THE ASSOCIATION BETWEEN PROVIDER CHARACTERISTICS AND POST-CATHETERIZATION PROCEDURES

Introduction: Classical teaching in pediatric laryngoscopy advocates the use of straight blades to be placed underneath the epiglottis, whereas curved blades are placed in the vallecula. Anesthesia studies suggest that straight blade positioning in the vallecula may be a satisfactory technique for small children. We sought to assess laryngoscope blade tip position during pediatric tracheal intubation (TI) and its association with intubation success. Methods: Observational single center study. Children undergoing TI from November 2017 until December 2018 in a pediatric emergency department (ED) and pediatric intensive care unit (PICU) using a CMAC video laryngoscope with recorded images available for review were eligible for inclusion. Patient and provider characteristics were obtained from quality improvement database. Each video was independently reviewed, and the blade tip position was determined by study personnel as ‘in vallecula’ or ‘under epiglottis’. TI success was defined as observation of the tube entering the trachea on video. Univariate analysis between blade tip position and success, as well as potential confounders, was performed by chi 2 testing. Multivariable logistic regression to determine the independent association between blade tip position and success while controlling for relevant confounders. Results: 95 TI attempts were analysed. 58% of attempts were successful (14/35 in infants, 8/15 in 1-7 yr old, 33/45 in 8+ yr, p=0.01). Blade tip position was in the vallecula for 20/31 (65%) attempts with curved blades and 23/64 (36%) with straight blades. In univariate analysis, TI attempts with blade tip position ‘in vallecula’ were significantly more successful than attempts with ‘under epiglottis’ (37% vs. 84%, p<0.001). Median duration of laryngoscopy was 41 sec (IQR 27-59), not significantly different between two blade tip positions (p=0.06). After controlling for patient age and blade type (potential confounders), TI attempts with blade tip ‘in vallecula’ was independently associated with success (aOR 7.2, 95% CI 2.6 - 20.1). Conclusion: During pediatric TI, laryngoscope blade tip position in the vallecula was independently associated with success when compared with placement under the epiglottis.

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Abstract P333: National Trends in the Quality of Office Blood Pressure Measurements, 2014-2019

Circulation ◽

10.1161/circ.141.suppl_1.p333 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Kathryn Foti ◽

Lawrence J Appel ◽

Kunihiro Matsushita ◽

Josef Coresh ◽

G Caleb Alexander ◽

...

Keyword(s):

Blood Pressure ◽

Clinical Practice ◽

Pressure Measurement ◽

Blood Pressure Measurement ◽

Pressure Measurements ◽

Hypertension Treatment ◽

Digit Preference ◽

Provider Characteristics ◽

Over Time

Introduction: Clinical practice guidelines emphasize the importance of accurate blood pressure measurement and recording to diagnose and treat hypertension. Trends in terminal digit preference (typically manifest by a terminal digit of ‘0’) have not been examined nationally. The growing use of automated blood pressure devices may have reduced terminal digit preference and improved accuracy over time. Objective: To evaluate trends in terminal digit preference in office blood pressure measurements among adults with hypertension by patient and provider characteristics. Methods: We used IQVIA National Disease and Therapeutic Index (NDTI) data from January 2014 through June 2019. The NDTI is designed to be nationally-representative of all patient visits to office-based physicians and uses a two-stage stratified sampling design to sample ~4,000 physicians per quarter who report information on all patient visits on 2 random workdays. We included all hypertension treatment visits (~60M/year) among adults aged ≥18. We examined trends in the proportion of hypertension treatment visits with recorded systolic (SBP) and diastolic (DBP) blood pressure measurements with a terminal digit ‘0’. The expected percent of blood pressures with ‘0’ is 10% for automated and 20% for manual readings. Results: There was a decrease in the percent of visits with SBP (43.0% to 37.4%) or DBP (44.3% to 38.1%) recordings ending in zero ( Table ). The decrease in percent of SBPs with a terminal zero was similar by patient and provider characteristics, though the percentage of SBPs with a terminal ‘0’ was consistently higher among patients aged ≥60, when SBP ≥140 mmHg, and among cardiologists. Conclusions: Terminal digit preference is common indicating systematic error in blood pressure measurement and recording, despite some improvement over time. This may lead to under- and overtreatment of patients with hypertension. Improving the quality of blood pressure measurement is central to improving hypertension diagnosis and control in clinical practice.

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Endoscopic History and Provider Characteristics Influence Gastric Cancer Survival in Asian Americans

Cancer Prevention Research ◽

10.1158/1940-6207.capr-20-0058 ◽

2020 ◽

Vol 13 (9) ◽

pp. 773-782

Author(s):

Christie Y. Jeon ◽

Yu-Chen Lin ◽

Samuel J. Klempner ◽

Bechien U. Wu ◽

Sungjin Kim ◽

...

Keyword(s):

Gastric Cancer ◽

Asian Americans ◽

Cancer Survival ◽

Provider Characteristics

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Effects of Primary Care Provider Characteristics on Changes in Behavioral Health Delivery During a Collaborative Care Trial

Academic Pediatrics ◽

10.1016/j.acap.2019.11.008 ◽

2020 ◽

Vol 20 (3) ◽

pp. 399-404

Author(s):

Elizabeth A. McGuier ◽

David J. Kolko ◽

K. Ashana Ramsook ◽

Anna S. Huh ◽

Olga V. Berkout ◽

...

Keyword(s):

Primary Care ◽

Behavioral Health ◽

Care Provider ◽

Collaborative Care ◽

Primary Care Provider ◽

Health Delivery ◽

Provider Characteristics

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Factors Influencing Disability Inclusion in General Eye Health Services in Bandung, Indonesia: A Qualitative Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16010023 ◽

2018 ◽

Vol 16 (1) ◽

pp. 23

Author(s):

Manjula Marella ◽

Fleur Smith ◽

Lukman Hilfi ◽

Deni Sunjaya

Keyword(s):

Health Care ◽

Pilot Project ◽

Related Factors ◽

Provider Characteristics ◽

Eye Health ◽

Factors Influencing ◽

Support Costs ◽

Inclusive System ◽

Health Care Strategies ◽

Specific Disability

The Inclusive System for Effective Eye-care (I-SEE) is a pilot project for disability inclusion in eye health in Bandung district of Indonesia. The aim of this research was to investigate factors influencing the introduction, i.e., adoption, implementation and continuation of I-SEE. A qualitative exploratory study was conducted by interviewing relevant stakeholders (n = 27) and users with disabilities (n = 12). A theoretical framework on the introduction of innovations in health care was used to guide data collection and thematic analysis. Factors related to the characteristics of the innovation (I-SEE) (e.g., infrastructure, equipment, engagement of people with disabilities, inclusive communication), service provider characteristics (e.g., motivation, attitudes, training), organizational characteristics (e.g., supervision, indicators, data), and the socio-political context of I-SEE (policy, motivation of users, family support, costs, transport) were essential for supporting the introduction process. Additionally, stakeholders proposed strategies for enhancing the introduction of I-SEE (e.g., awareness, collaborations). While there are specific disability related factors, most factors influencing the introduction of disability inclusive eye health were similar to introducing any innovation in general health care. Strategies for disability inclusion should be included from the planning phase of an eye health program and are reasonably simple to adapt.

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