Neuropsychologists' practice patterns in assessing the impact of multicultural factors on the neuropsychological evaluation

Abstract Background Despite significant policy concerns about the role of inpatient resource utilization on rising medical costs, little information is provided to residents regarding their practice patterns and the effect on resource use. Improved knowledge about their practice patterns and costs might reduce resource utilization and better prepare physicians for today's health care market. Methods We surveyed residents in the internal medicine residency at the Hospital of the University of Pennsylvania. Based on needs identified via the survey, discussions with experts, and a literature review, a curriculum was created to help increase residents' knowledge about benchmarking their own practice patterns and using objective performance measures in the health care market. Results The response rate to our survey was 67%. Only 37% of residents reported receiving any feedback on their utilization of resources, and only 20% reported receiving feedback regularly. Even fewer (16%) developed, with their attending physician, a concrete improvement plan for resource use. A feedback program was developed that included automatic review of the electronic medical record to provide trainee-specific feedback on resource utilization and outcomes of care including number of laboratory tests per patient day, laboratory cost per patient day, computed tomography scan ordering rate, length of stay, and 14-day readmission rate. Results were benchmarked against those of peers on the same service. Objective feedback was provided biweekly by the attending physician, who also created an action plan with the residents. In addition, an integrated didactic curriculum was provided to all trainees on the hospitalist service on a biweekly basis. Conclusions Interns and residents do not routinely receive feedback on their resource utilization or ways to improve efficiency. A method for providing objective data on individual resource utilization in combination with a structured curriculum can be implemented to help improve resident knowledge and practice. Ongoing work will test the impact on resource utilization and outcomes.

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The Impact of the COVID-19 Pandemic and Telemedicine Implementation on Practice Patterns and Electronic Health Record Utilization in an Academic Rheumatology Practice

JCR Journal of Clinical Rheumatology ◽

10.1097/rhu.0000000000001751 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Mithu Maheswaranathan ◽

Philip Chu ◽

Andrew Johannemann ◽

Lisa Criscione-Schreiber ◽

Megan Clowse ◽

...

Keyword(s):

Electronic Health Record ◽

Practice Patterns ◽

Health Record ◽

Electronic Health ◽

The Impact ◽

Rheumatology Practice

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Comparing practice patterns and outcomes for early-stage hormone receptor-positive and node-positive breast cancer patients with high-intermediate-risk Oncotype Dx scores in the National Cancer Database.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e12520 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e12520-e12520

Author(s):

Keerthi Tamragouri ◽

Ethan M. Ritz ◽

Ruta D. Rao ◽

Cristina O'Donoghue

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Predictive Value ◽

Practice Patterns ◽

Early Stage ◽

Oncotype Dx ◽

Breast Cancer Patients ◽

Node Positive ◽

The Impact ◽

Positive Breast Cancer

e12520 Background: Oncotype Dx (ODX) is a commercial diagnostic test primarily used to predict the likely benefit from chemotherapy in ER+, HER2-, and node negative breast cancer. The prognostic value (recurrence risk) has also been demonstrated to apply to early stage lymph node positive (LN+) disease in a number of retrospective and prospective studies. The ongoing RxPONDER trial aims to clarify the predictive value of RS in LN+ population. In light of the initial results, we analyzed the practice patterns and outcomes for HR+/Her2 -/node positive breast cancer patients receiving ODX testing in the years from 2010-2017 with RS 14-25 in a retrospective observational study of the NCDB. Methods: Women with HR+/Her2 -/node positive breast cancer receiving ODX testing from 2010-2017 were identified in the NCDB using TAILORx and RxPONDER patients’ inclusion criteria: ages 18-75, 6-50mm invasive tumors, N1, M0, ER+/HER2 -. The impact of ODX results in the high-intermediate range (14-25) and other clinico-pathologic variables on the receipt of chemotherapy were compared. Additionally, we examined the impact of chemotherapy on overall survival (OS). Frequencies, Kaplain-Meier analysis, and changepoint analysis using the Contal and O’Quigley method were utilized. Results: There were 109,652 T1-2 and N1 patients of whom 32,506 (29.6%) received ODX testing. 13,461 (41.4%%) women had scores in the high-intermediate (14-25) range. The majority tended to have only 1 LN involved (1LN: 77.2%, 2LNs: 17.5%, 3LNs: 5.3%), had a mean age of 57.8y, were Caucasian (86.4%), and were preferentially tested at academic or comprehensive community cancer programs (79.2%). 6,610 (49.3%) patients were recommended chemotherapy, the median ODX score for all women who were recommended chemotherapy was 20 compared to 17 for those whom chemotherapy was not recommended. 5,068 (76.7%) women had documentation of receiving chemotherapy which correlated with improved OS regardless of age. Conclusions: In the group of women with HR+/Her2 -/node positive breast cancer, clinicians appear to utilize ODX testing in less than one-third of patients, possibly finding RS to be most useful in guiding adjuvant therapy recommendations when only 1LN is involved. Both the recommendation and receipt of chemotherapy correlated linearly with increasing RS, as expected based on the current NCCN guideline recommendations. We identified an OS benefit when chemotherapy was administered, regardless of patient age. Long-term follow-up in the RxPONDER trial will likely continue to clarify the predictive value of RS < 25 in the ER+/HER2-/node positive breast cancer population.

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The Impact of Changes in Clinical Guideline on Practice Patterns and Healthcare Utilizations for Kawasaki Disease in Japan

Frontiers in Pediatrics ◽

10.3389/fped.2020.00114 ◽

2020 ◽

Vol 8 ◽

Author(s):

Yusuke Okubo ◽

Masaru Miura ◽

Tohru Kobayashi ◽

Naho Morisaki ◽

Nobuaki Michihata ◽

...

Keyword(s):

Kawasaki Disease ◽

Clinical Guideline ◽

Practice Patterns ◽

The Impact

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A-252 New Onset Severe Epilepsy in a Child with Existing Cerebral Palsy: Neuropsychological Findings Inform Medical Management

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa068.252 ◽

2020 ◽

Vol 35 (6) ◽

pp. 1047-1047

Author(s):

Mullen C ◽

Fulton F

Keyword(s):

Cerebral Palsy ◽

Status Epilepticus ◽

Corpus Callosum ◽

Clinical Decision Making ◽

Cognitive Change ◽

Temporal Lobectomy ◽

Neuropsychological Evaluation ◽

Wide Range ◽

The Impact ◽

New Onset

Abstract Objective Pediatric epilepsy is associated with a wide range of neurodevelopmental challenges. Few studies have established children’s cognitive function prior to seizure onset making study of the direct impact of seizures challenging. This is especially true in cases with preexisting neurological disorders. The present case provides insight into the impact that new onset of seizures (including status epilepticus) have on cognitive development and illustrates how documented cognitive change informs clinical decision-making. Method The patient is a 10-year-old boy with a history of cerebral palsy who initially completed neuropsychological testing in the fall of 2018. New onset of drug-resistant seizures presented in January 2019, including episodes of status epilepticus leading to repeat neuropsychological evaluation in the fall of 2019. EEG studies in infancy showed poorly regulated background rhythm and MRI showed dysplastic corpus callosum and bilateral occipital heterotopias. Following the onset of seizures EEG showed independent seizure foci over temporal regions bilaterally. MRI showed extensive bilateral temporal and occipital subependymal gray matter heteropi, and dysgenesis of the corpus callosum, cerebral vermis, and anterior commissure. Results Repeated neuropsychological assessment documented significant declines in intellectual function, visual and verbal memory (visual worse than verbal), and executive function, with limited academic progression. Persistent epileptic symptoms throughout testing complicated interpretation. Conclusions Findings were highly concerning for cognitive deterioration and the neurosurgical team deemed him as high risk for sudden unexpected death in epilepsy. He underwent right anterior temporal lobectomy and left stereoelectroencephalography placement in January 2020. Scheduled repeat neuropsychological evaluation will further monitor neurocognitive functioning post neurosurgical intervention.

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