The Practice of Pathology in Canada: Decreasing Pathologist Supply and Uncertain Outcomes

2012 ◽  
Vol 136 (1) ◽  
pp. 90-94 ◽  
Author(s):  
Terence J Colgan ◽  
Laurette Geldenhuys
Keyword(s):  
United States ◽  
Health Care ◽  
The United States ◽  
Population Based ◽  
Annual Number ◽  
New Era ◽  
Radiation Oncologists ◽  
Time Period ◽  
Study Population ◽  
Uncertain Outcomes

Context.—Pathology organizations in the United States are preparing for a new era of health care reform. Trends in the supply of pathologists in Canada's managed care system may provide some useful insights in any analysis and projection of future pathologist needs in the United States. Objective.—In this study, population-based Canadian databases were used to devise a parameter for physician supply, cancer cases per physician. The trend in this supply parameter for pathologists was compared to that for radiation oncologists. Design.—The number of Canadian pathologists and radiation oncologists and the annual number of new cancer cases in each of 2 years, 1999 and 2009, were extracted from reliable databases. Cancer cases per pathologist and oncologist were calculated, and relative trends in supply of physicians in both specialties were identified. Results.—The annual number of new cancer cases increased from 129 300 to 171 000 from 1999 to 2009. The absolute numbers of both pathologists and oncologists also increased in this time period. However, while the increase in the number of radiation oncologists led to an 8.2% decrease in cancer cases per radiation oncologist, the modest increase in the number of pathologists led to an increase of 17.1% in cancer cases per pathologist. Conclusions.—There is a trend toward a decreasing supply of Canadian pathologists relative to that of cancer demands. This finding confirms an earlier population-based study showing a decreased supply relative to population and number of clinical physicians. It is uncertain whether this decreased supply is a result of appropriate application of new, efficient methods or whether health care has been rationed or adversely impacted. Outcome measures to monitor Canadian pathology practice quality are clearly needed.

scholarly journals Firework-related injuries treated at emergency departments in the United States during the COVID-19 pandemic in 2020 compared to 2018–2019

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Nathan Maassel ◽  
Abbie Saccary ◽  
Daniel Solomon ◽  
David Stitelman ◽  
Yunshan Xu ◽  
...  
Keyword(s):  
United States ◽  
Census Data ◽  
The United States ◽  
Population Based ◽  
Emergency Department Visits ◽  
Consumer Product Safety Commission ◽  
Injury Surveillance System ◽  
Time Period ◽  
National Estimates ◽  
Us Census

Abstract Background Despite a national decrease in emergency department visits in the United States during the first 10 months of the pandemic, preliminary Consumer Product Safety Commission data indicate increased firework-related injuries. We hypothesized an increase in firework-related injuries during 2020 compared to years prior related to a corresponding increase in consumer firework sales. Methods The National Electronic Injury Surveillance System (NEISS) was queried from 2018 to 2020 for cases with product codes 1313 (firework injury) and narratives containing “fireworks”. Population-based national estimates were calculated using US Census data, then compared across the three years of study inclusion. Patient demographic and available injury information was also tracked and compared across the three years. Firework sales data obtained from the American Pyrotechnics Association were determined for the same time period to examine trends in consumption. Results There were 935 firework-related injuries reported to the NEISS from 2018 to 2020, 47% of which occurred during 2020. National estimates for monthly injuries per million were 1.6 times greater in 2020 compared to 2019 (p < 0.0001) with no difference between 2018 and 2019 (p = 0.38). The same results were found when the month of July was excluded. Firework consumption in 2020 was 1.5 times greater than 2019 or 2018, with a 55% increase in consumer fireworks and 22% decrease in professional fireworks sales. Conclusions Firework-related injures saw a substantial increase in 2020 compared to the two years prior, corroborated by a proportional increase in consumer firework sales. Increased incidence of firework-related injuries was detected even with the exclusion of the month of July, suggesting that the COVID-19 pandemic may have impacted firework epidemiology more broadly than US Independence Day celebrations.

scholarly journals Prevalence of Fistulizing Crohn’s Disease in the United States: Estimate From a Systematic Literature Review Attempt and Population-Based Database Analysis

2019 ◽  
Vol 25 (11) ◽  
pp. 1773-1779 ◽  
Author(s):  
David A Schwartz ◽  
Ignacio Tagarro ◽  
Mary Carmen Díez ◽  
William J Sandborn
Keyword(s):  
United States ◽  
Health Care ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Literature Review ◽  
Systematic Literature Review ◽  
The United States ◽  
Population Based ◽  
Number Of Patients ◽  
Reported Data

Abstract Background Fistulas may arise as a relevant complication of Crohn’s disease (CD). Despite their clinical significance and the substantial burden imposed on patients, limited data are available on the epidemiology of fistulizing CD in the United States. Methods A systematic literature review was conducted to identify data published between 1970 and 2017 on the epidemiology of fistulas in patients with CD, with the aim to estimate the number of prevalent cases in the United States. Retrieved titles and abstracts were screened by 2 independent researchers for inclusion criteria (US population-based studies reporting data on the epidemiology of fistulizing CD). To validate the literature-based estimate, data from a US claims database (Truven Health MarketScan database) were analyzed. This database has broad geographic coverage, with health care data for >60 million patients during the period of the analysis. Results The literature search retrieved 7 articles for full-text review, and only 1 met the criteria for inclusion. This study described the cumulative incidence of fistulas in a CD population from Minnesota over 20 years. From the reported data, the estimated number of prevalent cases with fistulizing CD in the United States was ~76,600 in 2017 (~52,900 anal, ~7400 rectovaginal, ~2300 enterocutaneous, and ~14,100 internal). Analysis from the US health care database resulted in an estimated number of ~75,700 patients, confirming the robustness of the original estimate from the literature. Conclusions Based on 2 separate analyses, the estimated number of patients with fistulizing CD in the United States is ~77,000 patients.

scholarly journals Assessment of Patient Experiences in Otolaryngology Virtual Visits During the COVID-19 Pandemic

OTO Open ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. 2473974X2093357 ◽  
Author(s):  
Kyohei Itamura ◽  
Franklin L. Rimell ◽  
Elisa A. Illing ◽  
Thomas S. Higgins ◽  
Jonathan Y. Ting ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Interpersonal Communication ◽  
Health Care Providers ◽  
Descriptive Analysis ◽  
The United States ◽  
Patient Experiences ◽  
Care Providers ◽  
Time Period ◽  
Virtual Visits

This study evaluates the patient experience during virtual otolaryngology clinic visits implemented during the coronavirus disease 2019 (COVID-19) pandemic. Patient satisfaction surveys were queried from January 1, 2020, to May 1, 2020, for both telehealth and in-person visits. A descriptive analysis of the question responses was performed. There were 195 virtual and 4013 in-person visits with surveys completed in this time period. Ratings related to provider-patient communication were poor for virtual visits. Telehealth has become the new norm for most health care providers in the United States. This study demonstrates some of the initial shortcomings of telehealth in an otolaryngology practice and identifies challenges with interpersonal communication that may need to be addressed as telehealth becomes increasingly prevalent.

scholarly journals Levothyroxine prescriptions trends may indicate a downtrend in prescribing

2020 ◽  
Vol 11 ◽  
pp. 204201882092055
Author(s):  
Jacqueline Jonklaas ◽  
Sameer DeSale
Keyword(s):  
United States ◽  
The United States ◽  
Thyroid Stimulating Hormone ◽  
Annual Number ◽  
Washington Dc ◽  
Time Period ◽  
Number Of Patients ◽  
Prescribing Trends ◽  
System Operating ◽  
Over Time

Background: There has been a trend for increased prescribing of levothyroxine (LT4) in many countries, including the United States. Several different factors have been suggested to be the cause of this practice pattern. These factors include increased size of the United States population, more diagnosis of hypothyroidism, more treatment of minimally elevated thyroid-stimulating hormone (TSH) levels, more use of LT4 in older patients, and use of LT4 for treatment of euthyroid patients with non-thyroidal conditions. Methods: The electronic databases of the MedStar Health system operating in the Washington, DC and Maryland areas were interrogated to determine the number of patients who were being prescribed levothyroxine during the time period 2008–2016, the number of prescriptions supplied to these individuals, the associated diagnosis, and whether the prescriptions were new or existing prescriptions. Regression analyses were also performed to determine the prescribing trends during this time period. Results: Although the annual number of levothyroxine prescriptions increased during this time period, the percentage of patients in the database receiving levothyroxine for hypothyroidism initially increased and then decreased over time (2.5% to 3.2% to 2.5%). The percentage of prescriptions written for patients who did not appear to carry a diagnosis of hypothyroidism steadily declined (3.5% to 1.0%). Although the percentage of patients with existing prescriptions for hypothyroidism initially increased and then were maintained at steady levels (1.4% to 2.4% to 2.2%), a smaller percentage of patients with existing prescriptions were documented over time when there was no diagnosis of hypothyroidism (1.45% to 0.89%). The percentage of patients with new prescriptions declined over time for all groups. The number of annual 90-day period prescriptions increased over the time for patients with a diagnosis of hypothyroidism, but down-trended starting over the latter part of the time period for those patients without a diagnosis of hypothyroidism. Conclusion: Taken together, these data suggest that there may be a stabilization, and even a down-trend in levothyroxine prescribing with the MedStar system. The decrease in levothyroxine prescribing appears to be accounted for by less use of levothyroxine without an established diagnosis of hypothyroidism, and less initiation of new prescriptions.

scholarly journals The State of Rural Public Health: Enduring Needs in a New Decade

2020 ◽  
Vol 110 (9) ◽  
pp. 1283-1290 ◽  
Author(s):  
Jonathon P. Leider ◽  
Michael Meit ◽  
J. Mac McCullough ◽  
Beth Resnick ◽  
Debra Dekker ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
The United States ◽  
Population Based ◽  
Social Spending ◽  
Life Expectancy At Birth ◽  
Rural Public Health ◽  
Time Period ◽  
Urban Rural ◽  
Health Enterprise

Public health in the rural United States is a complex and underfunded enterprise. While urban–rural disparities have been a focus for researchers and policymakers alike for decades, inequalities continue to grow. Life expectancy at birth is now 1 to 2 years greater between wealthier urban and rural counties, and is as much as 5 years, on average, between wealthy and poor counties. This article explores the growth in these disparities over the past 40 years, with roots in structural, economic, and social spending differentials that have emerged or persisted over the same time period. Importantly, a focus on place-based disparities recognizes that the rural United States is not a monolith, with important geographic and cultural differences present regionally. We also focus on the challenges the rural governmental public health enterprise faces, the so-called “double disparity” of worse health outcomes and behaviors alongside modest investment in health departments compared with their nonrural peers. Finally, we offer 5 population-based “prescriptions” for supporting rural public health in the United States. These relate to greater investment and supporting rural advocacy to better address the needs of the rural United States in this new decade.

scholarly journals A population-based estimate of the substantial burden of diarrhoeal disease in the United States; FoodNet, 1996–2003

2006 ◽  
Vol 135 (2) ◽  
pp. 293-301 ◽  
Author(s):  
T. F. JONES ◽  
M. B. McMILLIAN ◽  
E. SCALLAN ◽  
P. D. FRENZEN ◽  
A. B. CRONQUIST ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care System ◽  
Diarrhoeal Disease ◽  
The United States ◽  
Population Based ◽  
Daily Activities ◽  
Medical Provider ◽  
Weighted Prevalence ◽  
Over Time

From 1996 to 2003, four 12-month population-based surveys were performed in FoodNet sites to determine the burden of diarrhoeal disease in the population. Acute diarrhoeal illness (ADI) was defined as [ges ]3 loose stools in 24 hours with impairment of daily activities or duration of diarrhoea >1 day. A total of 52840 interviews were completed. The overall weighted prevalence of ADI in the previous month was 5·1% (95% CI±0·3%), corresponding to 0·6 episodes of ADI per person per year. The average monthly prevalence of ADI was similar in each of the four survey cycles (range 4·5–5·2%). Rates of ADI were highest in those age <5 years. Of those with ADI, 33·8% (95% CI±2·7%) reported vomiting, 19·5% (95% CI±2·1%) visited a medical provider, and 7·8% (95% CI±1·4%) took antibiotics. Rates of ADI were remarkably consistent over time, and demonstrate the substantial burden placed on the health-care system.

scholarly journals Submaximal Decision Theory and Health Resource Conservation

2007 ◽  
Vol 5 (SI) ◽  
pp. 41-47
Author(s):  
Kara McArthur ◽  
Clifford C. Dacso
Keyword(s):  
United States ◽  
Health Care ◽  
Chronic Illness ◽  
Health Workers ◽  
Point Of Care ◽  
Clinical History ◽  
The United States ◽  
Population Based ◽  
Underserved Communities ◽  
Underserved Patients

The challenge of eliminating disparities in chronic illness in the United States is hampered by the diversity of the epidemiology of the chronic conditions themselves, and by the individuality of the communities and patients affected by them. This article outlines some of the ways in which the complexity of chronic illness in underserved communities in the United States limits the data and the strategies available to clinicians and patients. We then present the example of chronic heart failure (CHF) to illustrate a possible solution that we are developing for supporting underserved patients’ selfmanagement of chronic illness: individualized health care (through “personal normals” derived from the patient’s own clinical history combined with population-based data), and distributed health care (point of care through wireless biosensors and community health workers). We present some of the possible barriers to the implementation of the model. Conclusion: we believe that this approach is a pathway to empowering CHF patients in underserved communities. Further research is necessary to test the clinical viability of the model and the acceptability of the model for patients, physicians, and families.

scholarly journals Health Care Utilization and Economic Burdens of Hemochromatosis in the United States: A Population-Based Claims Study

2019 ◽  
Vol 25 (12) ◽  
pp. 1377-1386
Author(s):  
Mohamed I. Elsaid ◽  
Tina John ◽  
You Li ◽  
Sobha Koduru ◽  
Saima Z. Ali ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Utilization ◽  
The United States ◽  
Population Based ◽  
Care Utilization
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