scholarly journals Cochlear Implant Practice Patterns: The U.S. Trends with Pediatric Patients

2018 ◽  
Vol 29 (08) ◽  
pp. 722-733 ◽  
Author(s):  
Carly Hemmingson ◽  
Jessica J. Messersmith
Keyword(s):  
Cochlear Implant ◽  
Online Survey ◽  
Practice Patterns ◽  
Pediatric Population ◽  
The United States ◽  
Practice Research ◽  
Clinical Practices ◽  
Cross Sectional Survey ◽  
Follow Up Care

AbstractMany factors affect an individual’s outcomes with a cochlear implant (CI); however, quality of device programming and consistency of follow-up appointments have been shown to be crucial contributors. As audiologists’ CI caseloads increase, time constraints on appointments also increase, thus fueling the need for efficient and effective programming strategies. Currently, there are no standardized guidelines describing what methods should be used during programming, nor are there standardized schedules that delineate what procedures should be performed at specific appointment intervals. Without standardized programming guidelines, clinical practices may be variable and may not align with best practice research; thus, outcomes with a CI, particularly for pediatrics, may not be reflective of the actual potential available.The purpose of this study was to identify the clinical practice patterns used by U.S. audiologists when programming and providing follow-up care to children who use CIs. This study aimed to determine the following: common programming approaches, provision intervals for these procedures, common validation assessments, typical follow-up care schedules, and source(s) of CI training. In addition, this study sought to evaluate if training and/or follow-up care differed between small and large CI centers.A cross-sectional survey design was used.Target population included practicing audiologists working with pediatric CI users throughout the United States. Participation was voluntary, thus random selection could not be used. A total of 167 participants opened and began the online survey and 113 successfully completed the survey instrument (23.99% return rate).Potential participants were identified using the “find a clinic” function on three CI manufacturers' websites. Potential participants were asked to complete an online survey seeking information about practices they employ in their clinical setting. Survey responses were analyzed for trends.Overall, a common follow-up schedule was determined, which included an average of 6.8 appointments within the first year. Minor differences in training and programming practices between small and large CI centers emerged; however, no statistically significant results were noted. Results did reveal trends in the use of certain clinical practices. This was particularly evident in the limited use of objective measures.Overall, the findings support other recent studies that suggest the development of CI guidelines that may standardize programming and follow-up practices of CI audiologists. This could prove valuable for the continual improvement of CI outcomes, particularly in the pediatric population.

scholarly journals Factors affecting orthodontists' management of the retention phase

2013 ◽  
Vol 84 (2) ◽  
pp. 225-230 ◽  
Author(s):  
Kevin Bibona ◽  
Bhavna Shroff ◽  
Al M. Best ◽  
Steven J. Lindauer
Keyword(s):  
Special Needs ◽  
Time Management ◽  
Null Hypothesis ◽  
Online Survey ◽  
Third Molars ◽  
Factors Affecting ◽  
Primary Responsibility ◽  
Follow Up Care ◽  
Number Of Visits

ABSTRACT Objective: To test the null hypothesis that orthodontist characteristics and factors related to retainer choice do not influence the management of the retention phase with regard to frequency and duration of follow-up care provided. Materials and Methods: Orthodontists (n  =  1000) were randomly selected to participate in an online survey divided into three categories: background, retainer choice, and time management. Results: Of the 1000 selected participants, 894 responded. When deciding the type of retainer to use, the following were considered most frequently: pretreatment malocclusion (91%), patient compliance (87%), patient oral hygiene (84%), and patients' desires (81%). Orthodontists who considered the presence of third molars (P  =  .03) or “special needs” patients (P  =  .02) had significantly more follow-up visits than those who did not. When vacuum-formed retainers (VFRs) were prescribed, there were significantly fewer visits (P  =  .02) compared to when other types of retainers were used. As practitioner experience increased, so did the number of visits (P < .0001). Orthodontists who considered the primary responsibility of retention to fall on the patient had significantly fewer follow-up visits (P < .0001) than those who considered it either a joint or orthodontist-only responsibility. Conclusions: The null hypothesis was rejected because the number of follow-up visits during the retention phase was affected by practitioner experience, whether VFRs were used, whether the orthodontist considered the presence of third molars or special-needs patients when choosing the type of retainer, and to whom the orthodontist attributed responsibility during the retention phase.

scholarly journals Similarities and Differences in COVID-19 Awareness, Concern, and Symptoms by Race and Ethnicity in the United States: Cross-Sectional Survey (Preprint)

2020 ◽  
Author(s):  
Jeb Jones ◽  
Patrick S Sullivan ◽  
Travis H Sanchez ◽  
Jodie L Guest ◽  
Eric W Hall ◽  
...  
Keyword(s):  
United States ◽  
Race And Ethnicity ◽  
Online Survey ◽  
Statistical Tests ◽  
The United States ◽  
Control Measures ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Similarities And Differences ◽  
Hispanic White

BACKGROUND Existing health disparities based on race and ethnicity in the United States are contributing to disparities in morbidity and mortality during the coronavirus disease (COVID-19) pandemic. We conducted an online survey of American adults to assess similarities and differences by race and ethnicity with respect to COVID-19 symptoms, estimates of the extent of the pandemic, knowledge of control measures, and stigma. OBJECTIVE The aim of this study was to describe similarities and differences in COVID-19 symptoms, knowledge, and beliefs by race and ethnicity among adults in the United States. METHODS We conducted a cross-sectional survey from March 27, 2020 through April 1, 2020. Participants were recruited on social media platforms and completed the survey on a secure web-based survey platform. We used chi-square tests to compare characteristics related to COVID-19 by race and ethnicity. Statistical tests were corrected using the Holm Bonferroni correction to account for multiple comparisons. RESULTS A total of 1435 participants completed the survey; 52 (3.6%) were Asian, 158 (11.0%) were non-Hispanic Black, 548 (38.2%) were Hispanic, 587 (40.9%) were non-Hispanic White, and 90 (6.3%) identified as other or multiple races. Only one symptom (sore throat) was found to be different based on race and ethnicity (<i>P</i>=.003); this symptom was less frequently reported by Asian (3/52, 5.8%), non-Hispanic Black (9/158, 5.7%), and other/multiple race (8/90, 8.9%) participants compared to those who were Hispanic (99/548, 18.1%) or non-Hispanic White (95/587, 16.2%). Non-Hispanic White and Asian participants were more likely to estimate that the number of current cases was at least 100,000 (<i>P</i>=.004) and were more likely to answer all 14 COVID-19 knowledge scale questions correctly (Asian participants, 13/52, 25.0%; non-Hispanic White participants, 180/587, 30.7%) compared to Hispanic (108/548, 19.7%) and non-Hispanic Black (25/158, 15.8%) participants. CONCLUSIONS We observed differences with respect to knowledge of appropriate methods to prevent infection by the novel coronavirus that causes COVID-19. Deficits in knowledge of proper control methods may further exacerbate existing race/ethnicity disparities. Additional research is needed to identify trusted sources of information in Hispanic and non-Hispanic Black communities and create effective messaging to disseminate correct COVID-19 prevention and treatment information.

Development and Preliminary Psychometric Evaluation of Decisional Balance and Self-Efficacy Measures for Managing Anxiety in a National Sample of Clinically Anxious Adults

2016 ◽  
Vol 32 (1) ◽  
pp. 215-223
Author(s):  
Jessica M. Lipschitz ◽  
Andrea L. Paiva ◽  
Colleen A. Redding ◽  
Deborah Levesque ◽  
Joseph S. Rossi ◽  
...  
Keyword(s):  
Psychometric Properties ◽  
Transtheoretical Model ◽  
Self Efficacy ◽  
Online Survey ◽  
The United States ◽  
Decisional Balance ◽  
Cross Sectional Survey ◽  
Core Element ◽  
Measurement Models ◽  
Confirmatory Factor

Purpose: Anxiety is the most common and costly mental illness in the United States. Reducing avoidance is a core element of evidence-based treatments. Past research shows readiness to address avoidance affects outcomes. Investigating avoidance from a transtheoretical model (TTM) perspective could facilitate tailored approaches for individuals with low readiness. This study developed and examined psychometric properties of TTM measures for addressing anxiety-based avoidance. Design: Cross-sectional survey. Setting: Community centers, online survey. Participants: Five hundred ninety-four individuals aged 18 to 70 with clinically significant anxiety. Measures: Overall Anxiety Severity Questionnaire, stages of change, decisional balance, and self-efficacy. Analysis: The sample was randomly split into halves for principal component analyses (PCAs) and confirmatory factor analyses (CFAs) to test measurement models. Further analyses examined relationships between constructs. Results: For decisional balance, PCA indicated two 5-item factors (pros and cons). Confirmatory factor analysis supported a 2-factor correlated model, Satorra-Bentler scaled chi-square [Formula: see text], comparative fit index (CFI = 0.94), root mean square error of approximation (RMSEA = 0.07), pros: α = 0.87, ρ = 0.87, cons: α = 0.75, and ρ = 0.75. For self-efficacy, PCA indicated one 6-item factor supported by CFA, [Formula: see text], P < .01, CFI = 0.98, RMSEA = 0.09, α = 0.90, ρ = 0.87. As hypothesized, significant cross-stage differences were observed for pros and self-efficacy, and significant relationships between anxiety severity and pros, cons, and self-efficacy were found. Conclusion: Findings show strong psychometric properties and support the application of a readiness-based model to anxiety. In contrast to findings of other behaviors, cons remain high in action and maintenance. These measures provide a solid empirical foundation to develop TTM-tailored interventions to enhance engagement in treatment.

No consensus exists for use of anticoagulation for calf vein thrombosis

Vascular ◽  
2013 ◽  
Vol 22 (2) ◽  
pp. 93-97 ◽  
Author(s):  
Michael J Anstadt ◽  
T Calloway Robertson ◽  
Ross Milner
Keyword(s):  
Online Survey ◽  
Practice Patterns ◽  
Low Molecular Weight ◽  
Multiple Choice Questions ◽  
Single Institution ◽  
Vein Thrombosis ◽  
Ivc Filters ◽  
Calf Vein ◽  
The Ideal

The ideal treatment of calf vein thrombosis (CVT) remains undefined. We assessed practice patterns at a single institution for CVT. Physicians were sent an online survey with 8 multiple choice questions about management of CVT. A total of 99 physicians of varying specialties participated in the survey. A total of 48.5% anticoagulate patients with CVT and 51.5% do not. Of those who anticoagulate, 62.3% use low molecular weight heparin and 11% use IV heparin. Treatment duration is 3 months for 58% and 6 months for 30% of responders. Of those who do not anticoagulate, 71.2% reassess for clot propagation or resolution with a duplex exam. IVC filters are used by 46% when there is a contraindication to anticoagulation and 13.7% when clot propagation is noted on follow-up scan. These results suggest that there is no consensus treatment of CVT. There is a higher than expected rate of IVC filters placed for CVT.

scholarly journals Pneumocystis jirovecii prophylaxis in patients treated for high-grade gliomas: a survey among neuro-oncologists

2018 ◽  
Vol 6 (4) ◽  
pp. 321-326
Author(s):  
Nebojša Skorupan ◽  
Surabhi Ranjan ◽  
Seema Mehta ◽  
Olga Yankulina ◽  
Nathan Nenortas ◽  
...  
Keyword(s):  
Online Survey ◽  
Practice Patterns ◽  
The United States ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
High Grade ◽  
Cancer Centers ◽  
Medical Oncologists ◽  
High Grade Gliomas ◽  
Cd4 Lymphocyte

Abstract Background Pneumocystis jirovecii pneumonia (PJP) is a known complication in patients with high-grade gliomas (HGGs) who are treated with radiation and chemotherapy. PJP prophylaxis is commonly recommended, but there are currently no clear guidelines regarding duration of treatment and choice of drugs. This study aimed to assess current practice patterns of PJP prophylaxis among neuro-oncologists. Methods An online survey of 14 multiple choice questions was sent to 207 neuro-oncologists and medical oncologists treating brain cancers at all National Cancer Institute-designated cancer centers in the United States. Recipients were identified via a search of the cancer centers’ websites. Results Sixty-one invited experts completed the survey (response rate 29%; of these, 72% were neuro-oncologists, 18% were medical oncologists, and 10% were pediatric neuro- or medical oncologists). Seventy percent of respondents stated that they routinely prescribe PJP prophylaxis, while 7% do not provide prophylaxis. Eighty-one percent of respondents use absolute lymphocyte count (ALC) to assess lymphopenia and 13% also monitor CD4 lymphocyte counts during prophylaxis. The most commonly used first-line agent is trimethoprim-sulfamethoxazole (88% of respondents), followed by pentamidine (6%). Discontinuation of PJP prophylaxis is determined by the following: count recovery (33% by ALC; 18% by CD4 lymphocyte counts), radiation completion (23%), and chemotherapy completion (7%). Glucose-6-phosphate dehydrogenase levels were routinely checked by only 13% of respondents. Conclusions PJP prophylaxis is commonly used in HGG patients, but there are large variations in practice patterns, including the duration of prophylaxis. As consideration for PJP prophylaxis affects all patients with HGG, standardization of prophylaxis should be formally addressed.

Sources of variation in follow-up expenditure after radical cystectomy.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 335-335
Author(s):  
Goutham Vemana ◽  
Joel Vetter ◽  
Ling Chen ◽  
Gurdarshan Singh Sandhu ◽  
Seth A. Strope
Keyword(s):  
Radical Cystectomy ◽  
Practice Patterns ◽  
Care Delivery ◽  
Total Variance ◽  
Office Visits ◽  
Recommended Care ◽  
Patient Level ◽  
Follow Up Care ◽  
The Impact

335 Background: Follow-up care after radical cystectomy is poorly defined with extensive variation in practice patterns. We sought to determine sources of these variations in care as well as examine the economic impact of standardization of care to guideline recommended care. Methods: Using linked SEER-Medicare data from 1992 to 2007, we determined follow-up care expenditures (time and geography standardized) for 24 months after surgery. Accounted costs included office visits, imaging studies, urine tests and blood work. A multilevel model was implemented to determine the impact of region, surgeon, and patient factors on care delivery. We then compared the actual expenditures on care in the Medicare system (interquartile range) to the expenditures if patients received care recommended by current clinical guidelines. Results: Expenditures over 24 months of follow-up were calculated per month and per patient. The mean and median monthly expenditures were $33 and $21 respectively (minimum $0, maximum $429, 25th to 75th percentile $9 to $43). The total variance of expenditure situated at the surgeon-level and SEER region-level was 9.9% and 4.0% respectively. After accounting for the region, the total variance of expenditure situated at the patient-level and surgeon-level was 14.95% and 7.81% respectively. The assessed cost of guideline follow-up recommendations varied from 0.78-9.05 times the calculated Medicare costs. The guideline recommended cost of follow-up was higher than actual Medicare expenditures in all but one category. Conclusions: While some regional and surgeon-level variations in care were found, most variation in expenditure on follow-up care was at the patient-level, largely based on comorbidity, node positivity, chemotherapy status, readmission rates, and final cancer stage. Standardization of care to current established guidelines would create larger expenditures for the Medicare system than current practice patterns.

Cochlear Implants 2016: Advances in Candidacy, Technology, and Outcomes, Factors That Drive the Expansion of Pediatric Cochlear Implant Candidacy

2016 ◽  
Vol 1 (9) ◽  
pp. 21-28 ◽  
Author(s):  
Teresa A. Zwolan ◽  
Donna L. Sorkin
Keyword(s):  
Cochlear Implant ◽  
Cochlear Implants ◽  
Early Identification ◽  
Surgical Intervention ◽  
Auditory Brainstem ◽  
Follow Up Care ◽  
Auditory Brainstem Implants

Cochlear implant candidacy and outcomes have advanced reflecting technology improvements, early identification, and better linkage between the surgical intervention and follow-up care. Children and adults with a range of hearing losses and other issues are now benefitting importantly from traditional cochlear implants as well as hybrid and auditory brainstem implants.

scholarly journals Screening and follow-up care for cognitive and emotional problems after transient ischaemic attack and ischaemic stroke: a national, cross-sectional, online survey among neurologists in the Netherlands

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e046316
Author(s):  
Jos Slenders ◽  
Renske Van den Berg-Vos ◽  
Johanna Visser-Meily ◽  
Caroline van Heugten ◽  
Vincent Kwa
Keyword(s):  
Clinical Practice ◽  
Ischaemic Stroke ◽  
Transient Ischaemic Attack ◽  
Online Survey ◽  
Emotional Problems ◽  
Information Provision ◽  
Cross Sectional ◽  
Follow Up Care ◽  
Ischaemic Attack

BackgroundAfter stroke, many patients experience cognitive and/or emotional problems. While national guidelines recommend screening for these problems, actual screening rates might be limited.ObjectiveThis study aimed to examine the clinical practice at neurology departments regarding screening, information provision and follow-up care for cognitive and emotional problems after transient ischaemic attack (TIA) and ischaemic stroke.MethodsA nationwide, cross-sectional, online survey was conducted between October 2018 and October 2019 among neurologists in all hospitals in the Netherlands.ResultsNeurologists in 78 hospitals were invited to join the survey, and 52 (67%) of them completed it. Thirty-one (59%) neurologists reported that screening for cognitive problems after TIA and ischaemic stroke was mostly or always performed. When cognitive screening was performed, 42 (84%) used validated screening instruments. Twenty-nine (56%) of the respondents reported that screening for emotional problems was mostly or always performed. When emotional screening was performed, 31 (63%) reported using validated screening instruments. Timing of screening and information provision was highly variable, and the majority reported that there was no protocol for follow-up care when cognitive or emotional problems were found.ConclusionsThis study demonstrates that clinical practice at neurology departments is highly variable regarding screening, information provision and follow-up care for cognitive and emotional problems in patients after TIA or ischaemic stroke. Approximately half of the participating neurologists reported that screening was performed only sometimes or never for cognitive and emotional problems after TIA and ischaemic stroke.

scholarly journals Cross-Sectional Survey Of Fertility Knowledge In Obstetrics And Gynecology Residents

2020 ◽  
Author(s):  
Leah May Roberts ◽  
Rashmi Kudesia ◽  
Huaqing Zhao ◽  
Shaliz Dolan ◽  
Marisa Rose
Keyword(s):  
Online Survey ◽  
Assisted Reproductive Technologies ◽  
Knowledge Score ◽  
The United States ◽  
Reproductive Technologies ◽  
Obstetrics And Gynecology ◽  
Success Rates ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Level Of Training

Abstract PURPOSE: To evaluate fertility knowledge among current Obstetrics and Gynecology (OB-GYN) residents using a recently published validated instrument, the Fertility and Infertility Treatment Knowledge Score (FIT-KS).METHODS: OB-GYN residents in the United States were recruited through an email to all residency coordinators nationwide. They were asked to voluntarily respond to a short questionnaire including demographic information and the FIT-KS instrument, through an online survey platform.RESULTS: The sample was 91% female, with 69% between the ages of 26 and 30. Participants evenly represented all four years of training. Mean FIT-KS score was 21.2 (73% correct). No statistically significant differences were noted across the level of training. Several knowledge gaps were noted. Residents could define the common assisted reproductive technologies; however overestimated their success rates per cycle. CONCLUSIONS: Substantial gaps exist in fertility knowledge among OB-GYN residents, with understanding of male fertility and success rates of Assisted Reproductive Technologies (ART) being particularly limited. Knowledge of fertility does not change throughout residency training, demonstrating consistent gaps in fertility knowledge. Knowledge during post graduate year (PGY)-1 year is consistent with mean scores found in prior research in Internal Medicine residents (65%), as well as a cohort of female medical students and obstetrics and gynecology residents and fellows (64.9%)(1, 2).

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