scholarly journals Access to MRI for patients with cardiac pacemakers and implantable cardioverter defibrillators

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001598
Author(s):  
Christopher Pieri ◽  
Anish Bhuva ◽  
Russell Moralee ◽  
Aderonke Abiodun ◽  
Deepa Gopalan ◽  
...  
Keyword(s):  
Supply And Demand ◽  
Complication Rates ◽  
Similar Data ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Pacemakers ◽  
Survey Tool ◽  
Mr Conditional ◽  
Mri Scans ◽  
Implantation Rates ◽  
The Impact

ObjectiveTo determine provision of MRI for patients with cardiac implantable electronic devices (CIEDs; pacemakers and defibrillators) in England, to understand regional variation and assess the impact of guideline changes.MethodsRetrospective data related to MRI scans performed in patients with CIED over the preceding 12 months was collected using a structured survey tool distributed to every National Health Service Trust MRI unit in England. Data were compared with similar data from 2014/2015 and with demand (estimated from local CIED implantation rates and regional population data by sustainability and transformation partnerships (STPs)).ResultsResponses were received from 212 of 223 (95%) hospitals in England. 112 (53%) MRI units’ scan patients with MR-conditional CIEDs (10% also scan non-MR conditional devices), compared with 46% of sites in 2014/2015. Total annual scan volume increased over fourfold between 2014 and 2019 (1090 to 4896 scans). There was widespread geographical variation, with five STPs (total population >3·5 million representing approximately 25 000 patients with CIED) with no local provision. There was no correlation between local demand (CIED implantation rates) and MRI provision (scan volume). Complication rates were extremely low with three events nationally in 12 months (0·06% CIED–MRI scans).ConclusionsProvision of MRI for patients with CIEDs in England increased over fourfold in 4 years, but an estimated 10-fold care gap remains. Almost half of hospitals and 1 in 10 STPs have no service, with no relationship between local supply and demand. Availability of MRI for patients with non-MR conditional devices, although demonstrably safe, remains limited.

Reduced influence of affective disorders on perioperative complication rates, length of hospital stay, and healthcare costs following spinal fusion for adolescent idiopathic scoliosis

2019 ◽  
Vol 24 (6) ◽  
pp. 722-727
Author(s):  
Aladine A. Elsamadicy ◽  
Andrew B. Koo ◽  
Megan Lee ◽  
Adam J. Kundishora ◽  
Christopher S. Hong ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Idiopathic Scoliosis ◽  
Affective Disorder ◽  
Affective Disorders ◽  
Complication Rates ◽  
Total Cost ◽  
Adolescent Patients ◽  
Perioperative Complication ◽  
The Impact

OBJECTIVEIn the past decade, a gradual transition of health policy to value-based healthcare has brought increased attention to measuring the quality of care delivered. In spine surgery, adolescents with scoliosis are a population particularly at risk for depression, anxious feelings, and impaired quality of life related to back pain and cosmetic appearance of the deformity. With the rising prevalence of mental health ailments, it is necessary to evaluate the impact of concurrent affective disorders on patient care after spinal surgery in adolescents. The aim of this study was to investigate the impact that affective disorders have on perioperative complication rates, length of stay (LOS), and total costs in adolescents undergoing elective posterior spinal fusion (PSF) (≥ 4 levels) for idiopathic scoliosis.METHODSA retrospective study of the Kids’ Inpatient Database for the year 2012 was performed. Adolescent patients (age range 10–17 years old) with AIS undergoing elective PSF (≥ 4 levels) were selected using the International Classification of Diseases, Ninth Revision, Clinical Modification coding system. Patients were categorized into 2 groups at discharge: affective disorder or no affective disorder. Patient demographics, comorbidities, complications, LOS, discharge disposition, and total cost were assessed. The primary outcomes were perioperative complication rates, LOS, total cost, and discharge dispositions.RESULTSThere were 3759 adolescents included in this study, of whom 164 (4.4%) were identified with an affective disorder (no affective disorder: n = 3595). Adolescents with affective disorders were significantly older than adolescents with no affective disorders (affective disorder: 14.4 ± 1.9 years vs no affective disorder: 13.9 ± 1.8 years, p = 0.001), and had significantly different proportions of race (p = 0.005). Aside from hospital region (p = 0.016), no other patient- or hospital-level factors differed between the cohorts. Patient comorbidities did not differ significantly between cohorts. The number of vertebral levels involved was similar between the cohorts, with the majority of patients having 9 or more levels involved (affective disorder: 76.8% vs no affective disorder: 79.5%, p = 0.403). Postoperative complications were similar between the cohorts, with no significant difference in the proportion of patients experiencing a postoperative complication (p = 0.079) or number of complications (p = 0.124). The mean length of stay and mean total cost were similar between the cohorts. Moreover, the routine and nonroutine discharge dispositions were also similar between the cohorts, with the majority of patients having routine discharges (affective disorder: 93.9% vs no affective disorder: 94.9%, p = 0.591).CONCLUSIONSThis study suggests that affective disorders may not have a significant impact on surgical outcomes in adolescent patients undergoing surgery for scoliosis in comparison with adults. Further studies are necessary to elucidate how affective disorders affect adolescent patients with idiopathic scoliosis, which may improve provider approach in managing these patients perioperatively and at follow-up in hopes to better the overall patient satisfaction and quality of care delivered.

The impact of regulations on labor markets in the U.S.

2019 ◽  
Vol 1 (1) ◽  
pp. 36-40
Author(s):  
Souad Adnane
Keyword(s):  
Supply And Demand ◽  
Demand Model ◽  
Lead Teachers ◽  
Associate's Degree ◽  
Childcare Workers ◽  
Educational Requirements ◽  
The Cost ◽  
Women's Labor Force Participation ◽  
The Impact ◽  
The U.S

The District of Columbia (DC) Office of the Superintendent of Education (OSSE) issued in December 2016 new educational requirements for childcare workers, according to which, all childcare center directors in the District must earn a bachelor’s degree by December 2022 and all lead teachers an associate’s degree by December 2020 (Institute for Justice, 2018). Moreover, DC has one of the lowest staff-child ratios in the country. How are regulations pertaining to childcare workers’ qualifications and staff-child ratio affecting the childcare market in DC? The present paper is an attempt to answer this question first by analyzing the effects of more stringent regulations on the cost and availability of childcare in the U.S based on existing studies. It also uses the basic supply and demand model to examine the possible impact of the new DC policy on the cost, quality and supply of childcare in the District and how it will affect working parents, especially mothers. Next, the paper discusses the impact of deregulation based on simulations and regressions conducted by studies covering the U.S., and implications for quality. It concludes that more stringent childcare regulations, regarding educational requirements and staff-child ratios, are associated with a reduced number of childcare centers and a higher cost, and eventually affects women’s labor force participation.

scholarly journals Exploring the Relationship between Biologics and Postoperative Surgical Morbidity in Ulcerative Colitis: A Review

2021 ◽  
Vol 10 (4) ◽  
pp. 710
Author(s):  
Abel Botelho Quaresma ◽  
Fernanda da Silva Barbosa Baraúna ◽  
Fábio Vieira Teixeira ◽  
Rogério Saad-Hossne ◽  
Paulo Gustavo Kotze
Keyword(s):  
Ulcerative Colitis ◽  
Postoperative Complications ◽  
Meta Analysis ◽  
Qualitative Evaluation ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Randomized Studies ◽  
Pubmed Database ◽  
Increased Risk ◽  
The Impact

Background: With the paradigm shift related to the overspread use of biological agents in the treatment of inflammatory bowel diseases (IBD), several questions emerged from the surgical perspective. Whether the use of biologicals would be associated with higher rates of postoperative complications in ulcerative colitis (UC) patients still remains controversial. Aims: We aimed to analyze the literature, searching for studies that correlated postoperative complications and preoperative exposure to biologics in UC patients, and synthesize these data qualitatively in order to check the possible impact of biologics on postoperative surgical morbidity in this population. Methods: Included studies were identified by electronic search in the PUBMED database according to the PRISMA (Preferred Items of Reports for Systematic Reviews and Meta-Analysis) guidelines. The quality and bias assessments were performed by MINORS (methodological index for non-randomized studies) criteria for non-randomized studies. Results: 608 studies were initially identified, 22 of which were selected for qualitative evaluation. From those, 19 studies (17 retrospective and two prospective) included preoperative anti-TNF. Seven described an increased risk of postoperative complications, and 12 showed no significant increase postoperative morbidity. Only three studies included surgical UC patients with previous use of vedolizumab, two retrospective and one prospective, all with no significant correlation between the drug and an increase in postoperative complication rates. Conclusions: Despite conflicting results, most studies have not shown increased complication rates after abdominal surgical procedures in patients with UC with preoperative exposure to biologics. Further prospective studies are needed to better establish the impact of preoperative biologics and surgical complications in UC.

scholarly journals Delivering an efficient and effective support group for patients with implantable cardioverter-defibrillators (ICDs): patient perspectives of key concerns and predictors of inclination to attend

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathryn Murray ◽  
Kelly Buttigieg ◽  
Michelle Todd ◽  
Vicky McKechnie
Keyword(s):  
Support Groups ◽  
Support Group ◽  
Qualitative Data ◽  
Implantable Cardioverter Defibrillators ◽  
Cardioverter Defibrillator ◽  
And Coping ◽  
Patients Experience ◽  
The Impact ◽  
Cardioverter Defibrillators ◽  
Patient Concerns

Abstract Background A subset of patients experience psychological distress following insertion of an implantable cardioverter-defibrillator (ICD) and ICD support groups are recommended, however access to these groups is limited. This study aimed: to gauge a better understanding of patients’ key ICD-related concerns; to determine patient interest in a support group and topics deemed helpful to address in a support group; and to examine factors which affect patient inclination to attend. Methods One hundred and thirty nine patients completed the ICD Patient Concerns Questionnaire – Brief (ICDC-B) and a semi-structured survey. Non-parametric tests were used to examine associations and differences in the quantitative data. Qualitative data were analysed using thematic analysis. Results 42% of respondents said they would attend a support group and inclination to attend was associated with higher ICD concerns and a shorter time since implant. Topics considered important to address in a group were information about heart conditions and devices, the impact of an ICD on daily life and coping with fear of shocks. Conclusion We concluded that there is interest in further support amongst many patients and that ICD support groups may be delivered efficiently by targeting patients who have higher levels of ICD concerns and within the first few years after implant.

scholarly journals Is there an imbalance in the supply and demand for universal accessibility knowledge? Twenty years of UAIS papers viewed through the lens of WCAG

2021 ◽  
Author(s):  
Frode Eika Sandnes
Keyword(s):  
Latin America ◽  
North America ◽  
Supply And Demand ◽  
Research Focus ◽  
Universal Accessibility ◽  
Geographical Regions ◽  
Research Profile ◽  
The Impact ◽  
Over Time

AbstractPurpose: Some universal accessibility practitioners have voiced that they experience a mismatch in the research focus and the need for knowledge within specialized problem domains. This study thus set out to identify the balance of research into the main areas of accessibility, the impact of this research, and how the research profile varies over time and across geographical regions. Method: All UAIS papers indexed in Scopus were analysed using bibliometric methods. The WCAG taxonomy of accessibility was used for the analysis, namely perceivable, operable, and understandable. Results: The results confirm the expectation that research into visual impairment has received more attention than papers addressing operable and understandable. Although papers focussing on understandable made up the smallest group, papers in this group attracted more citations. Funded research attracted fewer citations than research without funding. The breakdown of research efforts appears consistent over time and across different geographical regions. Researchers in Europe and North America have been active throughout the last two decades, while Southeast Asia, Latin America, and Middle East became active in during the last five years. There is also seemingly a growing trend of out-of-scope papers. Conclusions: Based on the findings, several recommendations are proposed to the UAIS editorial board.

scholarly journals Development of an electronic conversation aid to support shared decision making for children with acute otitis media

JAMIA Open ◽  
2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Jana L Anderson ◽  
e Silva Lucas Oliveira J ◽  
Juan P Brito ◽  
Ian G Hargraves ◽  
Erik P Hess
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Otitis Media ◽  
Acute Otitis Media ◽  
Medical Knowledge ◽  
Complication Rates ◽  
Shared Decision ◽  
Web Based ◽  
Quality Issue ◽  
The Impact

Abstract Objective The overuse of antibiotics for acute otitis media (AOM) in children is a healthcare quality issue in part arising from conflicting parent and physician understanding of the risks and benefits of antibiotics for AOM. Our objective was to develop a conversation aid that supports shared decision making (SDM) with parents of children who are diagnosed with non-severe AOM in the acute care setting. Materials and Methods We developed a web-based encounter tool following a human-centered design approach that includes active collaboration with parents, clinicians, and designers using literature review, observations of clinical encounters, parental and clinician surveys, and interviews. Insights from these processes informed the iterative creation of prototypes that were reviewed and field-tested in patient encounters. Results The ear pain conversation aid includes five sections: (1) A home page that opens the discussion on the etiologies of AOM; (2) the various options available for AOM management; (3) a pictograph of the impact of antibiotic therapy on pain control; (4) a pictograph of complication rates with and without antibiotics; and (5) a summary page on management choices. This open-access, web-based tool is located at www.earpaindecisionaid.org. Conclusions We collaboratively developed an evidence-based conversation aid to facilitate SDM for AOM. This decision aid has the potential to improve parental medical knowledge of AOM, physician/parent communication, and possibly decrease the overuse of antibiotics for this condition.

scholarly journals Overcapacity Risk of China’s Coal Power Industry: A Comprehensive Assessment and Driving Factors

2021 ◽  
Vol 13 (3) ◽  
pp. 1426
Author(s):  
Delu Wang ◽  
Xun Xue ◽  
Yadong Wang
Keyword(s):  
Evaluation Model ◽  
Supply And Demand ◽  
Correlation Effect ◽  
Power Industry ◽  
Environmental Benefits ◽  
Risk Level ◽  
Correlation Based Feature Selection ◽  
Coal Power ◽  
And Control ◽  
The Impact

The comprehensive and accurate monitoring of coal power overcapacity is the key link and an important foundation for the prevention and control of overcapacity. The previous research fails to fully consider the impact of the industry correlation effect; making it difficult to reflect the state of overcapacity accurately. In this paper; we comprehensively consider the fundamentals; supply; demand; economic and environmental performance of the coal power industry and its upstream; downstream; competitive; and complementary industries to construct an index system for assessing coal power overcapacity risk. Besides; a new evaluation model based on a correlation-based feature selection-association rules-data envelopment analysis (CFS-ARs-DEA) integrated algorithm is proposed by using a data-driven model. The results show that from 2008 to 2017; the risk of coal power overcapacity in China presented a cyclical feature of “decline-rise-decline”, and the risk level has remained high in recent years. In addition to the impact of supply and demand; the environmental benefits and fundamentals of related industries also have a significant impact on coal power overcapacity. Therefore; it is necessary to monitor and govern coal power overcapacity from the overall perspective of the industrial network, and coordinate the advancement of environmental protection and overcapacity control.

scholarly journals Impact of Pancreatic Resection on Survival in Locally Advanced Resectable Gastric Cancer

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1289
Author(s):  
Shih-Chun Chang ◽  
Chi-Ming Tang ◽  
Puo-Hsien Le ◽  
Chia-Jung Kuo ◽  
Tsung-Hsing Chen ◽  
...  
Keyword(s):  
Lymph Node ◽  
Pancreatic Resection ◽  
Locally Advanced ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Complication Rates ◽  
Lymph Node Yield ◽  
Whipple’S Operation ◽  
Whipple's Operation ◽  
The Impact

Whether gastric adenocarcinoma (GC) patients with adjacent organ invasion (T4b) benefit from aggressive surgery involving pancreatic resection (PR) remains unclear. This study aimed to clarify the impact of PR on survival in patients with locally advanced resectable GC. Between 1995 and 2017, patients with locally advanced GC undergoing radical-intent gastrectomy with and without PR were enrolled and stratified into four groups: group 1 (G1), pT4b without pancreatic resection (PR); group 2 (G2), pT4b with PR; group 3 (G3), positive duodenal margins without Whipple’s operation; and group 4 (G4), cT4b with Whipple’s operation. Demographics, clinicopathological features, and outcomes were compared between G1 and G2 and G3 and G4. G2 patients were more likely to have perineural invasion than G1 patients (80.6% vs. 50%, p < 0.001). G4 patients had higher lymph node yield (40.8 vs. 31.3, p = 0.002), lower nodal status (p = 0.029), lower lymph node ratios (0.20 vs. 0.48, p < 0.0001) and higher complication rates (45.2% vs. 26.3%, p = 0.047) than G3 patients. The 5-year disease-free survival (DFS) and overall survival (OS) rates were significantly longer in G1 than in G2 (28.1% vs. 9.3%, p = 0.003; 32% vs. 13%, p = 0.004, respectively). The 5-year survival rates did not differ between G4 and G3 (DFS: 14% vs. 14.4%, p = 0.384; OS: 12.6% vs. 16.4%, p = 0.321, respectively). In conclusion, patients with T4b lesion who underwent PR had poorer survival than those who underwent resection of other adjacent organs. Further Whipple’s operation did not improve survival in pT3–pT4 GC with positive duodenal margins.

scholarly journals The Role of Visceral Obesity, Sarcopenia and Sarcopenic Obesity on Surgical Outcomes After Liver Resections for Colorectal Metastases

2021 ◽  
Author(s):  
M. Runkel ◽  
T. D. Diallo ◽  
S. A. Lang ◽  
F. Bamberg ◽  
M. Benndorf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Visceral Obesity ◽  
The Body ◽  
Postoperative Outcomes ◽  
Sarcopenic Obesity ◽  
Colorectal Metastases ◽  
Complication Rates ◽  
The Impact ◽  
Body Compositions

Abstract Background The impact of body compositions on surgical results is controversially discussed. This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after hepatic resections of synchronous colorectal liver metastases. Methods Ninety-four consecutive patients with primary hepatic resections of synchronous colorectal metastases were identified from a single center database between January 2013 and August 2018. Patient characteristics and 30-day morbidity were retrospectively analyzed. Body fat and skeletal muscle were calculated by planimetry from single-slice CT images at the level of L3. Results Fifty-nine patients (62.8%) underwent minor hepatectomies, and 35 patients underwent major resections (37.2%). Postoperative complications occurred in 60 patients (62.8%) including 35 patients with major complications (Clavien–Dindo grade III–V). The mortality was nil at 30 days and 2.1% at 90 days. The body mass index showed no influence on postoperative outcomes (p = 1.0). Visceral obesity was found in 66 patients (70.2%) and was significantly associated with overall and major complication rates (p = .002, p = .012, respectively). Sarcopenia was observed in 34 patients (36.2%) without a significant impact on morbidity (p = .461), however, with longer hospital stay. Sarcopenic obesity was found in 18 patients (19.1%) and was significantly associated with postoperative complications (p = .014). Visceral obesity, sarcopenia and sarcopenic obesity were all identified as significant risk factors for overall postoperative complications. Conclusion Visceral obesity, sarcopenic obesity and sarcopenia are independent risk factors for overall complications after resections of CRLM. Early recognition of extremes in body compositions could prompt to perioperative interventions and thus improve postoperative outcomes.

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