Is Vascularized Composite Allograft Transplantation Experimental or an Accepted Surgical Procedure: Results from a National Survey

2020 ◽  
Vol 36 (04) ◽  
pp. 276-280
Author(s):  
Salih Colakoglu ◽  
Seth Tebockhorst ◽  
David Woodbridge Mathes
Keyword(s):  
Clinical Investigation ◽  
The United States ◽  
Representative Sampling ◽  
Electronic Survey ◽  
Internal Review ◽  
Vascularized Composite Allograft ◽  
American Society ◽  
Question Survey ◽  
Internal Review Board

Abstract Background More than 85 patients have received over 100 hand/arm transplants and more than 35 patients have received full or partial face transplants at institutions around the world. Given over two decades of experience in the field and in the light of successful outcomes with up to 17 years follow up time, should we still consider vascularized composite allograft (VCA) as a research/clinical investigation? We present the results of a nationwide electronic survey whose intent was to gather institutional bias with regard to this question. Methods An 11 question survey that was developed by VCA advisory committee of American Society of Transplantation was sent to all identified Internal Review Board chairs or directors in the United States. Results We received a total of 54 responses (25.3%) to the survey. The majority (78%) of responses came from either the chairperson, director, or someone who is administratively responsible for an IRB. Conclusion Though certainly not an exhaustive investigation into each institution's preference, we present a representative sampling. The results of which favor VCA as an accepted clinical procedure given the appropriate setting. Further research is needed to fully ascertain practices at each individual institution.

Assessment of the Implementation of AUC Dosing and Monitoring Practices With Vancomycin at Hospitals Across the United States

2021 ◽  
pp. 089719002110123
Author(s):  
Nicole Bradley ◽  
Yuman Lee ◽  
Muaz Sadeia
Keyword(s):  
The United States ◽  
Descriptive Statistics ◽  
Therapeutic Drug ◽  
User Friendliness ◽  
Electronic Survey ◽  
The Us ◽  
Institutional Adoption ◽  
American Society ◽  
Trough Levels ◽  
Do So

Introduction: The latest vancomycin therapeutic drug monitoring guidelines for serious MRSA infections have made a pivotal change in dosing, switching from targeting trough levels to AUC dosing. Because of these new recommendations, antimicrobial stewardship programs across the country are tasked with implementing AUC based dosing. Objectives: To assess plans for institutional adoption of vancomycin AUC dosing programs and perceptions of currently used programs in hospitals across the US. Methods: An electronic survey was distributed to members of the American College of Clinical Pharmacy IDprn Listserv and American Society of Health-System Pharmacists between May and June 2020 to assess current institutional vancomycin dosing. Institutional program use and multiple software user parameters were analyzed using descriptive statistics. Results: Two hundred two pharmacists responded to the survey with the majority practicing in institutions with 251-500 beds. Most respondents have yet to implement AUC dosing (142/202, 70.3%) with many of them planning to do so in the next year (81/142, 57.0%). Of those that already implemented AUC dosing programs, purchased Bayesian software (23/60, 38.3%) and homemade software (21/60, 35.0%) were the 2 methods most frequently utilized. Purchased Bayesian software users were more likely to recommend their software to other institutions and ranked user friendliness higher compared to non-purchased software. Conclusion: Most respondents have not made the switch to vancomycin AUC dosing, but there is a growing interest with many institutions looking to adopt a program within the next year.

scholarly journals P087: Procedural sedation in Canadian emergency departments a national survey of pharmacological agent selection and practice variation

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S87-S87
Author(s):  
E. Leci ◽  
K. Van Aarsen ◽  
A. Shah ◽  
J. W. Yan
Keyword(s):  
Practice Variation ◽  
Procedural Sedation ◽  
Pharmacologic Agent ◽  
Electronic Survey ◽  
Canadian Association ◽  
Institutional Influences ◽  
Agent Selection ◽  
Practice Variability ◽  
American Society ◽  
Question Survey

Introduction: Emergency department (ED) physicians strive to provide analgesia, amnesia and sedation for patients when performing painful procedures through the use of procedural sedation (PS). Examination of the literature suggests that the application of PS appears to be variable with institutional influences and clinician disagreement on pharmacology, airway management, and monitoring. The primary goal of this research project was to describe the variability of practice with respect to pharmacologic choices and clinical applications of PS among Canadian ED physicians. Methods: An electronic survey was distributed through the Canadian Association of Emergency Physicians (CAEP). Practicing physician members of CAEP were invited to complete the survey. The 20 question survey encompassed various aspects of PS including physician choices regarding PS indications and pharmacology. The primary outcome was the quantification of practice variability among ED physicians with respect to the above listed aspects of PS. The data was presented with simple descriptive statistics. Results: To date, 278 ED physicians responded to our survey (response rate 20.3%). Respondents were primarily academic hospital (53.2%) or community hospital based (38.2%). With emergency medicine training as: CCFP-EM (55.2%), FRCPC (30.1%), and CCFP (9.0%). There was relative agreement on the following interventions requiring PS: 98.4% applied PS for electrical cardioversion and 98.1% for brief (<10 mins) orthopedic manipulations. However, only 36.3% utilized PS for burn debridement in the ED. PS was utilized less frequently (78.1%) for prolonged (>10mins) orthopedic manipulations than brief manipulations. For all procedures aggregated, in hemodynamically stable patients with an American Society of Anesthesiology (ASA) score of 1, ED physicians utilized propofol 76.3% of the time. Additional agents were utilized at the following rates: fentanyl-propofol (7.6%), ketamine (7.6%), and fentanyl (4%). This inclination towards propofol alone appears to be consistent across modality of ER training, type of ER setting (rural vs academic), and volume of PS performed. Conclusion: This study demonstrates that Canadian ED physicians have a clear preference for propofol as a first line pharmacologic agent when administering PS in hemodynamically stable, ASA1 patients. Conversely, there appears to be more variation amongst ED physicians with respect to second line pharmaceutical choices for PS.

scholarly journals Hematology-Oncology Fellows’ Training in Geriatrics and Geriatric Oncology: Findings From an American Society of Clinical Oncology–Sponsored National Survey

2017 ◽  
Vol 13 (11) ◽  
pp. e900-e908 ◽  
Author(s):  
Ronald J. Maggiore ◽  
William Dale ◽  
Arti Hurria ◽  
Heidi D. Klepin ◽  
Andrew Chapman ◽  
...  
Keyword(s):  
United States ◽  
Older Adults ◽  
Geriatric Oncology ◽  
The United States ◽  
First Year ◽  
Clinical Experiences ◽  
Convenience Sample ◽  
Electronic Survey ◽  
Knowledge Based ◽  
American Society

Purpose: Older adults compose the majority of patients with cancer in the United States; however, it is unclear how well geriatrics or geriatric oncology training is being incorporated into hematology-oncology (hem-onc) fellowships. Methods: A convenience sample of hem-onc fellows completed a (written or electronic) survey assessing their education, clinical experiences, and perceived proficiency in geriatric oncology during training; knowledge base in geriatric oncology; confidence in managing older adults with cancer; and general attitudes toward geriatric oncology principles. Results: Forty-five percent of respondents (N = 138) were female, 67% were based in the United States, and most (60%) were past their first year of training. Most fellows rated geriatric oncology as important or very important (84%); however, only 25% reported having access to a geriatric oncology clinic and more than one half (53%) reported no lectures in geriatric oncology. Fellows reported fewer educational experiences in geriatric oncology than in nongeriatric oncology. For example, among procedure-based activities, 12% learned how to perform a geriatric assessment but 78% learned how to perform a bone marrow biopsy ( P < .05). Of those completing the knowledge-based items, 41% were able to identify correctly the predictors of chemotherapy toxicity in older adults with cancer. Conclusion: Despite the prevalence of cancer in older adults, hem-onc fellows report limited education in or exposure to geriatric oncology. The high value fellows place on geriatric oncology suggests that they would be receptive to additional training in this area.

scholarly journals Pharmacy resident teaching in psychiatry and neurology for pharmacy programs in the United States

2018 ◽  
Vol 8 (4) ◽  
pp. 163-168
Author(s):  
Victoria M. Cho ◽  
Julie A. Dopheide
Keyword(s):  
Health System ◽  
Assessment Tool ◽  
Pharmacy Practice ◽  
The United States ◽  
Electronic Survey ◽  
Resident Teaching ◽  
Resident Assessment ◽  
Teaching Psychiatry ◽  
American Society

Abstract Introduction: The American Society of Health-System Pharmacists' Postgraduate Year 1 and Year 2 Residency Accreditation Standards require that residents demonstrate effective teaching skills. The College of Psychiatric and Neurologic Pharmacists' survey of pharmacy program curricula assessed resident teaching in psychiatry and neurology, however, results were not published. The objective of this article is to describe resident teaching in psychiatry and neurology curricula as reported by responses to the college's survey. Methods: An electronic survey was sent to a curricular representative from each of 133 US pharmacy programs accredited as of July 2015. Programs were asked to report on psychiatry and neurology curricular content, faculty credentials, and types of teaching activities, including resident teaching. Results: Fifty-six percent (75/133) of programs responded to the survey. Fifty out of 75 (67%) distinct pharmacy programs reported utilizing residents for teaching topics in psychiatry and neurology. Residents were twice as likely to teach didactic topics in psychiatry (n = 44) compared to neurology (n = 22). Three times as many residents were involved in precepting psychiatric Advanced Pharmacy Practice Experiences (n = 37) compared to neurology Advanced Pharmacy Practice Experiences (n = 12). Discussion: Residents are involved in both didactic and experiential teaching with more residents teaching psychiatry content compared to neurology content. Authors recommend utilizing the American Society of Health-System Pharmacists' electronic resident assessment tool, PharmAcademic®, to capture the quantity and quality of resident teaching across accredited programs.

American Society of Clinical Oncology 2001 Presidential Initiative: Impact of Regulatory Burdens on Quality Cancer Care

2002 ◽  
Vol 20 (24) ◽  
pp. 4722-4726 ◽  
Author(s):  
Lawrence H. Einhorn ◽  
Jenifer Levinson ◽  
Susan Li ◽  
Laurie Lamar ◽  
Deborah Kamin ◽  
...  
Keyword(s):  
Clinical Oncology ◽  
House Of Representatives ◽  
Death And Dying ◽  
The United States ◽  
Physician Education ◽  
Quality Cancer Care ◽  
American Society ◽  
Oncology Practice ◽  
Key Aspects

PURPOSE: This study was conducted as part of the American Society of Clinical Oncology (ASCO) 2001 Presidential Initiative to assess the administrative burden of payer documentation requirements and their impact on oncology practice. METHODS: The study consisted of a physician questionnaire and an activity log. Site visits were conducted to support survey data. Analysis included 2,493 questionnaires and 1,115 activity logs; data were also collected from site visits to 10 oncology practices. RESULTS: Increased documentation was the greatest concern among respondents, greater even than the stress of dealing with death and dying. More than 97% of survey respondents reported an increase in documentation (averaging 1.4 h/d) and 77% reported an increase in work hours because of documentation in the past 5 years. As a result, more than 40% of respondents reported decreases in key aspects of patient care and decreases in teaching (48%) and research (39%). Site visit data demonstrate similar trends. CONCLUSION: It is critical to find ways to decrease physician burden without decreasing the ability to prevent fraud and abuse. Reforms include provisions in a recently passed bill in the United States House of Representatives to streamline Medicare regulation and increase physician education. To address oncology-specific concerns, changes also should be made to supervision requirements for residents and fellows and evaluation and management documentation for oncology follow-up visits.

Choosing Policies

2019 ◽  
pp. 252-271
Author(s):  
Robert L. Klitzman
Keyword(s):  
New Technologies ◽  
Assisted Reproductive Technologies ◽  
Insurance Coverage ◽  
Self Regulation ◽  
The United States ◽  
Professional Organizations ◽  
Control And Prevention ◽  
Donor Agencies ◽  
American Society

The United States regulates assisted reproductive technologies far less than do other Western countries, most of which have more nationalized health insurance. US states vary widely in whether they have any laws and, if so, what. Governmental agencies (e.g., Food and Drug Administration, Centers for Disease Control and Prevention) and professional organizations (e.g., American Medical Association, American Society of Reproductive Medicine) have begun addressing several areas but could potentially do more. Improved national and professional policies are needed regarding several areas, including egg and sperm donation, egg donor agencies, numbers of embryos transferred into wombs, gestational surrogacy, oversight of providers, insurance coverage, and data collection. Doctors generally perceive problems in the field but argue that industry self-regulation, rather than government policy, is adequate. Yet many providers fail to follow current guidelines and regulations. Moreover, new technologies continue to develop, including gene editing of embryos through CRISPR and mitochondrial replacement therapy (so-called three-parent babies). More data and research are crucial on current use of procedures and long-term medical and psychological follow-up of patients, egg donors, gestational surrogates, and offspring, to evaluate, for instance, the effectiveness of egg freezing and longitudinal follow-up of children born through these procedures.

scholarly journals Management of the Waiting List for Cadaveric Kidney Transplants: Report of a Survey and Recommendations by the Clinical Practice Guidelines Committee of the American Society of Transplantation

2002 ◽  
Vol 13 (2) ◽  
pp. 528-535
Author(s):  
Gabriel M. Danovitch ◽  
Sundaram Hariharan ◽  
John D. Pirsch ◽  
David Rush ◽  
David Roth ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Risk ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
The United States ◽  
Waiting List ◽  
Health Maintenance ◽  
Transplant Program ◽  
American Society

ABSTRACT. The Clinical Practice Guidelines Committee of the American Society of Transplantation developed a survey to review the policies of kidney transplant programs in the United States with respect to the management of the steadily expanding waiting list for cadaveric kidneys. The survey was sent to 287 centers, and 192 (67%) responded. The survey indicated that regular follow-up monitoring, most frequently on an annual basis, is required by the majority (71%) of programs. Patients considered to be at high risk and candidates for combined kidney-pancreas transplantation may be monitored more frequently. Annual screening for coronary artery disease is typically required for asymptomatic patients considered to be at high risk for covert disease. Noninvasive techniques are typically used, and a designated cardiologist is usually available to the transplant program. The dialysis nephrologist or the potential transplant recipient is expected to inform the transplant program of intercurrent events that may affect transplant candidacy. Standard health maintenance screening is required, together with the routine updating of serologic and other blood tests that may be relevant to the posttransplant course. Smaller transplant programs (<100 patients on the waiting list) are more likely to maintain closer contact with the wait-listed patients and to attempt to influence their treatment during dialysis and are less likely to cancel transplants because of unanticipated pretransplant medical problems. The work load necessitated by the follow-up monitoring of wait-listed patients was assessed and, in the absence of specific evidence-based information, a series of recommendations were developed to reflect current standards of practice and to suggest future research initiatives.

The 1970s

2011 ◽  
Author(s):  
Thomas Borstelmann
Keyword(s):  
Civil Rights ◽  
Free Market ◽  
The United States ◽  
Global Perspective ◽  
Retirement Plans ◽  
Free Agency ◽  
The World ◽  
The Disabled ◽  
Oil Crisis ◽  
American Society

This book looks at an iconic decade when the cultural left and economic right came to the fore in American society and the world at large. While many have seen the 1970s as simply a period of failures epitomized by Watergate, inflation, the oil crisis, global unrest, and disillusionment with military efforts in Vietnam, this book creates a new framework for understanding the period and its legacy. It demonstrates how the 1970s increased social inclusiveness and, at the same time, encouraged commitments to the free market and wariness of government. As a result, American culture and much of the rest of the world became more—and less—equal. This book explores how the 1970s forged the contours of contemporary America. Military, political, and economic crises undercut citizens' confidence in government. Free market enthusiasm led to lower taxes, a volunteer army, individual 401(k) retirement plans, free agency in sports, deregulated airlines, and expansions in gambling and pornography. At the same time, the movement for civil rights grew, promoting changes for women, gays, immigrants, and the disabled. And developments were not limited to the United States. Many countries gave up colonial and racial hierarchies to develop a new formal commitment to human rights, while economic deregulation spread to other parts of the world, from Chile and the United Kingdom to China. Placing a tempestuous political culture within a global perspective, this book shows that the decade wrought irrevocable transformations upon American society and the broader world that continue to resonate today.

Progressive Catholicism in the United States

2018 ◽  
Author(s):  
Matthew A. Shadle
Keyword(s):  
Common Good ◽  
The United States ◽  
Economic Life ◽  
Ethical Framework ◽  
Social Teaching ◽  
American Catholicism ◽  
The Common Good ◽  
The Us ◽  
The Common ◽  
American Society

American Catholicism has long adapted to US liberal institutions. Progressive Catholicism has taken the liberal values of democratic participation and human rights and made them central to its interpretation of Catholic social teaching. This chapter explores in detail the thought of David Hollenbach, S.J., a leading representative of progressive Catholicism. Hollenbach has proposed an ethical framework for an economy aimed at the common good, ensuring that the basic needs of all are met and that all are able to participate in economic life. The chapter also looks at the US Catholic bishops’ 1986 pastoral letter Economic Justice for All, which emphasizes similar themes while also promoting collaboration between the different sectors of American society for the sake of the common good.

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