TEMPORAL TRENDS, ENABLING FACTORS, COST AND SAFETY IMPLICATIONS OF SHIFTING HYSTERECTOMY FOR ENDOMETRIAL CANCER FROM INPATIENT TO OUTPATIENT SETTING IN THE US

Background Little is known about factors associated with recovery of kidney function—and return to dialysis independence—or temporal trends in recovery after starting outpatient dialysis in the United States. Understanding the characteristics of individuals who may have the potential to recover kidney function may promote better recognition of such events. The goal of this study was to determine factors associated with recovery of kidney function in children compared with adults starting dialysis in the US. Methods and findings We determined factors associated with recovery of kidney function—defined as survival and discontinuation of dialysis for ≥90-day period—in children versus adults who started maintenance dialysis between 1996 and 2015 according to the United States Renal Data System (USRDS) followed through 2016 in a retrospective cohort study. We also examined temporal trends in recovery rates over the last 2 decades in this cohort. Among 1,968,253 individuals included for study, the mean age was 62.6 ± 15.8 years, and 44% were female. Overall, 4% of adults (83,302/1,953,881) and 4% of children (547/14,372) starting dialysis in the outpatient setting recovered kidney function within 1 year. Among those who recovered, the median time to recovery was 73 days (interquartile range [IQR] 43–131) in adults and 100 days (IQR 56–189) in children. Accounting for the competing risk of death, children were less likely to recover kidney function compared with adults (sub-hazard ratio [sub-HR] 0.81; 95% CI 0.74–0.89, p-value <0.001; point estimates <1 indicating increased risk for a negative outcome). Non-Hispanic black (NHB) adults were less likely to recover compared with non-Hispanic white (NHW) adults, but these racial differences were not observed in children. Of note, a steady increase in the incidence of recovery of kidney function was noted initially in adults and children between 1996 and 2010, but this trend declined thereafter. The diagnoses associated with the highest recovery rates of recovery were acute tubular necrosis (ATN) and acute interstitial nephritis (AIN) in both adults and children, where 25%–40% of patients recovered kidney function depending on the calendar year of dialysis initiation. Limitations to our study include the potential for residual confounding to be present given the observational nature of our data. Conclusions In this study, we observed that discontinuation of outpatient dialysis due to recovery occurred in 4% of patients with end-stage kidney disease (ESKD) and was more common among those with ATN or AIN as the cause of their kidney disease. While recovery rates rose initially, they declined starting in 2010. Additional studies are needed to understand how to best recognize and promote recovery in patients whose potential to discontinue dialysis is high in the outpatient setting.

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The shift from inpatient to outpatient hysterectomy for endometrial cancer in the United States: trends, enabling factors, cost, and safety

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-002192 ◽

2021 ◽

pp. ijgc-2020-002192

Author(s):

Serena Cappuccio ◽

Yanli Li ◽

Chao Song ◽

Emeline Liu ◽

Gretchen Glaser ◽

...

Keyword(s):

Endometrial Cancer ◽

Abdominal Hysterectomy ◽

The United States ◽

Inpatient Setting ◽

Significant Shift ◽

Robotic Hysterectomy ◽

Post Discharge ◽

Enabling Factors ◽

Healthcare Database ◽

The Impact

ObjectiveTo evaluate trends in outpatient versus inpatient hysterectomy for endometrial cancer and assess enabling factors, cost and safety.MethodsIn this retrospective cohort study, patients aged 18 years or older who underwent hysterectomy for endometrial cancer between January 2008 and September 2015 were identified in the Premier Healthcare Database. The surgical approach for hysterectomy was classified as open/abdominal, vaginal, laparoscopic or robotic assisted. We described trends in surgical setting, perioperative costs and safety. The impact of patient, provider and hospital characteristics on outpatient migration was assessed using multivariate logistic regression.ResultsWe identified 41 246 patients who met inclusion criteria. During the time period studied, we observed a 41.3% shift from inpatient to outpatient hysterectomy (p<0.0001), an increase in robotic hysterectomy, and a decrease in abdominal hysterectomy. The robotic hysterectomy approach, more recent procedure (year), and mid-sized hospital were factors that enabled outpatient hysterectomies; while abdominal hysterectomy, older age, Medicare insurance, black ethnicity, higher number of comorbidities, and concomitant procedures were associated with an inpatient setting. The shift towards outpatient hysterectomy led to a $2500 savings per case during the study period, in parallel to the increased robotic hysterectomy rates (p<0.001). The post-discharge 30-day readmission and complications rate after outpatient hysterectomy remained stable at around 2%.ConclusionsA significant shift from inpatient to outpatient setting was observed for hysterectomies performed for endometrial cancer over time. Minimally invasive surgery, particularly the robotic approach, facilitated this migration, preserving clinical outcomes and leading to reduction in costs.

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Covid-19 Preparedness and Response Capability: A Case Study of the Hanoi Primary Healthcare System

Health Services Insights ◽

10.1177/11786329211019224 ◽

2021 ◽

Vol 14 ◽

pp. 117863292110192

Author(s):

Minh Van Hoang ◽

Anh Tuan Tran ◽

Trang Thu Vu ◽

Tuan Kim Duong

Keyword(s):

Public Information ◽

Enabling Factors ◽

Cross Sectional ◽

Emergency Operations ◽

The Us ◽

Local Stakeholders ◽

Control And Prevention ◽

Issue Public ◽

Analytical Frameworks

This study examined the coronavirus disease 2019 (COVID-19) preparedness and response of the health system (HS) in Hanoi, Vietnam, and identified enabling factors and barriers. This cross-sectional, mixed-methods study was conducted in 4 urban and peri-urban districts that included some wards with COVID-19-positive cases and some without. The US Centers for Disease Control and Prevention (CDC) analytical frameworks were used. Overall, 10% of health facilities (HFs) failed to fully implement COVID-19 risk determination; 8.8% failed to fully implement stronger community partnerships with local stakeholders to support public health (PH) preparedness; 35% and 2.5% incompletely implemented and did not implement evaluation of PH emergency operations, respectively; 10% did not identify communication channels to issue public information, alerts, warnings, and notifications; 25% incompletely implemented identification, development of guidance, and standards for information; 72.5% had good preventive and treatment collaboration; and 10% did not fully implement procedures for laboratory testing and reporting results. Enablers included sufficient infrastructure and equipment, strong leadership, and good cross-public-sector collaboration with police and military forces. Barriers included workforce constraints, overburdened and inconsistent reporting systems, inappropriate financial mechanisms, ambiguous health governance, and lack of private-sector engagement. Nonetheless, the HS preparedness and response were satisfactory, although further coordinated efforts in evaluation, coordination, communication, and volunteering remain necessary.

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Education Research: Neurology Resident EEG Education: A Survey of US Neurology Residency Program Directors

Neurology ◽

10.1212/wnl.0000000000011354 ◽

2020 ◽

pp. 10.1212/WNL.0000000000011354

Author(s):

Fábio A. Nascimento ◽

Jay R. Gavvala

Keyword(s):

Online Survey ◽

Program Directors ◽

Outpatient Setting ◽

Objective Measures ◽

Successful Completion ◽

Residency Programs ◽

Educational Methods ◽

The Us ◽

The Mean ◽

Residency Program Directors

Objective:To better understand the EEG education provided to adult neurology residents by surveying program directors (PDs) of adult neurology residency programs in the US.Methods:An online survey focused on characteristics of neurology residency programs and their EEG teaching systems was distributed to the 161 adult neurology residency PDs listed in the ACGME website at the time of the study.Results:Forty-seven (29%) out of the 161 PDs completed the survey – most of the participating programs (89%) were academic. The mean number of 1-month EEG rotation(s) required to graduate was 1.7 (range 0-4, median 1.75). EEG rotations involved the inpatient and outpatient setting in 91% and 70% of programs, respectively. The average number of EEGs read during a typical EEG rotation varied from more than 40, in about one-third of programs, to 0-10, in about 14% of programs. There was significant variability in the requirements for successful completion of EEG rotations, and most PDs (64%) reported not utilizing objective measures to assess EEG milestones. The most commonly used educational methods were didactics throughout the year (95%) and EEG teaching during EEG rotations (93%). The most commonly reported barriers to EEG education were insufficient EEG exposure (32%) and ineffective didactics (11%); possible solutions are summarized in table 1.Conclusion:Our study identified a lack of consistency in teaching and evaluating residents during residency and presented EEG education barriers alongside possible solutions. We encourage PDs across the country to re-evaluate their EEG teaching systems in order to optimize EEG education.

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Abstract 12276: The Changing Landscape of Ventricular Assist Device Utilization in Children Bridged to Transplant: The “Revolution” Begins

Circulation ◽

10.1161/circ.132.suppl_3.12276 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Chet R Villa ◽

Muhammad S Khan ◽

Farhan Zafar ◽

Jonathan W Byrnes ◽

David L Morales ◽

...

Keyword(s):

Temporal Trends ◽

Fold Increase ◽

Assist Device ◽

Ventricular Assist ◽

Global Trends ◽

Bridge To Transplant ◽

Number Of Children ◽

The Us ◽

Implantation Techniques ◽

Care Practices

Introduction: Growing clinical experience and innovative implantation techniques have allowed individual pediatric centers to push the boundaries of VAD use. However, data describing the global trends in VAD utilization are lacking. We sought to assess temporal trends in the use of VADS as a bridge to transplant in children across the US. Methods: Children <18 years listed for heart transplant 1/2006-6/2014 who were bridged with a VAD were identified in the UNOS database. Patients were stratified by era (Early: 2006-2010, Current: 2011-2014). Descriptive statistics were used to assess trends. Results: Of 3986 patients listed, 589 (15%) received a VAD as bridge to transplant during the study period. The percentage of patients bridged with a VAD increased in the current era (12% vs. 18%, p<0.001), while both durable cfVAD use and waitlist times increased (Table). Children < 25 kg continue to be bridged to transplant almost exclusively with pulsatile devices while 95% of patients ≥ 25 kg were bridged with a cfVAD in 2014 (Figure). Conclusions: The current era has seen a 1.5-fold increase in the percentage of children bridged to transplant with a VAD as well as a 3-fold increase in the percentage of patients bridged with a durable cfVAD in patients > 25 kg. The emergence of cfVAD technology in an era of increasing waitlist times, raises the prospect of a dramatic increase in the number of children discharged from the hospital while supported with a cfVAD. This underscores the need to rapidly define pediatric specific best care practices in outpatient VAD management.

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Abstract WP292: Temporal Trends in the Use of Ems Service as a Mode of Arrival by Acute Ischemic Stroke Patients

Stroke ◽

10.1161/str.51.suppl_1.wp292 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Syed F Ali ◽

Lee H Schwamm ◽

Sanjeeva Onteddu ◽

Krishna Nalleballe ◽

Kelly-Ann Patrice ◽

...

Keyword(s):

African Americans ◽

Univariate Analysis ◽

Temporal Trends ◽

Stroke Patients ◽

Altered Level ◽

Stroke Registry ◽

Stroke Risk Factors ◽

The Us ◽

Ems Education ◽

Iv Tpa

Intro: Utilization of emergency medical services (EMS) can increase the likelihood of appropriate therapy with IV tPA or endovascular intervention. We investigate the use of EMS services in three large states across the US during the past decade. Methods: Using GWTG stroke registry data from three large comprehensive stroke centers in the Northeast, South and West, we analyzed 9,251 stroke admissions from 01/2010 - 12/2018. Overall rates of EMS use and temporal trends were computed. Factors associated with EMS use were evaluated with univariate analysis. Results: Of the 9,251 patients, 29.2 % (2,697/9,251) presented via EMS service. Overtime use of EMS service increased from 29% in 2010-11 to 34% in 2018. Use of EMS increased among severe stroke patients but decreased among mild stroke patients. Patients presenting via EMS were older, more often females while less often African Americans. They had more stroke risk factors, including hypertension, diabetes, atrial fibrillation and previous stroke/TIA. Smokers less often use EMS services. Median NIHSS was higher among patients presenting via EMS, and those with altered level of consciousness used EMS more often. In-hospital intervention rates (IV tPA/endovascular) were higher among patients presenting via EMS. Conclusion: Our results showed that after extensive EMS education in most parts of the study states, stroke presentation has increased via EMS overtime. Disparity in the use of EMS still exists with African Americans using the service less often. Patients should be encouraged to use EMS services and decrease delay in presentation which can results in higher rates of intervention.

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Abstract 60: National Temporal Patterns in Recurrent Stroke by Demographic Characteristics and Geographic Regions: 2001-2016

Stroke ◽

10.1161/str.52.suppl_1.60 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Judith H Lichtman ◽

Erica C Leifheit ◽

Yun Wang ◽

Larry B Goldstein

Keyword(s):

Proportional Hazards Model ◽

Recurrent Stroke ◽

Temporal Trends ◽

Healthcare Delivery ◽

Temporal Patterns ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Fee For Service ◽

The Us ◽

Over Time

Background: There have been important advances in secondary stroke prevention and a focus on healthcare delivery in the US over the past two decades. Yet, little is known about temporal patterns of recurrent stroke in the US. We examined temporal trends in recurrent stroke by sociodemographic characteristics and geographic areas using national Medicare data. Methods: We included fee-for-service Medicare beneficiaries aged ≥65y with a primary discharge diagnosis of ischemic stroke from 2001 to 2016. We fit a Cox proportional hazards model that censored for change in Medicare enrollment and accounted for death to evaluate the temporal trend in 1-year recurrent stroke, adjusting for demographic and clinical factors. Models were repeated for subgroups defined by age, sex, race, and state. We mapped smoothed rates of 1-year recurrent stroke by county to assess geographic variation over time. Results: There were 3,485,618 unique beneficiaries discharged with stroke during the study period. Demographic and clinical characteristics remained relatively stable over time, but the proportions discharged with home health services and inpatient rehabilitation increased. The observed 1-year recurrent stroke rate decreased from 11.2% in 2001-2004 to 9.3% in 2013-2016, with an adjusted annual reduction in recurrence from 2001-2016 of 1.49% (95% CI 1.40%-1.58%). There were significant reductions for all age, sex, and race groups (A). Geographic areas with persistently high rates were identified over time (B). In state-stratified analysis, the annual percentage reduction in recurrence ranged from -1.2% to 2.5% and was significant for all but 12 states. Conclusions: Recurrent strokes decreased over time overall and by sociodemographic subgroups; however, we identified geographic areas with persistently high recurrence rates. Such findings can target secondary prevention intervention opportunities for high-risk populations and communities.

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Temporal and spatial variations in freeze warnings in the conterminous United States: 2005–2018

Theoretical and Applied Climatology ◽

10.1007/s00704-019-03056-8 ◽

2019 ◽

Vol 139 (3-4) ◽

pp. 1379-1384

Author(s):

Brandon Lawhorn ◽

Robert C. Balling

Keyword(s):

United States ◽

Temporal Trends ◽

The United States ◽

Temporal Variations ◽

Atmospheric Composition ◽

Southeastern Us ◽

The Us ◽

Temporal And Spatial ◽

Frost Free Period ◽

Spatial And Temporal Trends

AbstractIt is well-documented that the United States (US), along with other mid-latitude land locations, has experienced warming in recent decades in response to changes in atmospheric composition. Among other changes, Easterling (2002) reported that the frost-free period is now longer across much of the US with the first frost in fall occurring later and the last freeze in spring occurring earlier. In this investigation, we explore spatial and temporal variations in all freeze warnings issued by the US National Weather Service. Freeze warning counts are highest in the southeastern US peaking overall in the spring and fall months. Freeze warnings tend to occur more toward summer moving northward and westward into more northerly states. Consistent with the warming in recent decades, we find statistically significant northward movements in freeze warning centroids in some months (December, February) across the study period (2005–2018). Detection of spatial and temporal trends in freeze warnings may be of interest to any number of scientists with applied climatological interests.

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An analecta of visualizations for foodborne illness trends and seasonality

Scientific Data ◽

10.1038/s41597-020-00677-x ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Ryan B. Simpson ◽

Bingjie Zhou ◽

Tania M. Alarcon Falconi ◽

Elena N. Naumova

Keyword(s):

Visual Analytics ◽

Disease Surveillance ◽

Temporal Trends ◽

Disease Outbreaks ◽

Data Interpretation ◽

Population Based ◽

Annual Reports ◽

Surveillance Systems ◽

The Us ◽

Annual Time Series

Abstract Disease surveillance systems worldwide face increasing pressure to maintain and distribute data in usable formats supplemented with effective visualizations to enable actionable policy and programming responses. Annual reports and interactive portals provide access to surveillance data and visualizations depicting temporal trends and seasonal patterns of diseases. Analyses and visuals are typically limited to reporting the annual time series and the month with the highest number of cases per year. Yet, detecting potential disease outbreaks and supporting public health interventions requires detailed spatiotemporal comparisons to characterize spatiotemporal patterns of illness across diseases and locations. The Centers for Disease Control and Prevention’s (CDC) FoodNet Fast provides population-based foodborne-disease surveillance records and visualizations for select counties across the US. We offer suggestions on how current FoodNet Fast data organization and visual analytics can be improved to facilitate data interpretation, decision-making, and communication of features related to trend and seasonality. The resulting compilation, or analecta, of 436 visualizations of records and codes are openly available online.

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727: Temporal trends of risks among planned home births in the US 2006-2012

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2014.10.933 ◽

2015 ◽

Vol 212 (1) ◽

pp. S356

Author(s):

Amos Grunebaum ◽

Chelsea A. Clinton ◽

Frank Chervenak

Keyword(s):

Temporal Trends ◽

Home Births ◽

The Us

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