Hyaluronidase for Treating Complications Related to HA Fillers: A National Plastic Surgeon Survey

Background: Hyaluronic acid (HA) fillers have become a popular modality to address changes in the ageing face. There are many described indications of hyaluronidases in aesthetic medicine which include their use in the management of HA-associated complications. To better understand the current practice patterns, we surveyed Canadian plastic surgeons on their use of hyaluronidases. Methods: With the approval of the Canadian Society of Plastic Surgeons, an electronic survey was emailed to members. A total of 350 surveys were distributed and 98 surveys were completed for a response rate of 28%. Results: Approximately half (48%) of the survey respondents used HA fillers in their practice. Skin testing for hypersensitivity reactions was performed by less than 10% of hyaluronidase users. Nearly all respondents used hyaluronidase for filler over-correction (95.5%) and asymmetry (86.4%). Over half of the respondents have used hyaluronidase for inflammatory or infectious nodules and the Tyndall effect. Other reported applications included restoration of vascular compromise, and one respondent reported using hyaluronidase for assisting with haematoma resolution. When compared with the most recent guidelines, there was a wide range of doses used for common side effects and complications. Twenty-four percent of the respondents reported that their hyaluronidase formulation was prepared by a compounding pharmacy, and 20% of respondents who inject HA fillers did not stock hyaluronidase. Conclusion: There are many indications for hyaluronidase in aesthetic plastic surgery. Plastic surgeons should stock hyaluronidase and develop a specific plan in anticipation of adverse events. Although hyaluronidase is commonly used by plastic surgeons for over-correction and asymmetry, the dosages used in aesthetic practice is rather diverse and heterogeneous. When possible, plastic surgeons should perform allergy testing before hyaluronidase use.

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Rhinitis medicamentosa: a nationwide survey of Canadian otolaryngologists

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-019-0392-1 ◽

2019 ◽

Vol 48 (1) ◽

Cited By ~ 1

Author(s):

James Fowler ◽

Christopher J. Chin ◽

Emad Massoud

Keyword(s):

Practice Patterns ◽

Response Rate ◽

Nationwide Survey ◽

Neck Surgery ◽

Electronic Survey ◽

Nasal Decongestants ◽

Intranasal Steroids ◽

Oral Steroids ◽

Topical Medications ◽

Rhinitis Medicamentosa

Abstract Background Rhinitis medicamentosa is a non-allergic form of rhinitis that is typically caused by prolonged use of topical nasal decongestants. This condition commonly affects young adults and treatment is not trivial. We aimed to survey Canadian Otolaryngologists to determine practice patterns and their opinions regarding this under-studied condition. Methods An electronic survey was sent to practicing Otolaryngologists within the Canadian Society of Otolaryngology – Head and Neck Surgery. The survey contained 16 questions pertaining to the diagnosis and treatment of rhinitis medicamentosa, as well as opinions on public and primary care awareness of proper use of nasal decongestants. Results The survey was distributed to 533 Otolaryngologists and 69 surveys were returned (response rate of 13%). Cessation and weaning of decongestant (96%), and intranasal steroids (94%) were the most common methods for treating RM. Intranasal saline rinses (55%) and oral steroids (25%) were also supported by some respondents. For those who recommended cessation/weaning, 61% also concurrently introduced an intranasal steroid during this process. The majority responded that current warnings on nasal decongestants were inadequate (75%), and were not visible enough (79%). Conclusions Rhinitis medicamentosa is a common, and very preventable condition. Although the literature lacks a standardized approach to RM, our survey has shown that many Otolaryngologists diagnose and treat RM in a similar manner. Treatment tends to focus on decongestant cessation, often with concurrent introduction of intranasal steroids. It was felt the warning labels on the topical medications are not currently satisfactory.

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Identification of knowledge translation opportunities in the treatment of locally advanced breast cancer: Results of a national survey of physicians.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6585 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6585-6585

Author(s):

Yanchini Rajmohan ◽

Robyn Leonard ◽

Sophie Hogeveen ◽

Jalal Ebrahim ◽

Dolly Han ◽

...

Keyword(s):

Breast Cancer ◽

Knowledge Translation ◽

Advanced Breast Cancer ◽

Clinical Assessment ◽

Current Practice ◽

Practice Patterns ◽

Response Rate ◽

Locally Advanced Breast Cancer ◽

Locally Advanced ◽

Advanced Breast

6585 Background: Locally advanced breast cancer (LABC) accounts for only 10% of all breast cancers. While several guidelines and consensus statements exist, whether the current practice reflects these guidelines is unclear. We sought to survey the oncologists in Canada to assess current practice patterns and identify areas of targeted knowledge translation interventions (KTIs) in the treatment of LABC. Methods: 426 Canadian oncologists were surveyed with a 29 item survey-tool. They were subdivided into LABC experts (n=83) and non-experts (n=343). Physicians were removed from the survey if they identified that they were not involved in the treatment of breast cancer. The survey included demographic information as well as questions as to the current practice patterns utilized in the pathway of care for LABC patients. Level of discordance was calculated between the expert and non-expert responses using a z test. Results: 139 responses were obtained (48% response rate) from the non-experts and 51 responses were obtained from the experts (61% response rate). Areas of discordance in expert and non-expert survey included: frequency of clinical assessment during neoadjuvant therapy, methods for clinical assessment, radiographic re-evaluation post therapy, and assessment of receptor status (see Table). Conclusions: Several areas have been identified as targets for KTIs that may help to improve the quality and consistency of care of patients with LABC in Canada and may also have implications for improvements in resource utilization. [Table: see text]

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Weaning Strategy of Diuretics in Outpatient Preterm Infants with Bronchopulmonary Dysplasia: A National Survey

American Journal of Perinatology ◽

10.1055/s-0040-1716491 ◽

2020 ◽

Author(s):

Keren Armoni Domany ◽

Israel Amirav ◽

Efraim Sadot ◽

Nir Diamant ◽

Dror Mandel ◽

...

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Practice Patterns ◽

Response Rate ◽

Controlled Study ◽

Cross Sectional ◽

Web Based ◽

Key Points ◽

Wide Range

Objective Long-term diuretic treatment in patients with bronchopulmonary dysplasia (BPD) is common despite lack of data that support its use. We aimed to characterize the commonly used diuretics weaning strategies for outpatient clinically stable preterm infants with BPD. Study Design We conducted a cross-sectional web-based survey among all pediatric pulmonologists and neonatologists in Israel. Questionnaire included data regarding practitioners' different diuretics-weaning practice in this population. Results The response rate for pulmonologists and neonatologists were 35/50 (70%) and 36/120 (30%), respectively. When both oxygen and diuretics are used, 59% wean oxygen first and 32% wean diuretics first. If patients are solely on diuretics, 27% discontinue instantly, 34% decrease the dosage gradually, and 34% outgrow the discharge dosage. Significantly more pulmonologists decrease the dosage gradually, while more neonatologists discontinue at once (p < 0.001). Most participants (94%) reported being unsatisfied with the existing data and guidelines regarding these issues. Conclusion Our results showed a wide range of practice patterns in the weaning strategy of diuretics in outpatient preterm infants with BPD. Pulmonologists and neonatologists differ significantly in their weaning strategy. A prospective larger controlled study to explore the outcome of gradual tapering versus discontinuation without weaning is warranted. Key Points

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Mucolytics for Intubated Asthmatic Children: A National Survey of United Kingdom Paediatric Intensive Care Consultants

Critical Care Research and Practice ◽

10.1155/2015/396107 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5

Author(s):

Aarjan Peter Snoek ◽

Joe Brierley

Keyword(s):

United Kingdom ◽

Significant Variation ◽

Current Practice ◽

Response Rate ◽

Clinical Severity ◽

Mechanically Ventilated ◽

Electronic Survey ◽

Asthmatic Children ◽

The United Kingdom ◽

Bronchoscopic Guidance

Aim. The extent to which mucolytics are utilised in mechanically ventilated asthmatic children is unknown. We sought to establish current practice in the United Kingdom (UK) including choice of mucolytic, dose, and frequency of utilisation.Methods. A national electronic survey was distributed to UK consultants during April and May 2014. We were able to identify 168 PICU consultants at 25 institutions to whom we were able to electronically distribute a survey, representing an estimated 81% of UK NHS PICU consultants.Results. Replies were received from 87 consultants at 21 institutions (response rate=52%). Recombinant human DNase (rhDNase) does get administered by 63% of clinicians, with 54% and 19% that administer hypertonic saline or N-acetylcysteine, respectively. Of those that do administer rhDNase the majority (48%) dilute it with 0.9% saline and blindly administer it, whereas 35% administer rhDNase under bronchoscopic guidance and 17% judge the necessity for bronchoscopy according to clinical severity. 25 respondents described 7 different methods to calculate rhDNase dose. A majority (87%) of respondents expressed an interest to consider enrolling patients into an RCT that evaluates rhDNase.Conclusion. Significant variation exists regarding the necessity for mucolytics, choice of agent, optimal route, and dose in intubated asthmatic children.

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Local tumour ablation for localized kidney cancer: Practice patterns in Canada

Canadian Urological Association Journal ◽

10.5489/cuaj.3317 ◽

2015 ◽

Vol 9 (11-12) ◽

pp. 420

Author(s):

Vincent Trudeau ◽

Alessandro Larcher ◽

Paolo Dell'Oglio ◽

Katharina Boehm ◽

Mohamed Bishr ◽

...

Keyword(s):

Kidney Cancer ◽

National Survey ◽

Practice Patterns ◽

Response Rate ◽

Significant Proportion ◽

Demographic Information ◽

Local Tumor ◽

Electronic Survey ◽

Local Tumour ◽

Tumour Ablation

Introduction: Local tumor ablation (LTA) is a recommended option for the treatment of localized kidney cancer in nonsurgical candidates. We performed a survey to describe the practice patterns of this procedure in Canada.Methods: An electronic survey was sent by email to all urologists registered to the Canadian Urological Association (CUA). Urologists were queried about general demographic information, LTA availability at their institution (and reasons of non-availability, if it was the case) as well as the type and context of LTA use. Results: Overall, 103 individual responses were obtained (response rate of 19.5%). Of those, 58 (56.3%) had access to LTA at their institution. Urologists who had access to LTA were more likely to work at an academic institution (69 vs. 16%, p<0.001). Among individuals who did not use LTA, the main reasons were the lack of staff, such as radiologists, who can assist and/or perform the procedure (64%); and the lack of expertise with the procedure (62%). Among urologists who had access to LTA, percutaneous radiofrequency and cryoablation were the most commonly used (72% and 21%, respectively). However, urologists were rarely involved in those procedures (12%).Conclusions: In this national survey, we found that a significant proportion of Canadian urologists did not have access to LTA. We also found that when LTA was performed, urologists were rarely involved in the procedures. Those findings represent significant areas for improvement in the access to LTA. The conclusions of this study are limited by the low response rate.

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Chaperone use amongst UK urological surgeons – an evaluation of current practice and opinion

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0071 ◽

2016 ◽

Vol 98 (04) ◽

pp. 268-269

Author(s):

V Modgil ◽

R Barratt ◽

DJ Summerton ◽

A Muneer

Keyword(s):

Clinical Practice ◽

Current Practice ◽

Response Rate ◽

Significant Proportion ◽

General Medical Council ◽

Medical Council ◽

Considerable Variability ◽

Online Questionnaire ◽

Wide Range ◽

Opposite Sex

Introduction Intimate examinations are routinely performed by urologists as part of clinical practice. To protect patients and doctors, the General Medical Council offers guidance on the use of chaperones for intimate examinations. We assessed the opinions and use of chaperones amongst members of the British Association of Urological Surgeons (BAUS). Methods An online questionnaire comprising 12 questions on the use of chaperones in clinical practice was sent to all full, trainee and speciality doctor members of BAUS. Results The questionnaire had a response rate of 26% (n=331). The majority of respondents were consultant urologists, comprising 78.8% (n=261), with a wide range of years of experience. Of the respondents, 38.9% were not aware of the GMC guidance on chaperones. While 72.5% always used a chaperone., 22.9% never use a chaperone when the patient was of the same sex. Chaperones were most commonly used for intimate examinations (64.6%), and for examinations involving members of the opposite sex (77.3%). A majority of respondents felt that chaperones protect both the patient (77.3%), and the doctor (96.6%). However, 42.5% did not feel that using a chaperone assists the doctor’s examination, and some (17.2%) participants felt that chaperones were unnecessary. Conclusions This study shows considerable variability amongst urologists in their use of chaperones. A significant proportion of respondents were not aware of the GMC guidelines and did not regularly use a chaperone during an intimate examination. In addition, practice appears to be gender biased. Further study and education is suggested.

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Surgical interval after neo-adjuvant therapy in rectal cancer, current practice patterns in Canada

10.26226/morressier.596648e4d462b80290b520a5 ◽

2017 ◽

Author(s):

Antonio Caycedo

Keyword(s):

Rectal Cancer ◽

Adjuvant Therapy ◽

Current Practice ◽

Practice Patterns

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Assessing the utility and attitudes toward molecular testing in neuro-oncology: a survey of the Society for Neuro-Oncology members

Neuro-Oncology Practice ◽

10.1093/nop/npab003 ◽

2021 ◽

Author(s):

Shannon Fortin Ensign ◽

Maya Hrachova ◽

Susan Chang ◽

Maciej M Mrugala

Keyword(s):

Online Survey ◽

Clinical Decision Making ◽

Unmet Needs ◽

Practice Patterns ◽

Response Rate ◽

Clinical Decision ◽

Molecular Testing ◽

Newly Diagnosed ◽

Tumor Boards ◽

Oncology Practice

Abstract Background Molecular testing (MT) is utilized in neuro-oncology with increasing frequency. The aim of this study was to determine clinical practice patterns to acquire this information, interpret and utilize MT for patient care, and identify unmet needs in the practical clinical application of MT. Methods We conducted a voluntary online survey of providers within the Society for Neuro-Oncology (SNO) membership database between March and April 2019. Results We received 152 responses out of 2022 SNO members (7.5% of membership). 88.8% of respondents routinely order MT for newly diagnosed gliomas. Of those who do not, testing is preferentially performed in younger patients or those with midline tumors. 82.8% use MT in recurrent gliomas. Other common indications included: metastatic tumors, meningioma, and medulloblastoma. Many providers utilize more than one resource (36.0%), most frequently using in-house (41.8%) over commercially available panels. 78.1% used the results for clinical decision-making, with BRAF, EGFR, ALK, and H3K27 mutations most commonly directing treatment decisions. Approximately, half (48.5%) of respondents have molecular tumor boards at their institutions. Respondents would like to see SNO-endorsed guidelines on MT, organized lists of targeted agents available for specific mutations, a database of targetable mutations and clinical trials, and more educational programs on MT. Conclusion This survey was marked by several limitations including response rate and interpretation of MT. Among respondents, there is routine use of MT in Neuro-Oncology, however, there remains a need for increased guidance for providers to effectively incorporate the expanding genomic data resulting from MT into daily Neuro-Oncology practice.

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