diagnoses, prescribed treatment and its efficacy, concomitant diseases, was analyzed. BPPV was not timely diagnosed in 93.9% of cases. The cause of vertigo was most commonly mistakenly assumed to be cerebrovascular disease (66.6%) and cervical spine pathology (15.1%). During a primary examination, none of the patients underwent positional tests (otoneurological examination) that formed the basis for the diagnosis of BPPV. Alternatively, 90.3% of cases underwent instrumental examination: magnetic resonance imaging of the brain, X-ray of the cervical spine, and ultrasonic duplex scanning of the brachiocephalic arteries. Ineffective diagnosis led to the choice of nonoptimal treatment tactics: instead of therapeutic repositioning maneuvers (RM), the patients received therapy with drugs, such as various vasoactive agents (84.8%), nootropic and chondroprotective drugs (12%), or muscle relaxants (9.1%). After BPPV was detected, all patients underwent curative RM, which resulted in regression of the disease. One-year follow-up of the patients showed that the therapeutic effect of RM persisted. Lack of effective and timely diagnosis of BPPV reflects physicians' poor awareness that this condition is the most common cause of vestibular vertigo. The role of vascular and cervicogenic factors in the development of vertigo is overestimated. Most patients with BPPV undergo unreasonable examinations and receive ineffective treatment. It is necessary to raise awareness of BPPV among of physicians and to set up specialized centers for the management of patients with dizziness.

Economic impact of homeopathic practice in general medicine in France.

Health authorities are constantly searching for new ways to stabilise health expenditures. To explore this issue, we compared the costs generated by different types of medical practice in French general medicine: i.e. conventional (CM-GP), homeopathic (Ho-GP), or mixed (Mx-GP).Data from a previous cross-sectional study, EPI3 La-Ser, were used. Three types of cost were analysed: (i) consultation cost (ii) prescription cost and (iii) total cost (consultation + prescription). Each was evaluated as: (i) the cost to Social Security (ii) the remaining cost (to the patient and/or supplementary health insurance); and (iii) health expenditure (combination of the two costs).With regard to Social Security, treatment by Ho-GPs was less costly (42.00 € vs 65.25 € for CM-GPs, 35 % less). Medical prescriptions were two-times more expensive for CM-GPs patients (48.68 € vs 25.62 €). For the supplementary health insurance and/or patient out-of-pocket costs, treatment by CM-GPs was less expensive due to the lower consultation costs (6.19 € vs 11.20 € for Ho-GPs) whereas the prescription cost was comparable between the Ho-GPs and the CM-GPs patients (15.87 € vs 15.24 € respectively) . The health expenditure cost was 20 % less for patients consulting Ho-GPs compared to CM-GPs (68.93 € vs 86.63 €, respectively). The lower cost of medical prescriptions for Ho-GPs patients compared to CM-GPs patients (41.67 € vs 63.72 €) was offset by the higher consultation costs (27.08 € vs 22.68 € respectively). Ho-GPs prescribed fewer psychotropic drugs, antibiotics and non-steroidal anti-inflammatory drugs.In conclusions management of patients by homeopathic GPs may be less expensive from a global perspective and may represent an important interest to public health.

Neurologists' knowledge of and attitudes toward epilepsy surgery: a national survey.

In the current study, we aim to assess potential neurologist-related barriers to epilepsy surgery among Canadian neurologists. A 29-item, pilot-tested questionnaire was mailed to all neurologists registered to practice in Canada. Survey items included the following: (1) type of medical practice, (2) perceptions of surgical risks and benefits, (3) knowledge of existing practice guidelines, and (4) barriers to surgery for patients with epilepsy. Neurologists who did not complete the questionnaire after the initial mailing were contacted a second time by e-mail, fax, or telephone. After this reminder, the survey was mailed a second time to any remaining nonresponders. In total, 425 of 796 neurologists returned the questionnaire (response rate 53.5%). Respondents included 327 neurologists who followed patients with epilepsy in their practice. More than half (56.6%) of neurologists required patients to be drug-resistant and to have at least one seizure per year before considering surgery, and nearly half (48.6%) failed to correctly define drug-resistant epilepsy. More than 75% of neurologists identified inadequate health care resources as the greatest barrier to surgery for patients with epilepsy. A substantial proportion of Canadian neurologists are unaware of recommended standards of practice for epilepsy surgery. Access also appears to be a significant barrier to epilepsy surgery and surgical evaluation. As a result, we are concerned that patients with epilepsy are receiving inadequate care. A greater emphasis must be placed on knowledge dissemination and ensuring that the infrastructure and personnel are in place to allow patients to have timely access to this evidence-based treatment.

Factors Associated With Missed Opportunities for Influenza Vaccination: Review of Medical Records in a Diverse Sample of Primary Care Clinics, San Diego County, 2010-2011.

Annual influenza vaccination rates remain well below health objectives. Most primary care clinic visits present opportunities for vaccination. The purpose of this study was to quantify missed opportunities (MOs) during the entire influenza season. Patients and clinic characteristics associated with vaccination and MOs are identified. Influenza vaccinations recorded in random chart reviews of children 6 months to 5 years and of adults 50 years and older at 6 pediatric and 7 adult primary care clinics were assessed during the 2010-2011 influenza season. Patient-specific MOs accounted for variable timing and number of visits throughout the vaccination season. Data were assessed using descriptive, graphical, proportional hazards regression methods. Data for 1136 children and 1329 adults were analyzed. By the end of the season, influenza vaccination coverage recorded in medical records reached 56% and 26% for children and adults, respectively. MOs are common throughout the season and rise sharply after December. By the end of the season, 30.2% of children and 44.9% of adults had 2 or more MOs. Characteristics associated with MOs included age, insurance type, number of visits, and type of medical practice. Missed opportunities abound, especially after December. Strategies targeting patients most likely to have MOs and encouraging the use standing orders, reminders, and monitoring in order to reduce them need to be sustained.

NASPGHAN Guidelines for Training in Pediatric Gastroenterology

G.G.C. has received com M.C. has served on th served on the board o and Enteral Nutrition; her institution has rec collaborative and Prov pensation from Child L.A.G. has received c received compensatio employment, expert t stocks/stock options; LLC, consulted to No received or has grants Institutes of Health, th holds equity interest in has received compens Fibrosis Foundation; M Abbott Laboratories, Foundation, the Natio Diseases/National Ins ticals; E.A.R. has rece sionalism & Ethical institution has receive as the medical editor has received compen Pharmaceuticals, and Nutrition; J.T. has rec Pediatrics, Prometheu conflicts of interest. Copyright # 2012 by E Hepatology, and Nut Gastroenterology, He DOI: 10.1097/MPG.0b01

Gift Card Incentives and Non-Response Bias in a Survey of Vaccine Providers: The Role of Geographic and Demographic Factors

This study investigates the effects of non-response bias in a 2010 postal survey assessing experiences with H1N1 influenza vaccine administration among a diverse sample of providers (N = 765) in Washington state. Though we garnered a high response rate (80.9%) by using evidence-based survey design elements, including intensive follow-up and a gift card incentive from Target, non-response bias could exist if there were differences between respondents and non-respondents. We investigated differences between the two groups for seven variables: road distance to the nearest Target store, practice type, previous administration of vaccines, region, urbanicity, size of practice, and Vaccines for Children (VFC) program enrollment. We also examined the effect of non-response bias on survey estimates. Statistically significant differences between respondents and non-respondents were found for four variables: miles to the nearest Target store, type of medical practice, whether the practice routinely administered additional vaccines besides H1N1, and urbanicity. Practices were more likely to respond if they were from a small town or rural area (OR = 7.68, 95% CI = 1.44−40.88), were a non-traditional vaccine provider type (OR = 2.08, 95% CI = 1.06−4.08) or a pediatric provider type (OR = 4.03, 95% CI = 1.36−11.96), or administered additional vaccines besides H1N1 (OR = 1.80, 95% CI = 1.03−3.15). Of particular interest, for each ten mile increase in road distance from the nearest Target store, the likelihood of provider response decreased (OR = 0.73, 95% CI = 0.60−0.89). Of those variables associated with response, only small town or rural practice location was associated with a survey estimate of interest, suggesting that non-response bias had a minimal effect on survey estimates. These findings show that gift card incentives alongside survey design elements and follow-up can achieve high response rates. However, there is evidence that practices farther from the nearest place to redeem gift cards may be less likely to respond to the survey.