The Impact of Physician Subspecialty Training, Risk Calculation, and Patient Age on Treatment Recommendations in Ocular Hypertension

Background: Chondral damage from the impact of injury may contribute to the high incidence of post-traumatic arthritis after calcaneal fractures, but this has yet to be proven. We sought to study the effect of intra-articular calcaneal fractures on chondrocyte viability and to correlate these effects with injury severity, time from injury to surgery, and patient age and co-morbidities. Methods: Irreducible osteochondral fragments from 12 patients undergoing operative treatment for intra-articular calcaneal fractures were analyzed. Control cartilage was obtained from four tissue donors who died of unrelated causes. The cartilage was assessed for chondrocyte viability through the full thickness of tissue using a Live/Dead assay followed by laser scanning confocal microscopy. Patient demographics including injury classification and severity, time from injury to surgery, and patient age were recorded. Results: Chondrocyte viability from fracture patients averaged 72.8% ± 12.9% (range 53% to 95%), which was significantly lower than the 94.8% ± 1.5% viability observed in the control specimens ( p = 0.005). Chondrocyte viability declined with higher energy injuries ( p = 0.13), time from injury to surgery ( p = 0.07), and increasing patient age ( p = 0.07). However, none of these factors reached a level of statistical significance. Conclusions: A significant decline in chondrocyte viability occurs after intra-articular fractures of the calcaneus. This may contribute to the development of post-traumatic arthritis.

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A national survey of radiation oncologists and urologists on active surveillance for low-risk prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.133 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 133-133

Author(s):

Albert Kim ◽

Robert Abouassaly ◽

Simon P. Kim

Keyword(s):

Prostate Cancer ◽

Clinical Practice ◽

Active Surveillance ◽

National Survey ◽

Treatment Recommendations ◽

Low Risk ◽

Primary Therapy ◽

Patient Age ◽

Radiation Oncologists ◽

Patient Âgé

133 Background: Due to the growing concerns about over-diagnosis and overtreatment of localized prostate cancer (PCa), active surveillance (AS) has become an integral part of clinical practice guidelines. However, many men with low-risk PCa still receive primary therapy with surgery or radiation. Little is known about the barriers regarding the use of AS in clinical practice. To address this, we performed a national survey of radiation oncologists and urologists assessing the current attitudes and treatment for patients diagnosed with low-risk PCa. Methods: From January to July of 2017, 915 radiation oncologists and 940 urologists were surveyed about perceptions of AS for low-risk PCa. The survey queried respondents about their opinions and attitudes towards AS and treatment recommendations for a patient having low-risk PCa with clinical factors varying from patient age (55, 65 and 75 years old), PSA (4 and 8 ng per dl), and tumor volume for Gleason 3+3 disease (2, 4 and 6 cores). Pearson chi-square and multivariable logistic regression were used to identify respondent differences in treatment recommendations for low-risk PCa. Results: Overall, the response rate was 37.3% (n = 691) and similar for radiation oncologists and urologists (35.7% vs. 38.7%; p = 0.18). While both radiation oncologists and urologists viewed AS as effective for low-risk PCa (86.5% vs. 92.0%; p = 0.04), radiation oncologists were more likely to respond that AS increases patient anxiety (49.5% vs. 29.5%; p < 0.001). Overall, recommendations varied markedly based on patient age, PSA, number of cores positive for Gleason 3+3 prostate cancer and respondent specialty. For a 55-year-old male patient with a PSA 8 and 6 cores of Gleason 6 PCa, recommendations of AS were low for both radiation oncologists and urologists (4.4 % vs. 5.2%; adjusted OR: 0.6; p = 0.28). For a 75-year-old patient with a PSA 4 and 2 cores of Gleason 6 PCa, radiation oncologists and urologists most often recommended AS (89.6% vs. 83.4%; adjusted OR: 0.5; p = 0.07). Conclusions: While both radiation oncologists and urologists consider AS effective in the clinical management of low-risk PCa, its use varies markedly by patient age, PCa volume, PSA and physician specialty.

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Prehospital Emergency Medical Services Departure Interval: Does Patient Age Matter?

Prehospital and Disaster Medicine ◽

10.1017/s1049023x16000947 ◽

2016 ◽

Vol 31 (6) ◽

pp. 608-613 ◽

Cited By ~ 1

Author(s):

Bruno Schnegg ◽

Mathieu Pasquier ◽

Pierre-Nicolas Carron ◽

Bertrand Yersin ◽

Fabrice Dami

Keyword(s):

Response Time ◽

Emergency Medical Services ◽

Time Of Day ◽

Medical Services ◽

Time Interval ◽

Patient Age ◽

Emergency Medical ◽

Patient Âgé ◽

Prehospital Emergency ◽

The Impact

AbstractIntroductionThe concept of response time with minimal interval is intimately related to the practice of emergency medicine. The factors influencing this time interval are poorly understood.ProblemIn a process of improvement of response time, the impact of the patient’s age on ambulance departure intervals was investigated.MethodThis was a 3-year observational study. Departure intervals of ambulances, according to age of patients, were analyzed and a multivariate analysis, according to time of day and suspected medical problem, was performed.ResultsA total of 44,113 missions were included, 2,417 (5.5%) in the pediatric group. Mean departure delay for the adult group was 152.9 seconds, whereas it was 149.3 seconds for the pediatric group (P =.018).ConclusionA statistically significant departure interval difference between missions for children and adults was found. The difference, however, probably was not significant from a clinical point of view (four seconds).SchneggB, PasquierM, CarronPN, YersinB, DamiF. Prehospital Emergency Medical Services departure interval: does patient age matter?Prehosp Disaster Med. 2016;31(6):608–613.

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39 Are we ageist? The impact of patient age on chemotherapy treatment decisions in advanced non-small cell lung cancer at St James's Institute of Oncology

Lung Cancer ◽

10.1016/s0169-5002(13)70039-4 ◽

2013 ◽

Vol 79 ◽

pp. S13-S14

Author(s):

J. Kelly ◽

Z. Toukan ◽

C. Mulatero

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Treatment Decisions ◽

Small Cell ◽

Chemotherapy Treatment ◽

Small Cell Lung ◽

Patient Age ◽

Patient Âgé ◽

The Impact

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The impact of patient age and comorbidities on the occurrence of “never events” in cerebrovascular surgery: an analysis of the Nationwide Inpatient Sample

Journal of Neurosurgery ◽

10.3171/2014.4.jns131253 ◽

2014 ◽

Vol 121 (3) ◽

pp. 580-586 ◽

Cited By ~ 22

Author(s):

Timothy Wen ◽

Shuhan He ◽

Frank Attenello ◽

Steven Y. Cen ◽

May Kim-Tenser ◽

...

Keyword(s):

Hospital Costs ◽

Patient Characteristics ◽

High Risk Population ◽

Health Care Administrators ◽

Patient Age ◽

Medical Comorbidities ◽

Patient Âgé ◽

Never Events ◽

Tract Infections ◽

The Impact

Object As health care administrators focus on patient safety and cost-effectiveness, methodical assessment of quality outcome measures is critical. In 2008 the Centers for Medicare and Medicaid Services (CMS) published a series of “never events” that included 11 hospital-acquired conditions (HACs) for which related costs of treatment are not reimbursed. Cerebrovascular procedures (CVPs) are complex and are often performed in patients with significant medical comorbidities. Methods This study examines the impact of patient age and medical comorbidities on the occurrence of CMS-defined HACs, as well as the effect of these factors on the length of stay (LOS) and hospitalization charges in patients undergoing common CVPs. Results The HACs occurred at a frequency of 0.49% (1.33% in the intracranial procedures and 0.33% in the carotid procedures). Falls/trauma (n = 4610, 72.3% HACs, 357 HACs per 100,000 CVPs) and catheter-associated urinary tract infections (n = 714, 11.2% HACs, 55 HACs per 100,000 CVPs) were the most common events. Age and the presence of ≥ 2 comorbidities were strong independent predictors of HACs (p < 0.0001). The occurrence of HACs negatively impacts both LOS and hospital costs. Patients with at least 1 HAC were 10 times more likely to have prolonged LOS (≥ 90th percentile) (p < 0.0001), and 8 times more likely to have high inpatient costs (≥ 90th percentile) (p < 0.0001) when adjusting for patient and hospital factors. Conclusions Improved quality protocols focused on individual patient characteristics might help to decrease the frequency of HACs in this high-risk population. These data suggest that risk adjustment according to underlying patient factors may be warranted when considering reimbursement for costs related to HACs in the setting of CVPs.

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The effect of patient age, the presence of infection and neoplastic disease on the occurrence of dehiscence laparotomy

Acta chirurgica iugoslavica ◽

10.2298/aci1104089p ◽

2011 ◽

Vol 58 (4) ◽

pp. 89-92

Author(s):

Milorad Paunovic

Keyword(s):

Prospective Study ◽

General Surgery ◽

T Test ◽

Neoplastic Disease ◽

Patient Age ◽

Younger Patients ◽

Neoplastic Diseases ◽

Abdominal Organs ◽

Patient Âgé ◽

The Impact

Background/Aim. Dehiscence after laparotomy is one of the major complications of laparotomy. Laparotomy is a partial or complete wound with disruption and evisceratio abdominal organs and require urgent reintervention. The aim of this study was to determine the impact of age, infection and neoplastic disease on the occurrence of dehiscence laparotomy. Methods. A retrospective-prospective study were included 826 patients operated at the Clinic for General Surgery in Nis in the period from January 2008 to December 2009. The effect of patient age, the presence of infection and neoplastic disease on the occurrence of dehiscence laparotomy. Results are displayed numerically and in percentages. Results. Of the total 32 patients with dehiscence laparotomy, 20 patients were male or 62.5% and 12 female patients, or 37.5%. Patients with dehiscence laparotomy were significantly younger than patients without dehiscence laparotomy (T-test t=3.237, p<0.05). The average age of respondents with dehiscence was 57.93 years, while patients without dehiscence 63.97 years. There is a statistically highly significant correlation between laparotomy dehiscence and infection (X2=62.024, p<0,01). There was a statistically significant association between dehiscence laparotomy and neoplastic diseases (X2 =42,196; p<0,01). Conclusion. With respect to age, dehiscence laparotomy is significantly more common in younger patients. Infection was significantly more frequent in patients with dehiscence laparotomy. In patients with neoplastic diseases dehiscence laparotomy is common.

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The Impact of Patient Age on Foot and Ankle Arthrodesis Supplemented with Autograft or an Autograft Alternative (rhPDGF-BB/β-TCP)

JBJS Open Access ◽

10.2106/jbjs.oa.20.00056 ◽

2020 ◽

Vol 5 (4) ◽

pp. e20.00056-e20.00056

Author(s):

Gregory C. Berlet ◽

Judith F. Baumhauer ◽

Mark Glazebrook ◽

Steven L. Haddad ◽

Alastair Younger ◽

...

Keyword(s):

Ankle Arthrodesis ◽

Foot And Ankle ◽

Patient Age ◽

Patient Âgé ◽

The Impact

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Predictors of Prehospital On-Scene Time in an Australian Emergency Retrieval Service

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19004394 ◽

2019 ◽

Vol 34 (03) ◽

pp. 317-321

Author(s):

Patrick T. Fok ◽

David Teubner ◽

Jeremy Purdell-Lewis ◽

Andrew Pearce

Keyword(s):

Model Building ◽

South Australia ◽

Therapeutic Interventions ◽

Arterial Line ◽

Patient Age ◽

Line Placement ◽

Patient Âgé ◽

Time Required ◽

The Impact ◽

Rotary Wing

AbstractIntroduction:Prehospital physicians balance the need to stabilize patients prior to transport, minimizing the delay to transport patients to the appropriate level of care. Literature has focused on which interventions should be performed in the prehospital environment, with airway management, specifically prehospital intubation (PHI), being a commonly discussed topic. However, few studies have sought additional factors which influence scene time or quantify the impact of mission characteristics or therapeutic interventions on scene time.Hypothesis/Problem:The goal of this study was to identify specific interventions, patient demographics, or mission characteristics that increase scene time and quantify their impact on scene time.Methods:A retrospective, database model-building study was performed using the prehospital mission database of South Australian Ambulance Service (SAAS; Adelaide, South Australia) MedSTAR retrieval service from January 1, 2015 through August 31, 2016. Mission variables, including patient age, weight, gender, retrieval platform, physician type, PHI, arterial line placement, central line placement, and finger thoracostomy, were assessed for predictors of scene time.Results:A total of 506 missions were included in this study. Average prehospital scene time was 34 (SD = 21) minutes. Four mission variables significantly increased scene time: patient age, rotary wing transport, PHI, and arterial line placement increased scene time by 0.09 (SD = 0.08) minutes, 13.6 (SD = 3.2) minutes, 11.6 (SD = 3.8) minutes, and 34.4 (SD = 8.4) minutes, respectively.Conclusion:This study identifies two mission characteristics, patient age and rotary wing transport, and two interventions, PHI and arterial line placement, which significantly increase scene time. Elderly patients are medically complex and more severely injured than younger patients, thus, may require more time to stabilize on-scene. Inherent in rotary wing operations is the time to prepare for the flight, which is shorter during ground transport. The time required to safely execute a PHI is similar to that in the literature and has remained constant over the past two years; arterial line placement took longer than envisioned. The SAAS MedSTAR has changed its clinical practice guidelines for prehospital interventions based on this study’s results. Retrieval services should similarly assess the necessity and efficiency of interventions to optimize scene time, knowing that the time required to safely execute an intervention may reach a minimum duration. Defining the scene time enables mission planning, team training, and audit review with the aim of improved patient care.

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